超声造影与亚甲蓝示踪检测兔VX2乳腺癌前哨淋巴结的比较研究

目的通过与亚甲蓝(MB)示踪法比较,探讨超声造影检测乳腺癌前哨淋巴结(SLN)的前景。方法建立兔VX2乳腺癌模型24只,皮下注射SonoVue,超声造影显像SLN,观察其造影增强情况;再经皮下注射MB示踪;行腋窝淋巴结清扫术切除前哨淋巴结(sentinel lymph node,SLN)并行AE1/AE3免疫组化染色。结果 24只荷瘤兔超声造影检出回声均匀性增强的SLN 12个,回声不均匀性增强和部分充盈缺损的SLN 22个;MB示踪法检出SLN 32个;术中腋窝淋巴结清扫SLN 38个。以手术切除的SLN免疫组化结果为标准,超声造影的检出率(89.47%)、敏感性(95.24%)与MB示踪法检出率(84.21%)、敏感性(91.30%)比较无显著差异(P0.05);但其特异性(84.62%)和准确性(91.18%)均明显高于MB示踪法特异性(26.67%)和准确性(65.79%)(P0.05)。结论经皮下注射超声造影剂显像乳腺癌SLN与MB示踪法比较有一定优势,有望成为检测SLN的常用方法。

Detection of Ultrasound Contrast and Methylene BlueTracer on the Sentinel Lymph Node in Rabbit VX2 Breast Cancer

Objective To explore the prospects of contrast-enhanced ultrasound and methylene blue(MB)detection of breast cancer sentinel lymph node (SLN).Methods Twenty-four rabbit models of VX2 breast cancer were set up with subcutaneous injection of SonoVue to get contrast-enhanced ultrasound imaging of SLN.The situation of contrast-enhanced SLN was observed.Then subcutaneous injection of MB was performed to trace SLN.SLN was resected from axillary lymph nods,which underwent immuno-histochemistry of AE1/AE3.Results Among the twenty-four rabbits,12 SLN were with homogeneous echo-enhanced.22 SLN enhanced non-uniformities were found by contrast-enhanced ultrasound.By MB tracer method 32 SLN were detected.38 SLN were resected from axillary lymph nodes.To make surgical resection as the standard,the detection rate of contrast-enhanced ultrasound (89.47%) and the MB tracer detection rate (84.21%) showed no significant difference (P>0.05).Contrast-enhanced ultrasound sensitivity (95.24%) and the MB tracer method sensitivity (91.30%) showed no significant difference (P>0.05),but the specificity (84.62%) and accuracy (91.18%) from contrast-enhanced ultrasound sensitivity were significantly higher than those from tracer MB methodspecificity(26.67%) and accuracy(65.79%)](P<0.05).Conclusions Contrast-enhanced ultrasound imaging in detecting SLN of breast cancer gets a higher detection rate,specificity,accuracy and sensitivity compared with the MB tracer method,which is expected to become the common method in detection of SLN.