Pre-Operative Evaluation of Axillary Lymph Node Status in Patients with Suspected Breast Cancer Using Shear Wave Elastography

The aim of this study was to evaluate shear wave elastography (SWE) for pre-operative evaluation of axillary lymph node (LN) status in patients with suspected breast cancer. A total of 130 axillary LNs in 130 patients who underwent SWE before fine-needle aspiration, core biopsy or surgery were analyzed. On gray-scale images, long and short axes, shape (elliptical or round), border (sharp or unsharp) and cortical thickening (concentric, eccentric or no fatty hilum) of LNs were assessed. On SWE, mean, maximum, minimum, standard deviation and the lesion-to-fat ratio (E_ratio) values of elasticity were collected. Gray-scale and SWE features were compared statistically between metastatic and benign LNs using the χ²-test and independent t-test. Diagnostic performance of each feature was evaluated using the area under the receiver operating characteristic curve (AUC). Logistic regression analysis was used to determine gray-scale or SWE features independently associated with metastatic LNs. Of the 130 LNs, 65 (50%) were metastatic and 65 (50%) were benign after surgery. Metastatic LNs were significantly larger (p = 0.018); had higher elasticity indexes at SWE (p < 0.0001); and had higher proportions of round shape (p = 0.033), unsharp border (p = 0.048) and eccentric cortical thickening or no fatty hilum (p = 0.005) compared with benign LNs. On multivariate analysis, E_ratio was independently associated with metastatic LNs (odds ratio = 3.312, p = 0.008). E_ratio had the highest AUC among gray-scale (0.582–0.719) and SWE (0.900–0.950) variables. SWE had good diagnostic performance in metastatic axillary LNs, and E_ratio was independently associated with metastatic LNs.     

超声造影联合声触诊组织成像定量技术诊断乳腺癌前哨淋巴结

目的 观察超声造影（CEUS）联合声触诊组织成像定量（VTIQ）技术诊断乳腺癌前哨淋巴结（SLN）的价值。方法 对37例经病理确诊乳腺癌患者行乳腺超声造影,追踪显像淋巴管,观察SLN增强模式,评价CEUS对SLN的检出率及定位及定性诊断准确率;采用VTIQ测量CEUS所见SLN的剪切波速度平均值（SWV_mean）。绘制受试者工作特征（ROC）曲线,计算曲线下面积（AUC）,判断VTIQ诊断SLN的效能;观察2种方法联合诊断SLN的价值。结果 CEUS对乳腺癌SLN的检出率为91.89%,判断其良恶性的敏感度为90.91%,特异度为51.72%,准确率为62.50%。SWV_mean诊断SLN的AUC为0.848,截断值取1.79 m/s时,敏感度、特异度及准确率分别为90.91%、68.97%及75.00%。CEUS和VTIQ联合诊断SLN良恶性淋巴结的敏感度、特异度及准确率为90.91%、75.86%及80.00%。结论 CEUS及VTIQ联合诊断乳腺癌SLN的效能较高。     

Real-time tissue elastography for the diagnosis of lymph node metastasis in oral squamous cell carcinoma

We compared conventional ultrasound (US) B-mode, color Doppler and elastographic assessment of lymph node (LN) stiffness against pathological findings from surgical samples, to determine the most useful factors for identifying LN metastases. Seventy-one LNs in 19 patients with oral squamous cell carcinoma (OSCC) were examined. Using our new system, elastography images were scored from 1-5. The score 1-4 were correlated with the blue area of each LN, which indicated increased stiffness: (1) none; (2) < 50%; (3) 50%; or (4) > 50%. A score 5 indicated central necrosis and did not correlate with the blue area. We found significant differences in minimal diameter, shape index, margin, internal structure, hilus presence or absence, elastography score and percentage of blue area between metastatic and nonmetastatic LNs. Stepwise regression analysis identified elastography score 3-5 as an independent significant LN metastatic factor, suggesting that our scoring system may be useful for accurately diagnosing metastatic LNs.     

In vitro sonographic evaluation of sentinel lymph nodes for detecting metastasis in breast cancer: comparison with histopathologic results.

OBJECTIVE: To assess the accuracy and the effectiveness of in vitro sonography of sentinel lymph nodes (LNs) for differentiating benignity from metastasis during breast cancer operations. METHODS: Two hundred twenty-two fresh sentinel LNs obtained during surgery were examined by in vitro sonography to detect metastasis in 47 patients with breast cancer. Sonographic criteria of malignant LNs were defined as uneven cortical thickness of greater than 3 mm in depth, round hypoechoic nodes, and the absence of an echogenic hilum. Histopathologic results were correlated with those obtained by the sonographic study. Statistical analysis was performed with a kappa value to evaluate the accuracy of in vitro sonography of sentinel LNs. RESULTS: On sonographic examination, 190 (85.6%) of the 222 sentinel LNs were benign. Among the 190 benign LNs, in only 8 (4.2%) was the presence of metastasis pathologically proved, which indicated focal micrometastasis in the cortex. Thirty-two sentinel LNs were sonographically positive. In 19 (59.4%) of the 32 sentinel LNs, metastasis was pathologically confirmed. The remaining 13 sonographically positive LNs (40.6%) did not reveal any histologically malignant cells. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 70.4%, 93.3%, 59.4%, 95.7%, and 90.5%, respectively. CONCLUSIONS: The in vitro sonographic evaluation of the sentinel LNs during breast cancer operations may be a reliable method of predicting nodal metastasis and may be helpful in deciding the extent of LN dissection.     

Dynamic Visualization of Lymphatic Channels and Sentinel Lymph Nodes Using Intradermal Microbubbles and Contrast‐Enhanced Ultrasound in a Swine Model and Patients With Breast Cancer

Objective. Sentinel lymph node (SLN) identification using intradermal micro‐bubbles and contrast‐enhanced ultrasound (CEUS) has been recently reported in swine models and patients with breast cancer. The objective of this study was to investigate the dynamics of intradermally administered microbubbles as they travel to draining SLNs in pigs. We also performed a detailed study of the passage of microbubbles through breast lymphatic channels in a small group of patients with breast cancer. Methods. Nine anesthetized healthy pigs were used for the study, and 5 female patients with primary breast cancer were recruited. Pigs received intradermal injections of a microbubble contrast agent in several territories to access lymphatic drainage to regional lymph nodes. Patients had periareolar intradermal injection of the microbubble contrast agent. Ultrasound examination was performed in the real‐time contrast pulse sequencing mode with a commercial scanner. Results. Sentinel lymph nodes were identified rapidly (<1 minute) and consistently in pigs. Intradermal microbubble injection and CEUS were found to have perfect concordance with the Evans blue dye method in locating swine SLNs. In all 5 patients with breast cancer, the microbubble contrast agent entered breast lymphatic channels and traveled to draining ipsilateral axillary SLNs within 3 minutes. Conclusions. Intradermally injected microbubbles traverse readily though lymphatic channels in pigs and human breast tissue. The ability to rapidly identify SLNs in the diagnostic period would enable targeted biopsy and may facilitate preoperative axillary staging in patients with early breast cancer.     

经皮CEUS定位和定性诊断早期乳腺癌前哨淋巴结

目的 探讨经皮CEUS对早期乳腺癌前哨淋巴结（SLN）定位和定性诊断价值。方法 收集75例经病理证实的早期乳腺癌患者,在乳晕周围皮下注射超声造影剂（声诺维）行CEUS,实时、连续观察显影淋巴管及SLN增强模式,并于体表标记淋巴管及SLN。注射亚甲蓝后行前哨淋巴结活检术（SLNB）,计算经皮CEUS定位SLN的准确率;以病理结果为金标准,计算CEUS诊断SLN性质的敏感度和特异度。结果 75例患者,术前经皮CEUS共检出116枚SLN,亚甲蓝示踪后SLNB获得163枚SLN,差异有统计学意义（Z=-2.651,P=0.008）。经皮CEUS定位腋窝SLNS的准确率为94.67%（71/75）,且其诊断SLN性质的敏感度为98.04%（50/51）,特异度为49.23%（32/65）。结论 经皮CEUS可作为SLNB术前定位的有效方法,其对早期乳腺癌SLN定性诊断的敏感度较高,而特异度较低。     

Use of Contrast‐Enhanced Ultrasound Imaging to Detect the First Draining Lymph Node (FDLN) in a Swine Model

Objective. The purpose of this study was to investigate the use of contrast‐enhanced ultrasound imaging (CEUS) to detect the first draining lymph node (FDLN) in a swine model and to determine whether the distance from the contrast agent injection site to the FDLN has any affect on the ability to detect contrast‐enhanced FDLNs. Methods. Thirteen swine (25–32 kg) were anesthetized during examinations and euthanized afterward. In every swine, 1 mL of a sulfur hexafluoride microbubble ultrasound contrast agent was bilaterally injected subcutaneously below a mammilla. The examined distances varied from 6 to 36 cm. The contrast‐enhanced lymphatic channels were visualized with low–mechanical index CEUS and mapped from the injection site to the FDLN. After CEUS was performed, blue dye was injected in the same locations as the contrast agent, and dye‐guided surgery was used to localize the FDLNs. To ensure the lymph node detected with the blue dye technique was the same found with CEUS, it was scanned again to confirm contrast enhancement. Results. After 26 injections, 22 inguinal FDLNs were detected with CEUS and the blue dye technique. After 4 injections in 2 swine, contrast‐filled lymphatic channels were identified with a course running toward the neck. In all cases but 1, the FDLNs received the contrast agent within 5 minutes. Conclusions. In this swine model, it was possible to use CEUS to locate the FDLNs. In these preliminary experiments, the distances from the contrast agent injection site to the FDLN did not affect the ability to detect the contrast‐enhanced FDLNs.     

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

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...     

Subcapsular Injection of Ultrasonic Contrast Agent Distinguishes between Benign and Malignant Lymph Node Lesions Exhibiting Homogeneous Enhancement in Intravenous Contrast-Enhanced Ultrasound Images

We aimed to evaluate whether subcapsular injection of ultrasonic contrast agent (UCA) can distinguish between benign and malignant lymph node (LN) lesions exhibiting homogeneous enhancement in intravenous contrast-enhanced ultrasound (CEUS) images. From November 2012 to July 2015, 32 patients with superficial lymphadenopathy exhibiting homogeneous enhancement after intravenous CEUS were enrolled. A small amount of UCA was injected into LNs using a subcapsular approach, and perfusion characteristics were recorded. Using the pathology identified via core needle biopsy as the gold standard, we calculated the sensitivity, specificity and accuracy of the technique in terms of distinguishing between benign and malignant LN lesions. Pathology revealed 23 cases of true benign and 9 cases of true malignant LN lesions; the former included 2 cases of tuberculosis and 21 cases of reactive hyperplasia, and the latter included 7 lymphomas and 2 metastases. Subcapsular CEUS diagnosed 24 benign and 8 malignant LN lesions. Most lymphomas (6 of 7, 85.7%) exhibited heterogeneous perfusion, with lymphatic tract distortion in the absence of interruption. Reactive hyperplasia LNs manifested as diffuse homogeneous or brush-like perfusion from the subcapsular region to the center, without lymphatic tract distortion. Metastatic LNs had lymphatic tract interruptions. The sensitivity, specificity, consistency and positive and negative predictive values were 77.8%, 95.6%, 90.6%, 87.5% and 91.7%, respectively. For LNs exhibiting uniform enhancement in intravenous CEUS imaging, subcapsular CEUS may help to distinguish between benign and malignant lesions. In particular, lymphatic distortion without interruption may specifically indicate a lymphoma.     

超声造影联合声触诊组织成像定量技术对乳腺癌前哨淋巴结转移的评估

目的探讨超声造影（CEUS）联合声触诊组织成像定量（VTIQ）技术在术前评估乳腺癌前哨淋巴结（SLN）转移中的临床价值。 方法收集2019年6月至2020年1月因乳腺癌收住哈尔滨医科大学附属第一医院的患者,共72例患者的72个SLN纳入研究。所有患者均行手术治疗并取得病理结果,术前均行常规超声、CEUS及剪切波弹性成像检查。根据术后病理结果将SLN分为转移组21个和非转移组51个。比较2组SLN的超声造影模式及VTIQ剪切波速度（SWV）值。绘制ROC曲线比较超声造影、SWV及联合诊断预测乳腺癌SLN转移的效能。 结果转移性SLN与非转移性SLN的CEUS增强模式比较,差异有统计学意义（χ²=25.53,P=0.000）,2组VTIQ的SWV最大、最小、平均值比较,差异均有统计学意义（t=7.79、7.12、8.75,P均=0.000）。CEUS判断SLN转移的ROC曲线下面积（AUC）为0.829,最佳截断值为1.5,即I型增强模式为非转移性,II、III、IV型增强模式为转移性。以最佳截断值为SLN转移的判定标准,敏感度、特异度、阳性预测值、阴性预测值分别为85.71%、70.59%、54.54%、92.31%。绘制SWV最大值、最小值及平均值诊断SLN转移的ROC曲线,AUC分别为0.910、0.873、0.937,最佳截断值分别为3.06、2.23、2.64 m/s。以SWV平均值2.64 m/s为判定标准,敏感度、特异度、阳性预测值和阴性预测值分别为76.19%、94.23%、88.89%和90.74%。联合CEUS与VTIQ诊断SLN转移的敏感度、特异度、阳性预测值、阴性预测值分别为95.24%、96.08%、90.91%、96.08%。绘制CEUS与VTIQ联合方法诊断SLN转移的ROC曲线,AUC为0.957。 结论CEUS联合VTIQ技术可以提高乳腺癌淋巴结转移的诊断效能,为乳腺癌术前腋窝淋巴结评估提供可靠依据。     

Clinical Application of Contrast‐Enhanced Ultrasonography in Diagnosis of Superficial Lymphadenopathy

Objective. The purpose of this study was to evaluate the value of contrast‐enhanced ultrasonography (CEUS) in differential diagnosis of superficial lymphadenopathy. Methods. Ninety‐four superficial enlarged lymph nodes in 94 patients were studied by conventional ultrasonography (gray scale and color Doppler) and CEUS. Contrast‐enhanced sonograms were analyzed using contrast‐specific quantification software. All of the results were compared with pathologic diagnoses. Results. Of the 94 lymph nodes examined, 44 were benign and 50 were malignant (33 metastases and 17 lymphomas). The sensitivity, specificity, and accuracy of conventional ultrasonography in differential diagnosis between benign and malignant nodes were 51%, 47%, and 55%, respectively. Contrast‐enhanced ultrasonography showed intense homogeneous enhancement in 39 of 44 benign lymph nodes, inhomogeneous enhancement in 32 of 33 metastases, and intense homogeneous enhancement and absence of perfusion in 9 of 17 and 6 of 17 lymphomas, respectively. The sensitivity specificity, and accuracy of CEUS were 84%, 79%, and 80%. After time‐intensity curve gamma variates were calculated, the area under the curve of the benign lymph nodes was greater than those of the metastatic lymph nodes and lymphomas (P < .01). Conclusions. These results indicate that the use of CEUS and contrast‐specific software has a higher degree of diagnostic accuracy than conventional ultrasonography for evaluations of superficial lymphadenopathy. The contrast enhancement patterns and time‐intensity curves provide valuable diagnostic information for differential diagnosis of benign and malignant lymph nodes.     

Contrast-enhanced ultrasound–based nomogram for predicting malignant involvements among sonographically indeterminate/suspicious cervical lymph nodes in patients with differentiated thyroid carcinoma

This prospective study was aimed at assessing the value of nomograms based on conventional and contrast-enhanced ultrasound (CEUS) features in the pre-operative diagnosis of sonographically indeterminate/suspicious lymph node metastasis (LNM) in patients with differentiated thyroid carcinoma (DTC). A total of 72 cervical LNs from 47 patients with DTC from January to June 2018 were included in the primary data set, and 30 LNs from 15 patients with DTC from July to August 2018 were included in the external validation data set. The LNs of the included patients were preoperatively evaluated by conventional ultrasound (US) and CEUS. Each included LN was labeled by puncture localization with carbon nanoparticle suspension injection (Canalin) under US guidance and dissected separately to ensure the one-to-one correspondence between ultrasonic features and pathology status. Univariate logistic regression analysis was used to identify risk factors for LNM. A nomogram was used to construct a prediction model for cervical metastatic LNs. Round shape, absence of hilar structure, peripheral or mixed blood flow and centripetal or mass enhancement were risk factors for lymph node metastases. The area under the receiver operating characteristic curve of the nomogram model based on conventional US and CEUS features was 0.93 (95% confidence interval: 0.872–0.985), which was superior to that of the nomogram based on conventional US features(0.85, 95% confidence interval: 0.707–0.989). CEUS features can provide incremental benefit in the diagnosis of LNM among DTC cohorts. Nomograms based on conventional US and CEUS features can predict LN status with high accuracy.     

经皮超声造影诊断乳腺癌前哨淋巴结转移

目的 探讨经皮CEUS诊断乳腺癌前哨淋巴结（SLN）转移的价值。方法 对79例乳腺癌患者行二维及彩色多普勒超声检查,并行前哨淋巴结经皮CEUS,采用目测法分析造影模式,利用时间-强度曲线获得相关参数,并将CEUS结果与病理进行对比分析。结果 79例中,32例存在前哨淋巴结转移（转移组）,47例无转移（无转移组）。转移组前哨淋巴结增强模式以不均匀增强为主,无转移组以均匀增强为主（P<0.001）;转移组与无转移组灌注强度差、达峰强度及达峰平均强度的差异均有统计学意义（P均<0.05）,而造影剂到达时间、达峰时间及上升斜率差异均无统计学意义（P均>0.05）。结论 经皮CEUS对预测乳腺癌SLN转移有一定临床应用价值。     

实时超声造影检测乳腺癌前哨淋巴结的实验研究

目的探讨经皮下注射超声造影剂Sonazoid检测荷瘤兔乳腺癌前哨淋巴结的可行性。方法采用组织块悬液原位注射法制作兔VX2乳腺癌模型14只,经皮下注射Sonazoid对荷瘤兔模型肿块进行超声造影检查,定位同侧腋下前哨淋巴结,并分析造影增强声像图表现特征。然后采用99Tcm硫化物核素法及皮下注射美蓝的方法定位前哨淋巴结,三种方法对比并与手术及病理结果相对照。结果经手术和病理证实的25个前哨淋巴结中,超声造影检出20个,检出率为80.00%(20/25);99Tcm硫化物核素法检出率是76.00%(19/25),皮下注射美蓝检出率是80.00%(20/25),超声造影与另两者比较检出率相当(χ2=0.15,P>0.05)。超声造影对判定前哨淋巴结转移与否的灵敏度、特异度和正确率分别为94.11%、66.67%和90.00%。结论经皮下注射超声造影剂Sonazoid可较好地检测出前哨淋巴结,并能发现良恶性淋巴结的不同灌注特征,可为前哨淋巴结转移提供一种新的诊断依据。     

经皮超声造影观察荷瘤兔乳腺癌转移前哨淋巴结

目的 探讨经皮CEUS检测荷瘤兔乳腺癌转移前哨淋巴结（MSLN）的价值。方法 建立28只兔VX2乳腺癌模型,建模3周后对其行CEUS检查、⁹⁹Tc^m-SC淋巴闪烁照像和亚甲蓝示踪成像检测SLN,观察是否存在转移,以病理结果为金标准,计算并比较3种方法对SLN的检出率,并评价诊断效能。结果 CEUS、⁹⁹Tc^m-SC淋巴闪烁照像和亚甲蓝示踪对SLN检出率分别为80.56%（29/36）、86.11%（31/36）和77.78%（28/36）,差异无统计学意义（P=0.956）,诊断MSLN的敏感度、特异度、准确率分别为90.48%（19/21）、75.00%（6/8）、86.21%（25/29）,92.31%（24/26）、40.00%（2/5）、83.87%（26/31）和87.50%（21/24）、75.00%（3/4）、85.71%（24/28）,差异亦无统计学意义（P均>0.05）。结论 CEUS检测MSLN效能与⁹⁹Tc^m-SC淋巴闪烁照像和亚甲蓝示踪成像无明显差异,且无创、操作简便、价格低廉,临床前景广阔。     

乳腺癌前哨淋巴结经皮注射淋巴结超声造影的影像特征及定性评估

目的探究乳腺癌前哨淋巴结(SLN)经皮注射淋巴结超声造影(CEUS)的影像特征以及对乳腺癌SLN的定性评估。方法选取2018年3月至2019年11月我院收治的乳腺癌患者63例。经皮注射淋巴结CEUS观察SLN的显影特征,并根据淋巴结内部显影强度及造影剂分布分为Ⅰ型完全均匀高增强型,造影剂均匀灌注整个淋巴结;Ⅱ型周边及髓质均匀高增强型,造影剂明显均匀灌注周边及髓质区,皮质低或无灌注;Ⅲ型周边和(或)髓质不均匀增强型,局部灌注缺失,可见灌注缺损区;Ⅳ型无增强型,淋巴结内无造影剂灌注。评估经皮注射淋巴结CEUS诊断SLN是否发生转移的价值。结果63例患者中共显示SLN 85枚,无转移性52枚(61.18%),转移性33枚(38.82%);转移性SLN纵径、横径大于无转移性SLN(P<0.05),转移性SLN纵横比、淋巴结距体表距离与无转移性SLN相比,差异无统计学意义(P>0.05);无转移性SLN以Ⅰ型(57.69%)为主,其次为Ⅱ型(26.92%),转移性SLN以Ⅲ型(48.48%)为主,其次为Ⅳ型(42.42%)。无转移性SLN多表现为Ⅰ、Ⅱ型,转移性SLN多表现为Ⅲ、Ⅳ型;经皮注射淋巴结CEUS诊断SLN是否发生转移的AUC为0.923(95%CI0.855~0.986),敏感性为91.0%,特异性为89.2%。结论经皮注射淋巴结CEUS对乳腺癌SLN能够进行准确定位,并对SLN是否发生转移进行判定,敏感度和特异性高,具有较高的临床应用价值。     

剪切波弹性成像联合CEUS校正乳腺影像报告和数据系统3~5类乳腺病变

目的 探讨剪切波弹性成像（SWE）联合CEUS在校正乳腺影像报告和数据系统（BI-RADS）3~5类乳腺肿瘤中的应用价值。方法 收集50例乳腺病变患者（57个病灶）,其中良性病灶28个,恶性29个。对所有病灶术前行常规超声、SWE和CEUS检查,以常规超声进行BI-RADS分类,并采用SWE、CEUS及SWE联合CEUS对BI-RADS分类进行校正。以病理结果为金标准,计算常规超声、SWE、CEUS及SWE联合CEUS诊断乳腺良恶性病灶的敏感度、特异度和诊断正确率。结果 SWE参数最大杨氏模量值（E_max）诊断乳腺良恶性病灶的临界值为87.2 kPa,CEUS的临界值为8.5分,SWE联合CEUS的多因素Logistic回归模型为Y（P）=-18.785+0.161X₁+11.822X₂,X₁为E_max,X₂为增强后病灶大小改变。SWE联合CEUS将11个病灶正确降为3级,4个病灶误诊;SWE联合CEUS诊断乳腺良恶性病灶的敏感度、特异度和诊断正确率分别为100%（29/29）、85.71%（24/28）和92.98%（53/57）。结论 SWE联合CEUS对BI-RADS 3~5类乳腺病灶具有良好的校正作用,可提高超声诊断正确率。     

Small Atypical Cervical Nodes Detected on Sonography in Patients With Squamous Cell Carcinoma of the Head and Neck

Objective. The purpose of this study was to assess the probability of metastasis of small atypical cervical lymph nodes detected on sonography in patients with squamous cell carcinoma (SCC) of the head and neck. Methods. .We reviewed, retrospectively and blindly, sonographic findings of 148 patients (118 men and 30 women; mean age, 58.2 years) who underwent curative neck dissection. Each lymph node was classified by using a 4‐point scale: 1, definitely benign; 2, indeterminate (small [short‐axis diameter <10 mm for levels I and II and <7 mm for levels III–VI] atypical node); 3, definitely metastatic; and 4, large (>3‐cm) metastatic. Lymph nodes were considered atypical if they met at least 1 of the following criteria: a long‐ to short‐axis diameter ratio of less than 2.0, absence of a normal echogenic hilum, and heterogeneous echogenicity of the cortex. These results were verified, on a level‐by‐level basis, with histopathologic findings. Results. Small atypical nodes were found on sonography in 63 cervical levels of 48 patients, of which 18 (28.6%) were proved to have metastatic nodes. The probability of metastasis was significantly higher with than without a large (>3‐cm) ipsilateral metastatic node (0.50 versus 0.20; P = .038) and marginally higher with than without an ipsilateral metastatic node (0.41 versus 0.16; P = .061) but not significantly associated with the T stage of the primary tumor (P = .238) or the presence of an ipsilateral tumor (P = .904). Conclusions. Metastasis was encountered in about 30% of small atypical cervical nodes on sonography in patients with SCC of the head and neck. Our results indicate that small atypical nodes must be interpreted with consideration of metastatic nodes in the ipsilateral neck.     

Sentinel Node Detection Method Using Contrast-Enhanced Ultrasonography with Sonazoid in Breast Cancer: Preliminary Clinical Study

This study aimed to evaluate the usefulness of sentinel lymph node (SLN) detection in breast cancer using contrast-enhanced ultrasonography (CEUS) with subareolar Sonazoid injection. The subjects were 20 breast cancer patients. General anesthesia was induced and 2 mL of Sonazoid was injected subareolarly. After massage of the injection site, the axillary area was observed transdermally using coded phase inversion harmonic ultrasonography with mechanical indices of 0.15 to 0.19. When contrast-enhanced lymph nodes (LNs) were seen, they were defined as CE-SLN. Two other SLN detection methods, the γ-probe-guided and dye-guided methods, were performed together. We evaluated the SLNs detected by each method to determine if they corresponded with each other and calculated the SLN detection rate. After the SLNs were resected, pathologic examinations were done. The SLN detection rate of the CEUS-guided method, the dye-guided method and the γ-probe-guided method were 70%, 75% and 100%, respectively. There was no statistically significant difference in these rates between the CEUS-guided and dye-guided methods (p = 0.99) but the CEUS-guided method showed a significantly lower rate than the γ-probe-guided method (p = 0.020), and dye-guided method also showed a significantly lower rate than the γ-probe-guided method (p = 0.047). The number of CE-SLNs was 1 or 2 (average 1.1) and each took 2 to 20 (average 5.3) min to detect. The CE-SLNs corresponded grossly with SLNs detected by the γ-probe-guided and dye-guided methods. The pathologic results indicated no metastasis from the resected SLNs in 15 of 20 cases. However, the CEUS-guided method detected 12 cases of these 15 and CE-SLNs were detected in two of the remaining five metastasis cases. In summary, in breast cancer patients, after subareolar injection of Sonazoid, contrast-enhanced LNs were observed in real time with ultrasonography. In an initial clinical study of 20 cases, the detection rate of the CEUS-guided method was less than that of the γ-probe-guided method. It is suggested that the CEUS-guided method using Sonazoid may, with some improvements, be a useful new modality for sentinel node identification. (E-mail: kiyoka@jichi.ac.jp)     

超声造影诊断直肠癌前哨淋巴结

目的 探讨CEUS在直肠癌前哨淋巴结(SLN)诊断中的价值。方法 46例直肠癌患者中,选取接受直肠癌手术,且术中CEUS定位检测SLN的患者42例,观察SLN增强情况。术后常规病理学检测所有淋巴结,并与CEUS结果比较。结果 CEUS对SLN的检出率为91.30%(42/46),CEUS判定直肠癌SLN的敏感度87.50%(21/24)、特异度90.47%(38/42)、准确率89.39%(59/66)。结论 CEUS定位直肠癌SLN具有较好的效果,且增强方式可初步判断其是否发生转移,具有一定的临床应用价值。