Zheng Yan, Sun Jie, Zhu Lin, Hu Meng-Shang, Hou Li-Zhu, Liu Jian-Xia, Dong Feng-Lin
Department of Ultrasound, The First Affiliated Hospital of Soochow University, Suzhou, China.
Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China.
Quant Imaging Med Surg. 2023 Jun 1;13(6):3451-3463. doi: 10.21037/qims-22-1175. Epub 2023 Apr 4.
In patients with T1/T2 breast cancer (BC), sentinel lymph node (SLN) status is essential for prognosis and treatment. This study investigated the value of conventional ultrasound combined with double contrast-enhanced ultrasound in diagnosing the metastasis of SLNs in patients with T1/T2 BC.
This study employed a prospective design (this diagnostic study was not registered on a clinical trial platform), and the participants formed a convenience series. Based on the inclusion and exclusion criteria, 163 patients with BC who received treatment in the First Affiliated Hospital of Soochow University from July 2017 to December 2021 were included in this study. A total of 165 SLNs from 163 patients with T1/T2 BC were analyzed. All patients underwent percutaneous contrast-enhanced ultrasound (PCEUS) to trace SLNs before the operation. Subsequently, all patients underwent conventional ultrasound and intravenous contrast-enhanced ultrasound (ICEUS) examinations to observe the SLNs. The results of the conventional ultrasound, ICEUS, and PCEUS of the SLNs were analyzed. The associations between the risk of SLN metastasis and imaging features were evaluated via a nomogram based on the pathological results.
Overall, 54 metastatic SLNs and 111 nonmetastatic SLNs were evaluated. Metastatic SLNs displayed a greater cortical thickness, area ratio, eccentric fatty hilum, and hybrid blood flow on conventional ultrasound compared with nonmetastatic SLNs (P<0.001). According to PCEUS, 75.93% of metastatic SLNs showed heterogeneous enhancement (type II and III), and 73.88% of nonmetastatic SLNs showed homogeneous enhancement (type I; P<0.001). According to ICEUS, heterogeneous enhancement (type B/C, 20.37% . 11.71%) and overall enhancement (55.56% . 23.42%) were more common in metastatic SLNs than in nonmetastatic SLNs (P<0.001). Logistic regression analysis showed that the cortical thickness and enhancement type of PCEUS were independent predictors of SLN metastasis. Moreover, a nomogram combining these factors showed a high diagnostic ability for SLN metastasis (unadjusted concordance index 0.860, 95% CI: 0.730-0.990; bootstrap-corrected concordance index 0.853).
The nomogram of cortical thickness and enhancement type of PCEUS could effectively diagnose SLN metastasis in patients with T1/T2 BC.
在T1/T2期乳腺癌（BC）患者中，前哨淋巴结（SLN）状态对预后和治疗至关重要。本研究探讨了常规超声联合双对比增强超声在诊断T1/T2期BC患者SLN转移中的价值。
本研究采用前瞻性设计（本诊断性研究未在临床试验平台注册），参与者构成便利样本系列。根据纳入和排除标准，纳入了2017年7月至2021年12月在苏州大学附属第一医院接受治疗的163例BC患者。共分析了163例T1/T2期BC患者的165枚SLN。所有患者在手术前行经皮对比增强超声（PCEUS）追踪SLN。随后，所有患者接受常规超声和静脉对比增强超声（ICEUS）检查以观察SLN。分析SLN的常规超声、ICEUS和PCEUS结果。基于病理结果，通过列线图评估SLN转移风险与影像特征之间的关联。
总体上，评估了54枚转移SLN和111枚非转移SLN。与非转移SLN相比，转移SLN在常规超声上显示出更大的皮质厚度、面积比、偏心脂肪 hilum和混合血流（P<0.001）。根据PCEUS，75.93%的转移SLN表现为不均匀增强（II型和III型），73.88%的非转移SLN表现为均匀增强（I型；P<0.001）。根据ICEUS，转移SLN中不均匀增强（B/C型，20.37%对11.71%）和整体增强（55.56%对23.42%）比非转移SLN更常见（P<0.001）。逻辑回归分析表明，PCEUS的皮质厚度和增强类型是SLN转移的独立预测因素。此外，结合这些因素的列线图对SLN转移具有较高的诊断能力（未调整一致性指数0.860，95%CI：0.730 - 0.990；自举校正一致性指数0.85）。
PCEUS皮质厚度和增强类型的列线图可有效诊断T1/T2期BC患者的SLN转移。
