实时超声造影检测乳腺癌前哨淋巴结的实验研究

Experimental study for diagnosing sentinel lymph nodes of breast cancer using real time contrast-enhanced ultrasound

目的探讨经皮下注射超声造影剂Sonazoid检测荷瘤兔乳腺癌前哨淋巴结的可行性。方法采用组织块悬液原位注射法制作兔VX2乳腺癌模型14只,经皮下注射Sonazoid对荷瘤兔模型肿块进行超声造影检查,定位同侧腋下前哨淋巴结,并分析造影增强声像图表现特征。然后采用99Tcm硫化物核素法及皮下注射美蓝的方法定位前哨淋巴结,三种方法对比并与手术及病理结果相对照。结果经手术和病理证实的25个前哨淋巴结中,超声造影检出20个,检出率为80.00%(20/25);99Tcm硫化物核素法检出率是76.00%(19/25),皮下注射美蓝检出率是80.00%(20/25),超声造影与另两者比较检出率相当(χ2=0.15,P>0.05)。超声造影对判定前哨淋巴结转移与否的灵敏度、特异度和正确率分别为94.11%、66.67%和90.00%。结论经皮下注射超声造影剂Sonazoid可较好地检测出前哨淋巴结,并能发现良恶性淋巴结的不同灌注特征,可为前哨淋巴结转移提供一种新的诊断依据。

Objective To explore the feasibility for identifying and localizing the sentinel lymph nodes （SLN） of rabbit model bearing VX2 breast cancer by using contrast-enhanced ultrasound （CEUS） with subcutaneous injected agents（Son-azoid）. Methods Fourteen rabbit VX2 breast cancer models were established successfully. The detection of SLN was per-formed by CEUS with subcutaneous injected Sonazoid and followed with a characteristic and quantitative analysis. The 99Tc-SC dynamic imaging and blue dye methods were performed also to detect the SLN. The results of these methods and the pathological findings were compared each other. Results There were 25 SLNs identified by surgical dissection and pathology. The detected rate of CEUS, 99Tc-SC dynamic imaging and blue dye methods were 80.00%（20/25）, 76.00%（19/25） and 80.00%（20/25） respectively. There was no significant difference of the detected rate among these methods （χ2=0.15,P〉0.05）.The sensitivity, specificity and accuracy of CEUS for assessing the metastatic SLN were 94.l1%, 66.67% and 90.00% respectively. Conclusions CEUS can be considered as a new method to detect the lymphatic drainage pathways and SLNs in rabbits VX2 breast cancer models.