Qiao Jianghua, Li Juntao, Wang Lina, Guo Xiaoxia, Bian Xiaolin, Lu Zhenduo
Department of Breast Surgery, Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, China.
Department of Ultrasound, Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, China.
Gland Surg. 2021 Feb;10(2):761-769. doi: 10.21037/gs-20-867.
Sentinel lymph node biopsy (SLNB) is the standard procedure for axillary staging in clinically node-negative (cN0) breast cancer patients. The positive rate of SLNs in cN0 stage patients ranges from 20.5% to 25.5%, so identifying appropriate candidates for SLNB is quite challenging. The aims of this study were to assess whether contrast-enhanced ultrasound (CEUS) could be utilized to noninvasively predict SLN metastasis, and to explore the predictive value of the involved factors.
Between May 2016 and May 2018, 217 consenting breast cancer patients undergoing SLNB were enrolled. Before the surgery, CEUS was utilized to identify the SLNs, and predict whether metastasis had occurred according to their enhancement pattern. Blue dye was also used to identify the SLNs during SLNB. The rates of identification and accuracy of both methods were recorded. The predictive outcomes of SLNs identified by CEUS were recorded and compared with the pathological diagnosis.
Of the 217 cases, SLNs in 212 cases were successfully identified, comprising 208 cases identified by CEUS and 206 cases by blue dye, with no significant difference between the two methods (P=0.6470). A total of 78 cases were predicted SLN-positive preoperatively by CEUS, comprising 61 cases of SLN metastasis confirmed by pathology and 17 cases of no SLN metastasis, and 130 cases were predicted SLN-negative by CEUS, comprising 6 cases of SLN metastasis and 124 cases of no SLN metastasis. The sensitivity of CEUS preoperative prediction was 91.0%, the specificity was 87.9%, the positive and negative predictive values were 78.2% and 95.4%, respectively, and the accuracy was 88.9%. The maximum diameter size of positive SLNs predicted by CEUS was greater than that of negative SLNs (mean value 1.67±0.06 . 1.40±0.05 cm, P=0.0007). Similarly, the primary tumor size predicted SLN-positive by CEUS was greater than that in patients with negative SLNs (mean value 2.64±0.12 . 1.79±0.09 cm, P<0.0001).
CEUS accurately identified SLNs and can be used to noninvasively predict SLN metastasis in early-stage breast cancer patients. However, the primary tumor size and the SLN size should not be overlooked by clinicians when judging the status of SLNs. This novel method may be a recommended strategy for identifying appropriate SLNB candidates.
前哨淋巴结活检（SLNB）是临床腋窝淋巴结阴性（cN0）乳腺癌患者腋窝分期的标准程序。cN0期患者前哨淋巴结的阳性率在20.5%至25.5%之间，因此识别合适的前哨淋巴结活检候选者颇具挑战性。本研究的目的是评估超声造影（CEUS）是否可用于无创预测前哨淋巴结转移，并探讨相关因素的预测价值。
2016年5月至2018年5月，纳入217例同意接受前哨淋巴结活检的乳腺癌患者。手术前，使用超声造影识别前哨淋巴结，并根据其增强模式预测是否发生转移。在前哨淋巴结活检过程中也使用蓝色染料识别前哨淋巴结。记录两种方法的识别率和准确率。记录超声造影识别的前哨淋巴结的预测结果，并与病理诊断结果进行比较。
217例患者中，成功识别212例患者的前哨淋巴结，其中超声造影识别208例，蓝色染料识别206例，两种方法之间无显著差异（P = 0.6470）。共有78例患者术前经超声造影预测前哨淋巴结阳性，其中病理证实前哨淋巴结转移61例，未发生前哨淋巴结转移17例；130例患者经超声造影预测前哨淋巴结阴性，其中前哨淋巴结转移6例，未发生前哨淋巴结转移124例。超声造影术前预测的敏感性为91.0%，特异性为87.9%，阳性预测值和阴性预测值分别为78.2%和95.4%，准确率为88.9%。超声造影预测的阳性前哨淋巴结的最大直径大于阴性前哨淋巴结（平均值1.67±0.06 . 1.40±0.05 cm，P = 0.0007）。同样，超声造影预测前哨淋巴结阳性的原发肿瘤大小大于前哨淋巴结阴性患者（平均值2.64±0.12 . 1.79±0.09 cm，P<0.0001）。
超声造影能准确识别前哨淋巴结，可用于无创预测早期乳腺癌患者的前哨淋巴结转移。然而，临床医生在判断前哨淋巴结状态时，不应忽视原发肿瘤大小和前哨淋巴结大小。这种新方法可能是识别合适的前哨淋巴结活检候选者的推荐策略。
