可疑淋巴结导丝定位在乳腺癌前哨淋巴结状态评估中的应用价值

The application value of ultrasound guided wire-localization of suspicious lymph nodes in detecting sentinel lymph node status in breast cancer

目的探讨超声引导下导丝定位可疑淋巴结联合前哨淋巴结活检(SLNB)在评估早期乳腺癌腋窝淋巴结转移中的价值。方法收集2015年6月至2021年4月313例乳腺癌病例,术前在超声引导下导丝定位可疑淋巴结,手术中行SLNB和超声定位可疑淋巴结活检,对前哨淋巴结(SLN)、可疑淋巴结分两组标本行病理诊断,比较单纯SLNB与SLNB联合可疑淋巴结活检评估乳腺癌腋窝淋巴结转移状态的差异。结果313例患者术前均行超声引导下导丝定位可疑淋巴结及亚甲蓝染色。超声引导下导丝定位成功312例,检出率为99.7%(312/313)。亚甲蓝染色成功279例,检出率为89.1%(279/313)。166例术中证实可疑淋巴结即为SLN,符合率为53.0%(166/313)。术后病理证实,腋窝淋巴结阴性258例,腋窝淋巴结阳性55例,其中SLNB阳性44例,SLNB联合可疑转移淋巴结活检阳性55例。SLNB假阴性11例,假阴性率20.0%(11/55),灵敏度为80.0%(44/55),准确率为96.1%(268/279)。SLNB联合可疑淋巴结活检预测腋窝淋巴结状态未见假阴性,灵敏度为100.0%(55/55),准确率为100.0%(313/313)。与单纯SLNB比较,SLNB联合可疑淋巴结活检能显著降低假阴性的发生率(P<0.001)。两种方法一致性检验的Kappa值为0.865(P<0.001)。结论超声引导下导丝定位可疑淋巴结联合SLNB预测早期乳腺癌腋窝淋巴结状态优于单纯SLNB,且以亚甲蓝作为示踪剂配合超声引导下导丝定位可疑淋巴结操作相对简单,具有较好的安全性和应用前景。

Objective To explore the value of ultrasound guided wire-localization of suspicious lymph nodes combined with sentinel lymph node biopsy(SLNB)in detecting axillary lymph node(ALN)metastasis in early breast cancer.Methods A total of 313 breast cancer patients from Junurary 2015 to April 2021 were enrolled in this study.The patients were applied with ultrasound guided wire-localization of suspicious lymph nodes before operation.SLNB and ultrasound-localized suspicious lymph node biopsies were performed during surgery.The sentinel lymph node(SLN)and suspicious lymph nodes were divided into two groups for pathological diagnosis.The difference of node status prediction between SLNB and SLNB with axillary suspicious lymph node biopsy was compared.Results All 313 patients underwent ultrasound guided wire localization of suspicious lymph nodes and methylene blue staining before surgery.Ultrasound guided wire localization was successful in 312 cases,with a detection rate of 99.7%(312/313).Two hundred and seventy-nine cases were successfully stained with methylene blue,with a detection rate of 89.1%(279/313).One hundred and sixty-six suspected lymph nodes were confirmed as SLN during surgery,with a coincidence rate of 53.0%(166/313).The detection rate of SLNB was 89.1%(279/313),suspicious lymph nodes biopsies was 99.7%(312/313).The pathology proved that 166 suspected lymph nodes were confirmed as SLN during surgery,with a coincidence rate of 53.0%(166/313).There were 258 cases with pathological diagnosis of negative ALN,and 55 cases of ALN were positive.Among them,44 cases were SLNB positive,and 55 cases were SLNB combined with positive suspicious metastatic lymph nodes.There were 11 cases of false negatives in SLNB,the false negative rate was 20.0%(11/55),the sensitivity was 80.0%(44/55),and the accuracy rate was 96.1%(268/279).By contrast,SLNB with axillary suspicious node biopsy showed the false-negative rate of 0,the sensitivity of 100.0%(55/55)and the accuracy rate of 100.0%(313/313).SLNB combined with suspicious lymph node biopsy could significantly reduce the occurrence of false negative result(P<0.001).The Kappa value for consistency testing between the two methods was 0.865(P<0.001).Conclusion Ultrasound guided wire-localization of suspicious lymph nodes combined with SLNB is better than simple SLNB in predicting the ALN status of early breast cancer,and methylene blue in combination with ultrasound guided wire-localization of suspicious lymph nodes is easy to operate,which has better security and application prospects.