超声造影在乳腺癌前哨淋巴结活检中价值

Value of contrast enhanced ultrasound to sentinel lymph node biopsy in breast cancer

目的探讨超声造影对乳腺癌腋窝前哨淋巴结(sentinel lymph node,SLN)的诊断价值并分析其影响因素。方法乳腺癌患者41例,术前经皮下注射声诺维行超声造影确定SLN,在超声引导下对超声造影标记的SLN进行亚甲蓝染色,然后行腋窝淋巴结清扫术,术后对SLN行组织病理诊断。以手术组织病理结果为金标准,计算SLN超声造影成功率、假阴性率,分析假阴性率与临床病理因素的关系,比较有转移和无转移SLN直径。结果 41例中3例超声造影失败,未显示出SLN;38例超声造影显示出SLN,其中3例与手术组织病理诊断不符合,SLN超声显像成功率为85.37%(35/41),假阴性率为10.00%(2/20);不同年龄、肿瘤直径、肿瘤位置、月经状况、体质量指数及组织病理类型患者假阴性率比较差异无统计学意义(P>0.05);38例中有转移者SLN直径[(1.62±0.73)cm]大于无转移者[(1.21±0.57)cm],差异有统计学意义(P<0.05)。结论超声造影定位SLN并行前哨淋巴结活检具有较高的成功率和较低的假阴性率,是一种术前定位SLN并判定其性质的有效方法。

Objective To explore the value of contrast enhanced ultrasound （CEUS） to the diagnosis of sentinel lymph node （SLN） of breast cancer, and to analyze its influencing factors. Methods Forty-one patients with breast cancer were injected sonovue as the tracer agent to identify SLN before operation. SLNs were dyed by methylene blue under the guidance of CEUS and received pathological examination after the axillary lymph node dissection. Taking the pathology results as the gold standard, the success rate and false negative rate of CEUS were calculated. The correlation of false negative rate with clinicopathologic characteristics was analyzed, and the diameters of SLN were compared between metastasis group and non-metastasis group. Results In 41 patients, 3 patients were not showed SLN on CEUS. SLNs were showed in 38 patients, in which 3 patients had false CEUS results. The success rate of SLN was 85.37% （35/41）, and the false negative rate was 10. 00% （2/20）. There were no significant differences in the patients＇ age, tumor diameter, location, menstruation condition, body mass index and pathologic type （P〉0.05）. In 38 patients, the diameter of SLN was longer in those with metastasis （（1.62±0.73）cm） than that in those without （（1.21±0.57） cm） （P〈0.05）. Conclusion CEUS plus SLN biopsy has a high success rate and low false negative rate, and is a useful orientation and determination method for SLNs before operation. Key words： Breast cancer; sentinel lymph node; contrast enhanced ultrasound