超声造影结合改良标记法定位乳腺癌前哨淋巴结的临床应用

Clinical application of contrast-enhanced ultrasound combined with modified labeled method in locating sentinel lymph nodes of breast cancer

目的探讨超声造影结合改良标记法标记乳腺癌前哨淋巴结(sentinel lymph node,SLN)的临床应用价值。方法选择2017年7月至2019年4月在苏州大学附属第一医院就诊并行手术治疗的乳腺癌患者80例,分别用超声造影结合改良标记法及纳米碳染色法标记SLN。判断两种方法所标记的第一枚淋巴结是否一致,分别统计两种方法标记SLN的数量,并将所标记SLN的病理与腋窝清扫后的病理进行对比。结果两种方法在示踪乳腺SLN方面具有较好的一致性(Kappa=0.749,P=0.000)。改良标记法标记SLN数量明显少于染色法所标记的SLN数量(Z=-7.434,P=0.000)。改良标记法、染色法所标记淋巴结的病理与腋窝清扫后病理均有较高吻合度(Kappa=0.941,0.943;P=0.000,0.000),且两者诊断效能相当(AUC=0.964,0.967)。结论超声造影结合改良标记法标记乳腺SLN操作简单、定位准确,通过精准活检1~2枚SLN可对腋窝淋巴结分期做出准确评估。

Objective To explore the clinical value of contrast-enhanced ultrasound combined with modified labeled method in labeling sentinel lymph nodes of breast cancer in comparison with nano-carbon stained method.Methods Eighty female breast cancer patients who underwent surgery in the First Affiliated Hospital of Soochow University between July 2017 and April 2019 were enrolled.Sentinel lymph nodes in all patients were labeled by contrast-enhanced ultrasound combined with modified labeled method and nano-carbon stained method,respectively.The consistency of first lymph node labeled by the two methods was judged,the number of SLNs labeled by two methods was counted,and the pathology of the labeled SLN was compared with that after axillary dissection.Results The two methods have good consistency in locating sentinel lymph nodes of breast cancer(Kappa=0.749,P=0.000).The number of SLNs labeled by modified labeling method was significantly less than that labeled by stained method(Z=-7.434,P=0.000).The pathology of lymph nodes labeled by both the modified labeling method and stained method coincided well with that of axillary dissection(Kappa=0.941,0.943;P=0.000,0.000),and diagnostic efficiency was comparable(AUC=0.964,0.967).Conclusions Contrast-enhanced ultrasound combined with modified labeling method is simple and accurate in labeling sentinel lymph nodes of breast cancer.Accurate assessment of axillary lymph node staging can be made by precise biopsy of 1-2 SLNs.