联合经皮和经静脉超声造影对乳腺癌前哨淋巴结的诊断价值

Value of combination of percutaneous and transvenous contrast-enhanced ultrasound in diagnosis of sentinel lymph nodes in patients with breast cancer

目的探讨经皮超声造影联合经静脉超声造影在乳腺癌前哨淋巴结中的诊断价值。方法选取2016年11月至2018年6月南京中医药大学附属医院乳腺外科收治的174例乳腺癌患者,所有患者均进行经皮超声造影前哨淋巴结定位,并进行常规超声和经静脉超声造影检查,以亚甲蓝染色和手术病理结果为标准,对常规超声与联合经皮和经静脉超声造影诊断前哨淋巴结的效能进行分析。结果174例乳腺癌患者共计175个前哨淋巴结,亚甲蓝染色与经皮超声造影定位前哨淋巴结的检出率分别为99.4%和96.0%,差异无统计学意义(P=0.067)。病理结果显示,175个前哨淋巴结中56个发生转移,常规超声诊断前哨淋巴结转移的特异度为71.4%、敏感度为64.3%、准确性为69.1%,联合经皮和经静脉超声造影诊断前哨淋巴结转移的特异度为84.0%、敏感度为76.8%、准确性为81.7%,联合经皮和经静脉超声造影诊断前哨淋巴结转移的准确性高于常规超声检查,差异有统计学意义(χ2=7.46,P<0.05)。根据手术病理特征将175个前哨淋巴结分为宏转移组38个、微转移组18个、未转移组119个。常规超声诊断前哨淋巴结宏转移组准确性为71.1%,微转移组准确性为50.0%,未转移组准确性为71.4%。联合经皮和经静脉超声造影诊断前哨淋巴结宏转移组准确性为86.8%,微转移组准确性为55.6%,未转移组准确性为84.0%。结论经皮超声造影可在术前准确定位前哨淋巴结,联合经皮和经静脉超声造影对于乳腺癌前哨淋巴结转移具有较好的定性诊断价值。

Objective To assess the value of combined percutaneous and transvenous contrastenhanced ultrasound(CEUS)in the diagnosis of sentinel lymph nodes(SLN)in patients with breast cancer.Methods One hundred and seventy-four patients with breast cancer who underwent surgical treatment at Department of Breast Surgery of the Affiliated Hospital of Nanjing University of Chinese Medicine from November 2016 to June 2018 were selected.All patients underwent percutaneous CEUS for SLN localization,conventional ultrasound,and transvenous CEUS.Using the methylene blue staining method and pathological results as the standard,the effectiveness of conventional ultrasound and combined percutaneous and transvenous CEUS in diagnosing SLN was compared and analyzed.Results The rates of methylene blue staining and percutaneous CEUS for locating SLN were 99.4%and 96.0%,respectively,and there was no significant difference between them(P=0.067).Pathological results showed that 56 out of 175 SLN had metastasis.The specificity,sensitivity,and accuracy of conventional ultrasound in diagnosing SLN were 71.4%,64.3%,and 69.1%,respectively.The specificity,sensitivity,and accuracy of combined percutaneous and transvenous CEUS in diagnosing SLN were 84.0%,76.8%,and 81.7%,respectively.The accuracy of combined percutaneous and transvenous CEUS in diagnosing SLN was significantly higher than that of conventional ultrasonography(Chi-square value=7.46,P<0.05).According to the surgical and pathological characteristics,175 SLN were divided into macrometastasis(n=38),micrometastasis(n=18),and nonmetastasis groups(n=119).The accuracy of routine ultrasound in the diagnosis of SLN in the macrometastasis group,micrometastasis group,and non-metastatic group was 71.1%,50.0%,and 71.4%,separately.The accuracy of combined percutaneous and transvenous CEUS in the diagnosis of SLN in these three groups was 86.8%,55.6%,and 84.0%,separately.Conclusion Percutaneous CEUS is an important technique for localization of SLN before surgery.The combination of percutaneous and transvenous CEUS has good qualitative diagnostic value for SLN metastasis of breast cancer.