超声造影示踪腋窝前哨淋巴结研究现状与展望

Contrast-enhanced ultrasound in tracing axillary sentinel lymph nodes:Research status and prospects

目的 探讨超声造影示踪前哨淋巴结(SLN)的研究现状和进展,为临床工作提出新的有益信息。方法 使用中国知网数据库及PubMed检索系统,以“乳腺癌、前哨淋巴结、内乳区淋巴结、超声造影、淋巴结活检”为中文关键词,“breast neoplasms、sentinel lymph node、internal mammary lymph nodes、contrast-enhanced ultrasound、lymph node biopsy”为英文关键词,检索2001-01-01-2023-04-01相关文献。纳入标准:(1)乳腺癌的腋窝SLN示踪;(2)腋窝淋巴结(ALN)穿刺活检;(3)内乳区淋巴结示踪。排除标准:研究方法中存在统计学问题的文献以及内容相似或重复的文献。最终共纳入中文文献7篇,英文文献42篇。结果 超声造影可直观显示引流淋巴管与SLN的网络结构状态,示踪的第一站淋巴结符合SLN的定义,是真正意义上的SLN。目前,仅根据SLN超声造影增强模式判断SLN性质主观性较强,联合穿刺活检可提高诊断准确率,有助于术前评估ALN状态。术前采取适当的方式定位SLN有利于术中快速寻找,缩短手术时间。超声造影示踪SLN,无需特殊放射性诊疗资质,利于推广,可为临床病程分期、制定治疗方案及愈后预测提供依据。结论 超声造影示踪SLN联合穿刺活检,是术前评估ALN状态的可靠方法。相较于主流SLN示踪方法,超声造影示踪SLN更符合外科手术精准和微创的发展趋势。

Objective To explore the current research status and advance of contrast-enhanced ultrasound in tracing sentinal lymph nodes(SLN)and providing a reference for the clinical application.Methods In this literature review,relevant study from January 1st,2001to April 1st,2023were retrieved in Chinese National Knowledge Infrastructure databases and PubMed with the key words"breast neoplasms,sentinel lymph node,internal mammary lymph nodes,contrast-enhanced ultrasound and lymph node biopsy".The inclusion criteria were as follows:(1)Axillary SLN tracing of breast cancer;(2)Axillary lymph node puncture biopsy;(3)Tracing of lymph nodes in the inner breast region.Exclusion criteria were:Literature with statistical mistakes and similar or repetitive content.Totally 7Chinese literatures and 42English literatures were collected.Results Contrast-enhanced ultrasound can reveal the network structure of lymphatic drainage and SLN,the first lymph node traced conforms to the definition of SLN,proving that this is SLN in the true sense.Currently,diagnosing SLN properties solely based on image classification has strong subjectivity,while combining biopsy results can improve diagnostic accuracy and contribute to preoperative diagnosis of SLN properties.Adopting appropriate preoperative methods for SLN tracing is beneficial for rapid intraoperative search and shortened surgical time.CEUS tracing does not require special radiological diagnosis and treatment qualifications,which is conducive to popularization and can provide a basis for clinical staging,formulation of treatment plans,and postoperative prediction.Conclusion The combination of CEUS tracing and puncture biopsy is a reliable preoperative assessment method of SLN,which is more fit for the future development trend of precise and minimally invasive surgical procedures compared to mainstream SLN tracing methods.