经皮对比增强超声在早期乳腺癌前哨淋巴结识别、转移状态和负荷诊断中的价值。

The Value of Percutaneous Contrast-Enhanced Ultrasound in Sentinel Lymph Node Identification, Metastatic Status and Burden Diagnosis in Early Breast Cancer.

机构信息

Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China.

Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China.

出版信息

J Ultrasound Med. 2024 Feb;43(2):293-303. doi: 10.1002/jum.16359. Epub 2023 Oct 24.

DOI:10.1002/jum.16359

PMID:37876335

Abstract

OBJECTIVE

The aim of this study was to evaluate the value of percutaneous contrast-enhanced ultrasound (PCEUS) in the identification and characterization of sentinel lymph node (SLN).

METHODS

A total of 102 breast cancer patients were collected and underwent preoperative PCEUS, which was used to identify SLN and lymphatic drainage. SLNs were classified into 4 enhancement patterns, including 6 subtypes: homogeneous (I), featured inhomogeneous (II) including inhomogeneous hypoenhancement (IIa) and annular or semi-annular enhancement (IIb), focal filling defect (III) including filling defect area < 50% (IIIa) and filling defect area ≥ 50% (IIIb), and no enhancement (IV). The enhancement patterns of SLNs were compared with the final pathological diagnosis.

RESULTS

The identification rate of SLNs using PCEUS was 100% (102/102); the rate of identification of LCs was 100% (102/102), and the coincidence rate was 98.0% (100/102). Four lymphatic drainage patterns (LDPs) including 5 subtypes were found: single LC/single SLN(74.5%), multiple LCs/ single SLN (13.7%) including 2 subtypes:2 LCs/1 SLN and 3 LCs/1 SLN, single LC/multiple SLNs (7.8%), and multiple LCs/multiple SLNs (3.9%). A total of 86.3% (44/51) of patients without axillary metastasis could be safely selected for types I, IIa, and IIb, while the axillary metastasis rates of types III and IV were 74.4% and 87.5%, respectively (P < .001). Compared with grayscale US, the PCEUS significant improvement in diagnosing metastatic SLNs (.794 versus .579, P < .001). For the SLN metastatic burden, Types I, IIa, IIb, and IIIa had ≤2 SLNs metastases, with a pathological coincidence rate of (64/67, 95.5%), and types IIIb and IV had >2 SLNs metastases, with a pathological coincidence rate of (25/35, 71.4%) (P < .001). The AUC of PCEUS for the diagnosis of SLN metastatic status and burden was .794 and .879, respectively (P < .001).

CONCLUSION

PCEUS has a high identification rate for SLN and has good potential for diagnosing SLN metastatic status and burden by enhancement patterns.

摘要

目的

本研究旨在评估经皮对比增强超声（PCEUS）在识别和描述前哨淋巴结（SLN）中的价值。

方法

共纳入 102 例乳腺癌患者，均接受术前 PCEUS 检查，以识别 SLN 和淋巴引流。将 SLN 分为 4 种增强模式，包括 6 个亚型：均匀（I）、特征性不均匀（II），包括不均匀低增强（IIa）和环形或半环形增强（IIb）、局灶性充盈缺损（III），包括充盈缺损面积＜50%（IIIa）和充盈缺损面积≥50%（IIIb）、无增强（IV）。比较 SLN 的增强模式与最终病理诊断。

结果

PCEUS 对 SLN 的识别率为 100%（102/102）；对 LCs 的识别率为 100%（102/102），符合率为 98.0%（100/102）。发现 4 种淋巴引流模式（LDPs）包括 5 个亚型：单个 LC/单个 SLN（74.5%）、多个 LCs/单个 SLN（13.7%），包括 2 个亚型：2 个 LCs/1 个 SLN 和 3 个 LCs/1 个 SLN、单个 LC/多个 SLNs（7.8%）和多个 LCs/多个 SLNs（3.9%）。86.3%（44/51）无腋窝转移的患者可安全选择 I、IIa 和 IIb 型，而 III 和 IV 型的腋窝转移率分别为 74.4%和 87.5%（P<0.001）。与灰阶超声相比，PCEUS 显著提高了转移性 SLN 的诊断效能（0.794 比 0.579，P<0.001）。对于 SLN 的转移负荷，I 型、IIa 型、IIb 型和 IIIa 型的转移负荷为≤2 个 SLN，与病理符合率为（64/67，95.5%），而 IIIb 型和 IV 型的转移负荷为>2 个 SLN，与病理符合率为（25/35，71.4%）（P<0.001）。PCEUS 对 SLN 转移状态和转移负荷的诊断的 AUC 分别为 0.794 和 0.879（P<0.001）。