Guo Rui-Qian, Xiang Xi, Wang Li-Yun, Zhu Bi-Hui, Huang Song-Ya, Tang Xin-Yi, Chen Jun-Jie, Qiu Li
Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, China.
Plastic and Burn Surgery, West China Hospital of Sichuan University, Chengdu, China.
Quant Imaging Med Surg. 2022 Jan;12(1):366-375. doi: 10.21037/qims-21-249.
To explore the feasibility of sentinel lymph node (SLN) tracing by percutaneous contrast-enhanced ultrasound (pCEUS) in patients with cutaneous malignant melanoma (CMM) and the ability to enhance patterns of SLNs in diagnosing lymph nodes (LNs) metastases.
Fifty-three patients with CMM of the lower extremities treated at our hospital were included in the study. All the participants received pCEUS preoperatively. The enhanced lymphatic channels (LCs) and associated SLNs were observed and tracked in real-time. The number of enhanced LCs and enhancing patterns of SLNs were recorded. Subsequently, SLNs localized by pCEUS were pathologically examined.
Of the 53 cases, SLNs were successfully localized by pCEUS in 48 cases. In total, there were 59 detected SLNs averaging 1.23±0.42 SLNs per case. The main lymphatic drainage patterns (LDPs) were the following: one enhanced LC pointed to one or more than one SLN, and multiple enhanced LCs pointed to one or multiple SLNs. There were four enhancing patterns of SLNs (uniform, annular, uneven, and no enhancement), among which the first two were considered benign nodes, while the latter two were considered metastatic nodes. With pathological results as the gold standard, the diagnostic sensitivity and specificity by pCEUS were 90.9% and 75.0%, respectively.
Contrast-enhanced ultrasound (US) is a feasible approach for SLN identification in patients with CMM of the lower extremities. Enhancing patterns of SLNs may help predict metastasizing SLNs. This novel method may be a promising technique for clinical application.
探讨经皮超声造影（pCEUS）在皮肤恶性黑色素瘤（CMM）患者中进行前哨淋巴结（SLN）示踪的可行性，以及前哨淋巴结增强模式在诊断淋巴结（LN）转移中的能力。
纳入我院收治的53例下肢CMM患者。所有参与者术前均接受pCEUS检查。实时观察并追踪增强的淋巴管（LCs）及相关前哨淋巴结。记录增强的淋巴管数量和前哨淋巴结的增强模式。随后，对经pCEUS定位的前哨淋巴结进行病理检查。
53例患者中，48例通过pCEUS成功定位前哨淋巴结。共检测到59个前哨淋巴结，平均每例1.23±0.42个。主要淋巴引流模式（LDPs）如下：一条增强的淋巴管指向一个或多个前哨淋巴结，多条增强的淋巴管指向一个或多个前哨淋巴结。前哨淋巴结有四种增强模式（均匀、环形、不均匀和无增强），其中前两种被认为是良性淋巴结，后两种被认为是转移淋巴结。以病理结果为金标准，pCEUS的诊断敏感性和特异性分别为90.9%和75.0%。
超声造影（US）是下肢CMM患者前哨淋巴结识别的一种可行方法。前哨淋巴结的增强模式可能有助于预测转移的前哨淋巴结。这种新方法可能是一种有前景的临床应用技术。
