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原发性乳腺淋巴瘤(primary breast lymphoma,PBL)是一种原发于乳腺组织的结外淋巴瘤,其发病率很低,占乳腺恶性肿瘤的0.04%~0.53%,在非霍奇金淋巴瘤中的占比<1%,仅占结外淋巴瘤的1.7%~2.2%,其最常见的病理亚型是弥漫大B细胞淋巴瘤。PBL主要表现为单侧无痛性乳腺肿块,亦有11%左右的患者出现双侧乳腺受累[1]。虽然PBL相对少见,但其在全球的发病率在过去40年呈上升及年轻化趋势[2]。PBL的发病机制尚未明确,有研究结果表明,其可能来源于黏膜相关的淋巴组织或邻近乳腺导管和乳腺小叶的淋巴组织,甚至可能来源于乳腺内淋巴结[3]。PBL的治疗方法有别于其他乳腺肿瘤,化疗和放疗是其主要的治疗方法。乳腺钼靶和超声是乳腺肿瘤诊疗中常用的影像学检查方法,但它们对PBL的诊断缺乏特异性,很难鉴别PBL与其他乳腺肿瘤。尽管活体组织病理学检查是诊断PBL的“金标准”,但其仍存在3个方面的局限性:(1)无法提供全身的病灶信息;(2)需要有足够的组织作为检查样本才能做出准确的诊断,但行包块切除手术获得检查样本的方法对患者造成的创伤较大;③采用细针抽吸和芯针获得的检查样本大小有限,使诊断具有挑战性[4]。18F-FDG PET显像能够反映肿瘤细胞增殖和代谢等特点,联合CT和MRI可获得清晰的解剖结构图像,可帮助临床医师更好地了解病变的特点和解剖学细节,从而进一步提高诊断PBL的准确率和灵敏度,使患者得到及时有效的治疗,并改善预后。
18F-FDG PET在原发性乳腺淋巴瘤诊疗中的应用进展
Application progress of 18F-FDG PET in the diagnosis and treatment of primary breast lymphoma
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摘要: 原发性乳腺淋巴瘤(PBL)是一种罕见的、原发于乳腺组织的恶性结外肿瘤,其临床表现常缺乏特异性,且病程进展较快,早期诊断有利于改善患者预后。18F-氟脱氧葡萄糖(FDG)PET作为一种日趋成熟的分子影像技术,联合CT或MRI对PBL具有较高的诊断灵敏度和准确率,且在PBL的分期和疗效评价中具有重要价值。笔者就18F-FDG PET在PBL诊疗中的应用进展进行综述。
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关键词:
- 淋巴瘤 /
- 氟脱氧葡萄糖F18 /
- 正电子发射断层显像术 /
- 体层摄影术,X线计算机 /
- 磁共振成像
Abstract: Primary breast lymphoma (PBL) is a rare malignant extranodal tumor originating in the mammary gland. The clinical manifestations of PBL are often lack of specificity, and the course of the disease progresses rapidly. Early diagnosis is beneficial to improve the prognosis of patients. As an increasingly mature molecular imaging technology, 18F-fluorodeoxyglucose (FDG) PET combined with CT or MRI has high diagnostic sensitivity and accuracy for PBL, and has important value in cancer staging and efficacy evaluation. This paper reviews the application progress of 18F-FDG PET in the diagnosis and treatment of PBL. -
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