不同超声造影注射方式在早期乳腺癌前哨淋巴结诊断中的对比研究

Differently Injected Ultrasound Contrast Agents in the Diagnosis of Sentinel Lymph Nodes in Early Breast Cancer

目的:探讨超声造影对早期乳腺癌前哨淋巴结(sentinel lymph node,SLN)的诊断价值以及两种超声造影注射方式的对比研究。方法:将2012年6月至2019年12月在我院经穿刺活检确诊为乳腺癌T1-2期,且行常规超声检查腋窝未见异常淋巴结的190例患者作为研究对象,术前均行超声造影定位SLN并根据增强模式对其性质进行初步判断,通过腋窝淋巴结清扫术或前哨淋巴结活检术取得病理结果。依据超声造影注射方式不同,分为乳晕区单点注射法(单点法)92例和乳晕区四点注射法(四点法)98例。以术后病理为金标准分别计算两组SLN显影的显影率、灵敏度、特异度、阳性预测值、阴性预测值等,并将2种方法进行对比分析。结果:单点法显影率83.7%、灵敏度55.0%、特异度84.7%、阳性预测值50.0%、阴性预测值87.1%、准确度78.3%、AUC 0.699;四点法显影率86.7%、灵敏度57.7%、特异度86.1%、阳性预测值60.0%、阴性预测值84.9%、准确度78.6%,AUC 0.719;这2种注射方法中四点法显影率、灵敏度、特异度、准确度、阳性预测值数值均高于单点法、阴性预测值低于单点法,但各项指标之间差异均无统计学意义(P>0.05)。结论:不同超声造影注射方式均可以提高超声对乳腺癌腋窝淋巴结转移判断的准确性,对SLN的定位和性质判定有一定的临床应用价值。

Objective : To investigate the value of contrast-enhanced ultrasound(CEUS) in the diagnosis of sentinel lymph nodes(SLN) in patients with early breast cancer, and comparatively study two injection modalities of CEUS. Methods : 190 patients with stage T1-2breast cancer confirmed by puncture biopsy in our hospital from June 2012 to December 2019 and without abnormal lymph nodes in the axilla in conventional ultrasound were collected as study subjects. Preoperative ultrasonography was performed to locate the SLN and make a preliminary determination of their nature based on the form of enhancement, and pathological results were obtained by axillary lymph node dissection or sentinel lymph node biopsy. According to different injection methods of ultrasound contrast agents, 92 cases were assigned to the single-point injection group(areola single-point injection), and 98 cases to the four-point injection group(areola four-point injection). The imaging rate, sensitivity, specificity, positive predictive value, negative predictive value and accuracy of SLN imaging in two groups were calculated using postoperative pathology as the gold standard, and the two methods in two groups were compared and analyzed. Results : The imaging rate, sensitivity, specificity, positive predictive value, negative predictive value and accuracy of single-point injection were 83.7%, 55.0%, 84.7%, 50.0%, 87.1% and 78.3%, with the AUC of 0.699, while those of four-point injection were 86.7%, 57.7%, 86.1%, 60.0%, 84.9% and 78.6%, with the AUC of 0.719. The imaging rate, sensitivity, specificity, accuracy and positive predictive value of the latter were higher than those of the former, but there were no significant differences between these two methods(P > 0.05). Conclusion : Both injection methods can improve the accuracy of ultrasound in the diagnosis of axillary lymph node metastasis of breast cancer, which is of certain clinical value in the localization and determination of the nature of SLN.