多模态超声成像对乳腺癌前哨淋巴结转移的诊断价值

Diagnostic value of multimodal ultrasound in sentinel lymph node metastasis of breast cancer

目的探讨多模态超声成像对乳腺癌腋窝前哨淋巴结(sentinel lymph node,SLN)转移的诊断价值。方法选取2020年3月至2021年7月青岛市市立医院收治的经病理学证实的乳腺癌患者52例,均进行经皮超声造影(contrast-enhanced ultrasound,CEUS)SLN定位,并进行常规超声和实时弹性成像(real-time elastography,RTE)检查,以亚甲基蓝染色和病理结果为标准,比较常规超声、CEUS和RTE多模态超声诊断SLN的效能。结果52例乳腺癌患者共计68枚SLN,亚甲基蓝染色与经皮CEUS定位SLN的检出率分别为97.1%和98.5%,差异无统计学意义。转移性与非转移性SLN在长径/短径比值是否≤2,皮质最大厚度是否大于3.0 mm,形态、内部回声、淋巴门是否正常,血流类型,CEUS增强模式,RTE评分方面的差异均有统计学意义(均P<0.05)。常规超声、CEUS、RTE和联合诊断对诊断乳腺癌SLN转移的灵敏度分别为61.3%、71.0%、67.7%和83.9%,特异度分别为81.1%、75.7%、70.2%和81.1%,准确率分别为72.1%、73.5%、69.1%和82.4%;多模态超声联合诊断的灵敏度、特异度、准确率均高于单一检查方法。ROC曲线显示常规超声、CEUS、RTE和三者联合诊断的曲线下面积分别为0.712、0.761、0.737和0.825。结论经皮CEUS可在术前准确定位SLN,联合常规超声和RTE对鉴别乳腺癌腋窝SLN转移有良好的诊断效能,为诊断SLN转移提供更多的影像学依据。

Objective To explore the diagnostic value of multimodal ultrasound imaging in axillary sentinel lymph node(SLN)metastasis of breast cancer.Methods 52 patients with breast cancer confirmed by pathology in Qingdao Municipal Hospital from March 2020 to July 2021 were selected.The SLN localization was performed by contrast-enhanced ultrasound(CEUS),and routine ultrasound and real-time elastography(RTE)were performed.The efficacy of combined conventional ultrasound,CEUS and RTE multimodal ultrasound in the diagnosis of SLN was analyzed based on methylene blue staining and pathological results.Results There were 68 SLN in 52 patients with breast cancer.The detection rates of SLN by methylene blue staining and percutaneous CEUS were 97.1%and 98.5%,respectively,with no significant difference.There were statistically significant differences between metastatic and non-metastatic SLN in terms of long-diameter/short-diameter ratio≤2,maximum thickness of cortex 3.0 mm,morphology,internal echo,normal lymph nodes,blood flow type,CEUS enhancement mode and RTE score(P<0.05).The sensitivity of conventional ultrasound,CEUS,RTE and combined diagnosis for the diagnosis of SLN metastasis in breast cancer was 61.3%,71.0%,67.7%and 83.9%respectively,the specificity was 81.1%,75.7%,70.2%and 81.1%respectively,and the accuracy was 72.1%,73.5%,69.1%and 82.4%respectively.The sensitivity,specificity and accuracy of multimodal ultrasound combined diagnosis were higher than that of single examination.ROC curve indicated the area under the curve of conventional ultrasound,CEUS,RTE and their combined diagnosis were 0.712,0.761,0.737 and 0.825,respectively.Conclusions Transcutaneous CEUS can accurately locate the SLN before operation,and it has good diagnostic efficacy in differentiating axillary SLN metastasis from breast cancer combined with conventional ultrasound and RTE,providing more imaging evidence for the diagnosis of SLN metastasis.