超声造影联合空心针活检在浸润性乳腺癌前哨淋巴结转移评估中的价值

Application of contrast-enhanced ultrasound combined with core needle biopsy in the evaluation of sentinel lymph nodes metastasis in invasive breast cancer

目的探讨超声造影联合空心针组织穿刺活检评估浸润性乳腺癌患者腋窝前哨淋巴结(sentinel lymph node,SLN)转移的价值。方法120例浸润性乳腺癌患者行乳腺癌根治术前均行常规超声及超声造影检查,记录SLN数目及超声造影增强模式,对超声造影检出SLN者行超声引导下空心针组织穿刺活检;乳腺癌根治术中行SLN活检。以SLN组织活检病理检查结果为金标准,评估超声造影、超声造影联合空心针组织穿刺活检诊断腋窝SLN转移的价值。结果120例患者超声造影检出SLN共158枚,手术组织病理检查证实发生转移57枚,未转移101枚。超声造影表现为均匀增强96枚,不均匀增强57枚,微弱增强或无增强5枚。超声造影诊断腋窝SLN转移62枚,未转移96枚。超声造影联合空心针组织穿刺活检诊断腋窝SLN转移49枚,未转移109枚。以SLN组织活检病理检查结果为金标准,超声造影诊断腋窝SLN转移的灵敏度为78.95%,特异度为83.17%,阳性预测值为72.58%,阴性预测值为87.50%,准确率为81.65%;超声造影联合空心针穿刺活检诊断腋窝SLN转移的灵敏度为85.96%,特异度为100%,阳性预测值为100%,阴性预测值为92.66%,准确率为94.94%。结论超声造影联合空心针组织穿刺活检在浸润性乳腺癌患者腋窝SLN转移诊断中具有较高价值。

Objective To investigate the clinical value of contrast-enhanced ultrasound(CEUS)combined with core needle biopsy(CNB)to the evaluation of sentinel lymph node(SLN)metastasis in patients with invasive breast cancer.Methods A total of 120 invasive breast cancer patients received ultrasound and CEUS before radical mastectomy.The number of SLN and CEUS enhancement mode were recorded.The patients with SLN detected by CEUS underwent ultrasound-guided CNB.All patients received SLN biopsy in operation.Taking SLN biopsy histopathological results as the gold standard,the diagnosis values of CEUS and CEUS combined with CNB to the diagnosis of SLN metastasis were evaluated.Results CEUS detected 158 SLNs in 120 patients,and the surgical resection and histopathological examination showed 57 metastatic axillary SLNs and 101 non-metastatic axillary SLNs.CEUS showed 96 evenly enhanced nodes,57 unevenly enhanced nodes,and 5 weakly enhanced or unenhanced nodes.CEUS detected 62 metastatic axillary SLNs and 96 non-metastatic axillary SLNs.CEUS combined with CNB showed 49 metastatic SLNs and 109 non-metastatic SLNs.Taking SLN biopsy histopathological results as the gold standard,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of CEUS on the diagnosis of SLN were 78.95%,83.17%,72.58%,87.50%and81.65%,respectively;the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of CEUS combined with CNB were 85.96%,100%,100%,92.66%and 94.94%,respectively.Conclusion CEUS combined with CNB of SLN has a high value to the prediction of SLN metastasis in invasive breast cancer patients.