经皮下注射超声造影剂对乳腺癌前哨淋巴结的诊断效果

Efficacy of percutaneous injection of ultrasonic contrast agents in the diagnosis of sentinel lymph node in breast cancer

目的探讨经皮下注射超声造影剂对乳腺癌前哨淋巴结(SLN)的诊断效果。方法选取2012年1月至2015年1月间上海市奉贤区中心医院收治的98例乳腺癌患者,所有患者先经皮下注射声诺维进行检查(观察组),后经腺体注射声诺维进行检查(对照组),对前后两次检查准确率、临床诊断效果及肿块结构病变情况进行定期随访、检测数据分析、影像学图像分析及记录详细临床信息。结果观察组SLN的诊断效果(灵敏度100.0%、特异度98.0%、准确度96.9%和阳性检出率87.8%)更优于对照组(86.7%、62.2%、77.6%和66.3%),两者差异均有统计学意义(均P<0.05)。观察组SLN检测的增强效果[增强时间(35.83±11.58)s、达峰时间(136.66±39.04)s和退减时间(1783.20士90.11)s]更优于对照组[(63.14±14.62)s、(242.57±43.82)s和(1964.62±96.28)s],差异均有统计学意义(均P<0.05)。经皮下注射造影剂检查对SLN病变的性质判定总准确率为87.8%,明显优于经腺体注射造影剂检查的66.3%,差异有统计学意义(P<0.05)。结论对乳腺癌患者进行诊断和治疗时,采取经皮下注射超声造影剂声诺维的方式有助于SLN诊断和性质判定,具有快速简便、合理有效、分辨率高及特异性好的临床效果,具有较高的临床推广价值。

Objective To evaluate the feasibility and efficacy of percutaneous injection of ultra- sound contrast agents in the diagnosis and evaluation of sentinel lymph node （SLN） in breast cancer. Meth- ods Select 98 female patients with breast cancer treated at Shanghai Fengxian Central Hospital from Janu- ary 2012 to January 2015. Percutaneous injection of sonovue was performed in all the patients （ observation group）. Then gland injection of sonovue was performed in all the patients （control group）. Diagnosis accuracy, effectiveness of clinical diagnosis and pathological changes of tumor structure were regularly followed- up, the statistical data and image was analyzed, and detailed clinical information was recorded. Results Diagnosis accuracy of SLN in the observation group （sensitivity 100%, specificity 98. 0%, accuracy 96. 9% and positive rate 87. 8% ） was better than in the control group （ 86. 7%, 62. 2%, 77. 6% and 66. 3% respectively （ all P 〈 0. 05 ）. SLN detection accuracy using contrast-enhanced ultrasound （ time to enhancement, 35.83 ~ 11.58 s; ,time to peak, 136. 66 ~39.04 s; time to fading, 1753.20 ~90. 11 s） in the observation group was better than in the control group （63.14 ~ 14. 62 s, 242. 57 ~ 43.82 s and 1964. 62 ＋ 96. 28 s respectively） （ all P 〈 0. 05 ）. The overall accuracy of percutaneous injection of contrast agent for SLN lesions was 87.8% which was significantly superior to 66. 3% of gland injection group （P 〈 0. 05）. Conclusion For the diagnosis and treatment of breast cancer, percutaneous injection of ultrasound contrast agent sonovue was helpful in determing the nature of SLN, which is fast and simple, and reasonable and effective, with high resolution and specific clinical effectiveness and has great clinical application value.