超声造影导丝定位与纳米碳染色示踪探测乳腺癌前哨淋巴结的研究

Ultrasonography-guided wire-localization and nano-carbon staining for detection of sentinel lymph node in breast cancer

目的探讨超声造影导丝定位、纳米碳染色示踪以及二者联合在乳腺癌前哨淋巴结（SLN）探测中的价值。方法选取2015年5月至2017年12月山西省肿瘤医院收治的159例乳腺癌患者，术前分别行超声造影导丝定位、纳米碳染色示踪以及二者联合探测SLN，术后分别将各组的前哨淋巴结、腋窝淋巴结标本行病理诊断。结果病理诊断SLN转移者69例，未发现异常者90例。超声造影导丝定位探测SLN的灵敏度为100.0%（69/69），特异度为3.3%（3/90）；纳米碳染色示踪探测SLN的灵敏度为98.6%（68/69），特异度为2.2%（2/90）；二者联合探测SLN的灵敏度为98.6%（68/69），特异度为5.6%（5/90）。将三种方法诊断SLN数目进行比较，结果显示超声造影导丝定位联合纳米碳染色探测SLN的诊断效能最高，差异具有统计学意义（χ2=34.31，P〈0.001）。结论超声造影导丝定位与纳米碳染色联合探测SLN安全可行，可为早期乳腺癌提供精准诊治，并保护医务人员免受辐射，有望成为探测乳腺癌SLN的优选方法。

ObjectiveTo evaluate the usage of ultrasound guided wire-localization, nano-carbon staining and the combination of the above two methods in detecting sentinel lymph node （SLN） in breast cancer.MethodsA total of 159 cases of breast cancer from May 2015 to December 2017 in Shanxi Provincial Cancer Hospital were selected, and they were treated with ultrasound guided wire-localization, nano-carbon staining and combination of the two methods separately to detect SLN before the operation. After the operation, SLN and axillary lymph node in each group were marked and made pathological diagnosis.ResultsThere were 69 cases with pathological diagnosis of SLN metastasis and 90 cases without abnormal representation. With the patient as the unit, the sensitivity of ultrasound guided wire-localization was 100.0% （69/69）, the sensitivity of nano-carbon staining was 98.6% （68/69）, and the sensitivity of combination of the two methods was 97.1% （67/69）. The specificity of ultrasound guided wire-localization was 3.3% （3/90）, the specificity of nano-carbon staining was 2.2% （2/90）, and the specificity of combination of the two methods was 5.6% （5/90）. With the count of SLN as the unit, the combination of the two methods had the highest diagnostic efficiency in detecting SLN, and the difference was statistical significant （χ2 = 34.31, P 〈 0.001）.ConclusionsUltrasound guided wire-localization and nano-carbon staining are safe and accessible methods for detecting SLN. It provides a precise treatment for early breast cancer, and it can protect medical staff from radiation, which is expected to be the best method for detection of SLN in breast cancer.