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。

Imaging characteristics and qualitative evaluation of sentinel lymph node in percutaneous injection of lymph node contrast-enhanced ultrasound in breast cancer

Objective To explore the imaging features and the qualitative assessment of sentinel lymph node(SLN)in percutaneous injection of lymph node contrast-enhanced ultrasound(CEUS)for breast cancer.Methods Sixty-three breast cancer patients treated in our hospital from March 2018 to November 2019 were selected.Percutaneous injection of lymph node CEUS was used to observe the image characteristics of SLN.According to the internal development intensity of the lymph node and the distribution of the contrast agent,the images were divided into types I,II,III,and IV.The type I was the completely uniform and high-enhancement type and the contrast agent was perfused in the entire lymph node.The type II was uniform and high-enhancement type around the medulla,and the contrast agent was clearly and evenly perfused to the periphery and medulla area with low or no cortex perfusion.The type III showed that the peripheral and(or)medulla was unevenly enhanced with loss of local perfusion,and perfusion defects could be seen.The type IV was no enhancement and no contrast agent perfusion in the lymph nodes.The value of percutaneous injection of lymph node CEUS to diagnose SLN metastasis was analyzed.Results A total of 85 SLNs were shown in 63 patients.Of these,52 were metastasis(61.18%)and 33 were metastasis(38.82%).The longitudinal and transverse diameters of metastatic SLN were greater than those of non-metastatic SLN(P<0.05).There was no significant difference in the aspect ratio of metastatic SLN and the body surface distance of lymph nodes when compared to non-metastatic SLN(P>0.05).The non-metastatic SLN was mainly type I(57.69%)followed by type II(26.92%).The metastatic SLN was mainly type III(48.48%),and the second was type IV(42.42%).The AUC of percutaneous injection of lymph node CEUS for diagnosis of SLN metastasis was 0.923(95%CI:0.855~0.986),and the sensitivity and the specificity were 91.0%,and 89.2%,respectively.Conclusion Percutaneous injection of lymph node CEUS can accurately locate breast cancer SLN and determine SLN transfer.It has high sensitivity and specificity,thus,has high clinical application value.