Agliata Giacomo, Valeri Gianluca, Argalia Giulio, Tarabelli Elisa, Giuseppetti Gian Marco
Scuola di Specializzazione in Radiodiagnostica, Università Politecnica delle Marche, Ancona, Italy.
Clinica di Radiologia d'Urgenza e dell'Area Oncologica, Ospedali Riuniti, Ancona, Italy.
J Ultrasound Med. 2017 Mar;36(3):505-511. doi: 10.7863/ultra.16.04012. Epub 2017 Jan 18.
To evaluate the diagnostic performance of contrast-enhanced sonography for characterization of the lymph node status (metastatic or not) in patients with breast carcinomas by comparison with sentinel lymph node biopsy.
From January to August 2015, 50 female patients with a histologic diagnosis of invasive breast carcinoma were prospectively examined by ipsilateral axillary contrast-enhanced sonography. The test was performed by a single radiologist using an ultrasound system with a broadband 8-12-MHz, 38-mm high-resolution linear transducer. For the target lymph node, we chose a node with a sonographic pattern that was suspicious for malignancy: ie, a longitudinal-to-transverse diameter ratio of less than 2, absence of a central hyperechogenic hilum, or both. In cases with a lack of sonographic signs of malignancy, we evaluated the node with the maximal transverse diameter. Nodes were considered malignant in cases with total absence of contrast enhancement and in those with enhancement alterations. Within 1 week, all patients underwent sentinel lymph node biopsy, followed by a histologic test.
The histologic test showed benignity in 22 of 50 sentinel lymph nodes, whereas 28 were metastatic. Among the 22 patients with negative biopsy results, contrast-enhanced sonography showed 18 concordances and 4 false-positives results; among the 28 with positive biopsy results, contrast-enhanced sonography obtained 100% correct characterizations of the axillary status. The sensitivity, specificity, and accuracy were 100%, 82%, and 92%, respectively.
Contrast-enhanced sonography appears to be a method with high accuracy for characterization of axillary lymph nodes, very close to the reference-standard sentinel lymph node biopsy. This technique seems to have overall high sensitivity.
通过与前哨淋巴结活检相比较，评估超声造影对乳腺癌患者淋巴结状态（有无转移）的诊断效能。
2015年1月至8月，对50例经组织学确诊为浸润性乳腺癌的女性患者进行同侧腋窝超声造影前瞻性检查。检查由一名放射科医生使用配备宽带8-12MHz、38mm高分辨率线性探头的超声系统进行。对于目标淋巴结，我们选择具有可疑恶性超声特征的淋巴结：即纵横径比小于2、无中央高回声淋巴结门或两者皆有。在缺乏恶性超声征象的情况下，我们评估最大横径的淋巴结。在完全无造影剂增强和有增强改变的情况下，淋巴结被视为恶性。在1周内，所有患者均接受前哨淋巴结活检，随后进行组织学检查。
组织学检查显示50个前哨淋巴结中有22个为良性，28个有转移。在22例活检结果为阴性的患者中，超声造影显示18例结果一致，4例假阳性；在28例活检结果为阳性的患者中，超声造影对腋窝状态的特征描述100%正确。敏感性、特异性和准确性分别为100%、82%和92%。
超声造影似乎是一种对腋窝淋巴结特征描述准确性高的方法，非常接近参考标准的前哨淋巴结活检。该技术似乎总体具有较高的敏感性。
