目的:研究前哨淋巴结活检与保乳手术联合治疗早期乳腺癌的效果及预后.方法:选取北京市顺义区妇幼保健院2019年1月—2021年12月收治的160例早期乳腺癌患者,应用随机数表法分成观察组(n=80,应用前哨淋巴结活检联合保乳手术治疗)和对照组(n=80,应用腋窝淋巴结清扫术联合保乳手术治疗).比较两组的围手术期指标、并发症发生率、乳腺美容优良率及预后情况.结果:观察组手术时间长于对照组,住院时间、拔管时间均短于对照组,术中出血量、引流量均少于对照组,差异均有统计学意义(P<0.05).观察组并发症总发生率为5.00％,低于对照组的16.25％,差异有统计学意义(P<0.05).术后6个月,观察组乳腺美容优良率为100.00％,高于对照组的75.00％,差异有统计学意义(P<0.05).术后6个月,两组转移率、复发率、生存率比较,差异均无统计学意义(P>0.05).结论:前哨淋巴结活检与保乳手术联合治疗早期乳腺癌的效果较好,且可避免一部分创伤,是优秀的手术方法.

OBJECTIVE:To investigate whether anti-phosphatidylserine/prothrombin antibodies and its IgG or IgM subtypes were correlated with unexplained recurrent miscarriages. METHODS:In our a single-center retrospective study, 283 patients with at least one unexplained miscarriage who visited the Third Hospital of Peking University between January 2021 and August 2023, aged between 18-40 years, and tested for anti-phosphatidylserine/prothrombin antibodies IgG or IgM subtypes, were included. The patients with either positive IgG or IgM anti-phosphatidylserine/prothrombin antibody were regarded as positive for anti-phosphatidylserine/prothrombin antibody. SPSS 26.0 software was used for statistical analysis. Chi-square test and Logistic regression analysis were used to study the correlation of anti-phosphatidylserine/prothrombin antibodies and its IgG or IgM subtypes with unexplained recurrent miscarriages. And the diagnostic sensitivity, specificity, the positive predictive value, the negative predictive value of anti-phosphatidylserine/prothrombin antibodies and its IgG or IgM subtypes in unexplained miscarriages was calculated with four-fold table. RESULTS:Chi-square analysis showed that anti-phosphatidylserine/prothrombin antibodies and its IgM subtypes were correlated with recurrent miscarriages (both P < 0.05), while the IgG subtype was not correlated with recurrent miscarriages (P>0.05). After adjusting with anticardiolipin antibodies, anti-β2 glycoprotein antibodies, lupus anticoagulants, antinuclear antibodies, and age by Logistic regression analysis, anti-phosphatidylserine/prothrombin antibodies were correlated with unexplained recurrent miscarriages (OR=2.084, 95%CI 1.045-4.155, P < 0.05), and anti-phosphatidylserine/prothrombin antibody IgM subtypes were correlated with unexplained recurrent miscarriages (OR=2.368, 95%CI 1.187-4.722, P < 0.05).The sensitivity of anti-phosphatidylserine/prothrombin antibody in recurrent miscarriage was 65.43%, the specificity was 48.51%, the positive predictive value was 33.76%, and the negative predictive value was 77.78%. In the patients with recurrent miscarriages with negative classical antiphospholipid antibodies, the sensitivity of anti-phosphatidylserine/prothrombin antibody was 59.09%, the specificity was 63.23%, the positive predictive value was 40.63%, and the negative predictive value was 78.40%. The sensitivity of the anti-phosphatidylserine/prothrombin antibody IgM subtype for the diagnosis of recurrent miscarriage was 65.43%, the specificity was 50.99%, the positive predictive value was 34.87%, and the negative predictive value was 78.63%. CONCLUSION:Anti-phosphatidylserine/prothrombin antibody and IgM subtype antibody are correlated with unexplained recurrent miscarriages in patients with at least one unexplained miscarriage. Whether positive anti-phosphatidylserine/prothrombin antibody or IgM subtype could predict future unexplained recurrent miscarriages warrants a prospective study.

目的 了解温州地区食源性腹泻患者副溶血性弧菌流行情况及分子分型特征,为预防食源性疾病提供科学依据.方法 对分离自腹泻患者中的副溶血性弧菌进行流行情况分析,同时对分离菌株开展血清学分型和药敏试验,进-步通过脉冲肠凝胶电泳(PFGE)分型技术分析菌株之间的遗传关系.结果 温州地区食源性疾病腹泻患者中,分离出446株副溶血性弧菌,检出率为6.79％;共鉴定出17个血清型,其中以O10 ∶K4(80.49％)为优势型别;以青壮年为多;夏秋季易感,8月-11月是高峰期,具有明显的季节性;122株副溶血性弧菌可分成28种PFGE型,大部分O10 ∶K4血清型聚集成簇;对头孢唑啉普遍耐药.结论 温州地区副溶血性弧菌监测具有明显的流行特征,应该继续加强食源性疾病监测,特别要关注新的O10 ∶ K4血清型引起大流行的可能,更要进一步提高食品安全隐患的早期识别、预警与防控能力.

目的 探讨导丝定位联合示踪剂亚甲蓝在腋窝反应性肿大淋巴结乳腺癌患者中的应用价值.方法 选取2015年1月至2021年12月北京儿童医院顺义妇儿医院收治的102例存在腋窝反应性肿大淋巴结的早期乳腺癌患者,术前对腋窝反应性肿大淋巴结进行超声导丝定位及亚甲蓝示踪剂染色.以病理检查结果为金标准,分析两种方法前哨淋巴结(SLN)的检出情况及灵敏度.结果 病理检查结果显示,SLN阳性35例,阴性67例.亚甲蓝示踪剂染色联合超声导丝定位SLN的检出率、灵敏度高于单纯亚甲蓝示踪剂染色,差异有统计学意义(P<0.05).结论 超声导丝定位联合亚甲蓝示踪剂在腋窝反应性肿大淋巴结的乳腺癌患者中应用价值较高,值得临床推广.

目的 了解2020年—2021年温州市畜肉中小肠结肠炎耶尔森菌的污染现状及病原特征.方法 对2020年—2021年温州市食品安全风险监测中的畜肉样本进行小肠结肠炎耶尔森菌的分离鉴定、血清分型、生物分型、毒力基因检测、耐药性分析和脉冲场凝胶电泳(PFGE)分子分型.结果 356份样本共检出小肠结肠炎耶尔森菌31株,检出率为8.71％.分离菌株血清型以O∶5型为主,生物型以1A型为主.检出1株4/O∶3型菌株携带毒力基因ail、ystA、yadA、virF,其余菌型菌株仅携带ystB或不携带任何毒力基因.分离株对头孢西丁、磺胺异恶唑耐药率最高,为32.26％,多重耐药株有4株,占12.90％.31株分离株经PFGE分型,共获得31种带型.结论 小肠结肠炎耶尔森菌是温州市畜肉中的潜在污染源,菌株耐药率处于较低水平但存在多重耐药株,PFGE带型呈多态性分布.

目的:探究保乳术联合前哨淋巴结活检对乳腺癌患者近期疗效及乳房美观度的影响.方法:回顾性分析2019年1月-2021年12月于笔者医院就诊的采用改良根治术联合腋窝淋巴结清扫术治疗的乳腺癌患者临床资料,随机选取84例纳入对照组;回顾性分析同期于笔者医院就诊的采用保乳术联合前哨淋巴结活检进行治疗的乳腺癌患者临床资料,随机选取76例纳入研究组.统计两组患者手术指标(手术时长、术中出血量、腋窝拔管时间),比较两组患者术后6个月近期疗效,记录两组患者术前及术后6个月肩关节活动度(外展、内旋、后伸、屈曲度)、生活质量[乳腺癌生活质量调查问卷(Quality of life questionnaire breast module,QLQ-BR23)、乳腺癌生活质量测定表(Functional assessment of cancer therapy-breast,FACT-B)、创伤后应激障碍筛查量表(Post-traumatic stress disorder checklist-civilian version,PCL-C)],并于两组患者术后6个月评价其乳房美观度(乳房美学评分),记录两组患者术后6个月内并发症发生情况.结果:术后,研究组患者术中出血量少于对照组,手术时长、腋窝拔管时间均短于对照组,肩关节活动度高于对照组,QLQ-BR23、PCL-C评分低于对照组,FACT-B评分高于对照组,患者乳房美观度优良率高于对照组,以上指标组间比较差异均有统计学意义(P＜0.05);但两组患者治疗有效率及并发症总发生率比较差异无统计学意义(P＞0.05).结论:保乳术联合前哨淋巴结活检与改良根治术联合腋窝淋巴结清扫术具有相近的治疗效果,但进行保乳术联合前哨淋巴结活检的患者术后恢复更快,且该术式对患者肩关节活动度、乳房美观度及日常生活质量影响更小.

目的 调查温州市售食品香辛料和调味品中克罗诺杆菌污染情况,进一步分析不同菌株间的分子分型特征.方法 采用国家标准方法对克罗诺杆菌进行鉴定,结合脉冲场凝胶电泳(PFGE)和多位点序列分型(MLST)方法对其进行基因分型研究.结果 296份香辛料和调味品中分离出66株克罗诺杆菌,总检出率为22.30％,其中不同分类中调味粉类和椒粉类克罗诺杆菌污染非常高.33株克罗诺杆菌种水平鉴定结果显示分属于6个种,其中阪崎克罗诺杆菌和丙二酸盐克罗诺杆菌为主要分离菌种.66株克罗诺杆菌共分成51个PFGE带型.而33株克罗诺杆菌MLST型共分为25个ST型,其中ST148、ST7为常见型别.结论 食品香辛料和调味品中存在克罗诺杆菌的污染,应该加强该类食品的调查和监测工作,同时将分离株鉴定到种和分子分型的水平,将有利于预防和控制克罗诺杆菌引起的食源性疾病事件.

Introduction: Periductal mastitis (PDM) is a complex benign breast disease with a prolonged course and a high risk of recurrence after treatment. There are many available treatments for PDM, but none is widely accepted. This study aims to evaluate the various treatment failure rates (TFR) of different invasive treatment measures by looking at recurrence and persistence after treatment. In this way, it sets out to inform better clinical decisions in the treatment of PDM. Methods: We searched PubMed, Embase, and Cochrane Library databases for eligible studies about different treatment regimens provided to PDM patients that had been published before October 1, 2019. We included original studies written in English that reported the recurrence and/or persistence rates of each therapy. Outcomes were presented as pooled TFR and 95% CI for the TFR. Results: We included 27 eligible studies involving 1,066 patients in this study. We summarized 4 groups and 10 subgroups of PDM treatments, according to the published studies. Patients treated minimally invasively (group 1) were subdivided into 3 subgroups and pooled TFR were calculated as follows: incision and drainage (n = 73; TFR = 75.6%; 95% CI 27.3-100%), incision alone (n = 74; TFR = 20.1%; 95% CI 0-59.9%), and breast duct irrigation (n = 123; TFR = 19.4%; 95% CI 0-65.0%). Patients treated with a minor excision (excision of the infected tissue and related duct; group 2) were divided into 4 subgroups and pooled TFR were calculated as follows: wound packing alone (n = 127; TFR = 2.1%; 95% CI 0-5.2%), primary closure alone (n = 66; TFR = 37.1%; 95% CI 9.5-64.8%), primary closure under antibiotic treatment cover (n = 55; TFR = 4.8%; 95% CI 0-11.4%) , and additional nipple part removal (n = 232; TFR = 9.6%; 95% CI 5.8-13.4%). Patients treated with a major excision (excision of the infected tissue and the major duct; group 3) included the following 2 subgroups: patients treated with a circumareolar incision (n = 142; TFR = 7.5%; 95% CI 0.4-14.7%) and patients treated with a radial incision of the breast (n = 78; TFR = 0.6%; 95% CI 0-3.6%). Group 4 contained patients receiving different major plastic surgeries. The pooled TFR of this group (n = 86) was 3.4% (95% CI 0-7.5%). Conclusion: Breast duct irrigation, which is the most minimally invasive of all of the treatment options, seemed to yield good outcomes and may be the first-line treatment for PDM patients. Minor excision methods, except for primary closure alone, might be enough for most PDM patients. Major excision, especially with radial incision, was a highly effective salvage therapy. The major plastic surgery technique was also acceptable as an alternative treatment for patients with large lesions and concerns about breast appearance. Incision and drainage and minor excision with primary closure alone should be avoided for PDM patients. Further research is still needed to better understand the etiology and pathogenesis of PDM and explore more effective treatments for this disease.

目的 分析一起甲型副伤寒暴发疫情菌株的分子分型特征,为病原菌的确定和暴发疫情的防控提供科学依据.方法 利用生化试验、血清学试验对病原菌进行鉴定,并将分离到的病原菌进行微量肉汤稀释法药物敏感性试验、PFGE分子分型分析、全基因组测序,利用全基因组数据与沙门菌MLST标准数据库比对获得序列型别(ST)、cgMLST序列号以及rMLST序列号并进行聚类分析,通过细菌基因组分析平台fIDBA分析病原菌的耐药、毒力相关基因.结果 11株沙门菌血清型均为甲型副伤寒沙门菌,具有100％相似性的PFGE带型,MLST、cgMLST、rMLST的型别均分别为ST129型、cgST-2191型、rST3678型,表明此次暴发疫情菌株从分子特征角度可诊断为同一传染源导致.对萘啶酸100％耐药,对链霉素100％中介.发现本次疫情菌株基因组均携带29种耐药基因.通过毒力因子数据库比对,均携带21类250种已知毒力基因,其中以Ⅲ型分泌系统、粘附、鞭毛等最为常见.结论 本次暴发疫情是由共同来源的、具有相同分子分型特征的甲型副伤寒沙门菌引起.在病原溯源研究中,应用全基因组数据可更精细分析菌株遗传进化特征、亲缘关系及毒力基因、耐药基因携带情况,可以作为替代PFGE、MLST的技术用于更精准的传染病分子流行病学调查分析研究.

目的 探讨激素受体状态在不同临床特征的亚组中对Her-2阳性乳腺癌新辅助化疗效果的影响.方法 收集北京儿童医院顺义妇儿医院2011年1月至2018年12月141例接受新辅助化疗的Her-2阳性乳腺癌患者进行回顾性分析,根据年龄、肿瘤T分期、淋巴结(LN)情况、Ki-67指数、是否抗Her-2治疗将患者分成不同的亚组,对每个亚组中两种激素受体状态的病理完全缓解(pCR)与非病理完全缓解(non-pCR)的构成比进行比较.统计学采用两个独立样本的Pearsonχ2检验或Fisher确切概率法.结果 入组141例Her-2阳性乳腺癌患者新辅助化疗后均可行疗效评价,总体pCR率为44.0％(62/141).总体上,HR阴性的患者较HR阳性患者更容易在新辅助化疗后达到pCR(P=0.011).亚组分析中,在年龄≤50岁、肿瘤T分期≤2 cm、LN阴性、Ki-67≤30％、应用抗Her-2治疗的亚组,HR阴性的患者较HR阳性患者更容易在新辅助化疗后达到pCR(P=0.005、0.032、0.045、0.017、0.003).结论 对于Her-2阳性乳腺癌,HR状态是影响新辅助化疗效果的重要因素,HR阴性的患者较HR阳性患者更容易在新辅助化疗后达到pCR,尤其是在肿瘤负荷低、同时应用抗Her-2治疗的年轻患者中,这种优势更明显.

筛查是早期发现恶性肿瘤的二级预防策略,乳腺癌是可以通过筛查而早期发现的恶性肿瘤,从而经过规范的综合治疗,降低死亡风险,改善预后.在筛查工作开展的同时,乳腺癌防治知识的健康教育也十分重要.通过健康教育,提高公众的乳腺癌防治意识,从而养成健康的生活方式,进而转化为健康行为,即主动参与乳腺癌筛查,这也是提高居民慢性病健康素养的一种手段[1].

目的 了解温州市弯曲菌引起腹泻的流行病学特点,掌握弯曲菌的耐药状况、分子型别特征.方法 在2017至2019年间对2家温州市区哨点医院的腹泻病例进行流行病学调查,并采集粪便标本进行弯曲菌的分离培养和常规生化鉴定,采用聚合酶链反应(Polymerase Chain Reaction,PCR)进一步鉴定,同时进行药敏试验、多位点序列分型(Multilocus-sequence typing,MLST)研究.结果 909例腹泻病例弯曲菌检出率为10.2％(93/909),空肠弯曲菌和结肠弯曲菌阳性率分别为8.9％(81/909)和1.3％(12/909).6个年龄组间及不同季节的弯曲菌阳性率差异无统计学意义(x2年龄=2.09,P＞0.05;x2季节=0.468,P＞0.05).93株弯曲菌对11种抗菌药物共产生了22种耐药谱,耐萘啶酸(Nalidixic acid,NAL)-环丙沙星(Ciprofloxacin,CIP)-四环素(Tetracycline,TET)谱型最多,占38.7％(36/93).空肠弯曲菌和结肠弯曲菌多重耐药率(耐3种以上抗生素)分别为42.0％(34/81)、50.0％ (6/12).MLST分型结果显示本地分离株中,空肠弯曲菌被分成54种ST型,含15个克隆群,最多的克隆群为ST45CC,占11.1％(9/81),结肠弯曲菌分为8种ST型,主要的克隆群为ST828CC,占83.3％(10/12).本研究共发现16个新的ST型.结论 温州市食源性腹泻病例中弯曲菌已成为主要病原,且呈现很高的多重耐药性,在遗传特征上表现为遗传多样性.

乳腺癌是威胁女性健康和生命的最常见的恶性肿瘤.目前,乳腺癌诊疗领域具有规范的诊疗标准,通过筛查而早期发现并尽早治疗是乳腺癌防控工作的有效措施.国家非常重视慢性病防控工作,"健康中国2030"规划纲要提出到2030年,总体癌症5年生存率提高15％,其中乳腺癌生存率的提高至关重要.我国妇幼保健系统在长期实践中形成了"县、乡、村"三级妇幼卫生服务网络以及群防群控和临床诊疗相结合的有效模式,在开展乳腺癌筛查方面具有独特优势.北京市乳腺癌筛查工作开展10余年来,形成了妇幼保健院为主导的组织构架和筛查体系,在乳腺专科的引领下,筛查的技术水平不断提升.在卫生行政部门的支持下,妇幼保健院应利用管理和体系优势开展乳腺癌筛查相关研究,探索适合中国人群的乳腺癌筛查模式.

目的 了解温州市农贸市场禽肉中空肠弯曲菌污染现状及耐药情况,为禽肉类食品安全风险评估、弯曲菌病防控和临床用药提供依据.方法 于2018年2月-2019年10月从温州市鹿城区、龙湾区、瓯海区、瑞安市、苍南县、平阳县和文成县7个县(市、区)的农贸市场采集禽肉样品.采用双孔滤膜法检测空肠弯曲菌,并进行药敏试验.结果 共采集样品200份,检出空肠弯曲菌66份,检出率为33.00％.鸡肉中检出空肠弯曲菌45份,检出率为34.09％;鸭肉中检出空肠弯曲菌21份,检出率为30.88％,不同样品空肠弯曲菌检出率差异无统计学意义(P＞0.05).鹿城区、平阳县和苍南县空肠弯曲菌检出率最高,均为35.00％,不同采样地区空肠弯曲菌检出率差异无统计学意义(P＞0.05).多重耐药38株,多重耐药率为57.58％,以萘啶酸、四环素和环丙沙星耐药率较高,分别为84.85％、83.33％和80.30％.结论 温州市农贸市场禽肉空肠弯曲菌污染较重,且对萘啶酸、四环素、环丙沙星等多种抗生素有显著耐药性.

目的:探讨乳腺癌激素受体表达与新辅助化疗(neoadjuvant chemotherapy,NCT)后病理完全缓解(pathologic complete response,pCR)的关系,指导筛选对化疗敏感的个体.方法:选取笔者所在医院2015年1月-2019年9月收治的102例接受NCT的激素受体阳性的乳腺癌患者作为研究对象,使用免疫组化方法检测NCT前乳腺癌患者的ER、PR表达情况,NCT结束后对手术标本采用Miller-Payne病理评价,分析激素受体的表达与pCR关系.结果:ER<50％组的乳腺癌患者pCR率为66.7％,明显高于ER≥50％组的28.7％,差异有统计学意义(x2=8.165,P=0.004).ER<50％且PR<50％组患者pCR率为69.2％,明显高于其他组,差异有统计学意义(P<0.05).PR<50％组的乳腺癌患者pCR率为36.6％,PR≥50％组乳腺癌患者pCR率为32.8％,两组比较差异无统计学意义(P>0.05).结论:激素受体阳性型乳腺癌pCR与ER表达情况有关,与PR表达情况无关.

目的 对碳青霉烯类抗生素耐药的肺炎克雷伯菌进行耐药分析及分子分型,为临床治疗提供病原学依据.方法 收集定点医院2016年8月-2018年12月临床标本中分离的耐碳青霉烯类肺炎克雷伯菌,采用VITEK 2 Compact进行细菌鉴定及药敏试验,标准纸片扩散法作为补充,碳青霉烯酶相关基因通过PCR扩增和产物测序确定,用脉冲场凝胶电泳(PFGE)进行分子分型并分析菌株的同源性.结果 71株肺炎克雷伯菌均耐15种药物以上,多重耐药率为100％.其中67株菌产超广谱β-内酰胺酶(94.4％),59株携带碳青霉烯酶blaKPC-2基因(80.3％).经PFGE图谱分析分为49个PFGE型,其中以WZFK001型最多,占9.8％.结论 产KPC-2型碳青霉烯酶是该院肺炎克雷伯菌碳青霉烯类抗生素耐药的主要原因,产超广谱β-内酰胺酶是β-内酰胺酶类抗生素耐药的主要机制.ICU等病房存在高度同源性的耐碳青霉烯肺炎克雷伯菌流行,应加强这些病房的院感管理,控制多重耐药菌的传播和流行.

目的 分析2014年-2018年温州市伦敦沙门菌和德尔卑沙门菌临床分离株耐药性和分子型别特征.方法 对2014年-2018年食源性疾病腹泻患者分离得到的25株伦敦沙门菌和20株德尔卑沙门菌采用微量肉汤稀释法进行15种抗菌药物的敏感试验,并运用脉冲场凝胶电泳(pulsed-field gel electrophoresis,PFGE)进行分子分型.结果 实验菌株除对3种抗生素敏感外,对其余12种抗生素均有不同程度的耐药,有34株多重耐药(占75.56％).四环素耐药率最高(占91.11％);25株伦敦沙门菌用Xba Ⅰ酶切获得16种带型,相似度为66.5％～100％.20株德尔卑沙门菌用Xba Ⅰ酶切获得10种带型,相似度为75.4％～100％.结论 温州市食源性沙门菌耐药状况严重,PFGE带型呈现出多样性的同时又具有较显著的优势带型特点.部分带型与其对应的耐药谱具有一定的关联性.

OBJECTIVE:To investigate factors influencing pathological response to neoadjuvant chemotherapy (NAC) in operable primary breast cancer.STUDY DESIGN:Descriptive study.PLACE AND DURATION OF STUDY:Breast Center, Shunyi District Health Care Hospital for Women and Children of Beijing, Beijing 101300, P.R. China, from January 2009 to December 2017.METHODOLOGY:Two hundred and sixty-one operable primary invasive breast cancer patients treated with NAC were included in this observational study. Pathological complete response (pCR) was defined as no residual invasive disease in either the breast or the axillary lymph nodes, with non-invasive breast residuals permitted (ypT0/is ypN0). Factors affecting pCR were subjected to univariate and multivariate analysis.RESULTS:Seventy-six patients (29.1%) achieved pCR after NAC. Tumor size, histological grade, status of estrogen receptor (ER) and progesterone receptor (PgR), expression of human epidermal growth factor receptor 2 (HER2) and Ki67, axillary lymph node status, and chemotherapy regimen were all significantly associated with pCR in univariate analysis (all p<0.05). In multivariate analysis, high histological grade, negative HR status and lymph nodes, positive HER2 status, and taxane-based regimens were independent predictive factors of pCR. Patients with HER2-positive tumors were more sensitive to NAC regimen including trastuzumab.CONCLUSION:In this study, breast cancer patients with high histological grade, negative HR status and lymph nodes, positive HER2 status, as well as taxane-based regimens were significantly associated with achieving pCR with NAC. Key Words: Breast neoplasms, Neoadjuvant therapy, Surgery, Pathology.

目的:该研究旨在分析前哨淋巴结(sentinel lymph lobar,SLN)阳性乳腺癌患者非前哨淋巴结(non-sentinel lymph lobar,NSLN)转移的相关危险因素及,避免不必要的腋窝淋巴结清扫(axillary lymph node dissection,ALND).方法:研究对象来自于2008年1月至2017年1月期间所有进行前哨淋巴结穿刺(sentinel lymph lobar biopsy,SLNB)的乳腺癌共490例,最终对81例SLN阳性且行ALND的乳腺癌患者进行回顾性分析,用单因素及多因素分析探究影响NSLN转移的危险因素.结果:81例SLN阳性乳腺癌患者中,有21例(25.9％)患者出现了NSLN转移.单因素分析显示,NSLN转移的乳腺癌患者更易表现为更多的SLN阳性数(2枚:28.6％vs.18.3％;3枚:19.0％vs.1.7％,P=0.015)及更高的SLN(+)/SLN比率(40.9％vs.48.9％,P=0.026),以及原发肿瘤较大(中位肿瘤大小:2.63 cm vs.2.49 cm P=0.044)等特点.多因素分析显示:SLN(+)/SLN比率(P=0.042;OR:1.06;95％CI:1.06-29.39)是NSLN转移的独立预测因子.结论:SLN(+)/SLN比率、SLN阳性数和肿瘤大小与NSLN密切相关,SLN(+)/SLN比率是NSLN的独立预测因子.

目的 评估乳腺影像报告和数据系统(BI-RADS)在临床超声检查中对3～5级病灶诊断的准确性.方法 回顾性分析北京市顺义区妇幼保健院乳腺中心2016年1月至2018年2月因乳腺不适就诊,乳腺超声检查3～5级且行穿刺活检取得病理诊断的2644例女性患者的临床资料,计算各类阳性预测值(PPV),与美国放射学院(ACR)提供的参考范围进行对比分析.结果 2644例研究对象中,病理诊断为恶性肿瘤者299例(11.3％),良性病变者2345例(88.7％).各BI-RADS分级的PPV均在ACR推荐的参考范围内,随着BI-RADS分级的增加,恶性率呈逐渐上升趋势,差异有统计学意义(P<0.01).299例恶性肿瘤病例,随着分级的升高,血流速度≥20 cm/s、阻力指数≥0.7、伴有淋巴结肿大的病例所占百分比均呈上升趋势(均P<0.05).结论 ACR所提出的BI-RADS分级在乳腺超声检查中具有良好的诊断效能,能够为临床医生提供比较可靠的依据.