钼靶显示腋窝淋巴结增大的临床意义

Clinical significance of axillary lymph nodes growth in breast mammography

目的：评价钼靶Ｘ线显示下腋窝淋巴结增大在乳腺疾病诊断中的价值。材料与方法：分析４２例乳腺病合并腋窝淋巴结增大病例，其中１８例乳腺癌、４例纤维腺瘤、３例浆细胞乳腺炎、皮下脂肪瘤、乳管内乳头状瘤各１例，均行手术且病理证实，１５例乳腺增生病除２例手术且病理证实外，其他依据典型临床表现、Ｘ线征象及治疗结果而诊断。均行钼靶轴位、斜位拍片，腋窝淋巴结均在斜位上显示。结果：乳腺良性病（乳腺增生病、纤维腺瘤、脂肪瘤等）腋窝淋巴结增大多数为双侧，数目较多，多数（ １７／２１）直径≤１ｃｍ，且有偏心性脂肪中心，周围脂肪线清晰；乳腺癌及乳腺炎患者，淋巴结增大多为同侧，数目较少，绝大多数（２１／２１）直径≥１ｃｍ，密度致密均匀，周围脂肪线消失。乳腺癌腋窝淋巴结转移，多为浸润性癌，癌灶直径一般≥１ｃｍ。结论：乳腺癌和乳腺良性病（除乳腺炎）的钼靶 Ｘ线显示腋窝增大的淋巴结各有其特点，两者具有一定的影像学差异，可以作为两类疾病的鉴别点之一。改进乳腺投照方法，提高摄片清晰度，对腋窝部淋巴结显示有重要意义。

Objective:To evaluate the value of breast diseases with axillary lymph nodes growth in breast mammography. Methods: 42 patients with axillary lymph nodes growth including 18 cases of breast carcinoma, 15 cases of breast hyperplasia, 4 cases of fibroadenoma, 3 cases of plasmocyte mammitis. 1 case of papilloma and 1 case of adipoma were analysed. 13 cases of breast hyperplasia were diagnosed by the clinical manifestation.X-ray findings and treatment, the rest were confirmed by surgicopathology.The axillary lymph nodes were showed in slope position mammography. Result: the axillary lymph nodes with benign hyperplasia, fibroadenoma, adipoma, are double axilla and num- bers, the diameter measuring ≤1. 0cm, the lymph nodes have fat centre and the fat line in circumference is plain. The trait of axillary lymph nodes with breast carcinoma and mammitis are apposite. Most of breast carcinomas with axillary lymph nodes inetastasis are infiltrating, mea- suring≥ 1. 0cm. Conclusion: A specific shape of axillary lymph nodes is one of discriminating diagnosis of benign and malignant breast dis- ease.It is very important that raise the clarity of mammography and reform the way of mammography camera for showing axillary lymph nodes.