Xia ShuJun, Hua Qing, Song YanYan, Yuan CongCong, Zheng YuHang, Tao RuoLin, Xu JiaLe, Cai EnHeng, Zhang YuLu, Wu FangGang, Guo Wei, Tian Yuan, Dong YiJie, Zhou JianQiao
Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Eur Radiol. 2025 Apr 5. doi: 10.1007/s00330-025-11520-5.
Accurate preoperative localization and characterization of sentinel lymph nodes (SLNs) is vital in breast cancer management. The application of super-resolution ultrasound (SRUS) imaging to visualize intranodal lymphatic sinuses for the prediction of SLN metastasis has yet to be investigated. The study aimed to assess the value of SRUS imaging of intranodal lymphatic sinuses in predicting SLN metastasis in breast cancer patients.
A total of 154 SLNs from 143 patients with breast cancer were prospectively included. All patients underwent conventional US of axillary lymph nodes and SRUS imaging of lymph sinus by percutaneous microbubble injection. Qualitative and quantitative analysis were performed for SRUS imaging, with qualitative analysis focusing on identifying perfusion defects and quantitative analysis including parameters such as lymphatic sinus density, sinus diameter, sinus distance, and lymph flow velocity. The areas under the receiver operating characteristic curve (AUC), sensitivity, and specificity were calculated for conventional US, SRUS, and combined conventional US and SRUS.
Among the 154 SLNs, 73 were metastatic and 81 were reactive. In predicting metastatic SLNs, the AUC for SRUS (0.824; 95% CI: 0.761-0.888) was significantly higher than that for conventional US (0.661; 95% CI: 0.596-0.726) (p < 0.001). The combination of SRUS and conventional US achieved the highest AUC (0.844; 95% CI: 0.785-0.904), which was significantly higher than conventional US alone (p < 0.001), but not significantly different from SRUS alone (p = 0.2).
Imaging lymphatic sinuses by SRUS has the potential to predict metastatic SLNs in patients with breast cancer.
Question Super-resolution ultrasound (SRUS) used for visualizing intranodal lymphatic sinuses for the prediction of sentinel lymph nodes (SLNs) metastasis has yet to be investigated. Findings Microlymphatic circulation of SLNs were imaged by SRUS at ten microns scale. SRUS showed better performance for predicting metastatic SLNs than conventional ultrasound. Clinical relevance SRUS is a reliable tool to image lymphatic sinuses and characterize metastatic SLNs in patients with breast cancer. It helps diagnosis of lymph node status and clinical decision-making of breast cancer.
前哨淋巴结（SLN）的准确术前定位和特征描述在乳腺癌治疗中至关重要。超分辨率超声（SRUS）成像用于可视化结内淋巴窦以预测SLN转移的应用尚未得到研究。本研究旨在评估结内淋巴窦的SRUS成像在预测乳腺癌患者SLN转移中的价值。
前瞻性纳入143例乳腺癌患者的154个SLN。所有患者均接受腋窝淋巴结的常规超声检查以及经皮微泡注射对淋巴窦进行SRUS成像。对SRUS成像进行定性和定量分析，定性分析重点在于识别灌注缺损，定量分析包括淋巴窦密度、窦直径、窦间距和淋巴流速等参数。计算常规超声、SRUS以及常规超声与SRUS联合检查的受试者操作特征曲线（AUC）下面积、敏感性和特异性。
在154个SLN中，73个为转移性，81个为反应性。在预测转移性SLN方面，SRUS的AUC（0.824；95%CI：0.761 - 0.888）显著高于常规超声（0.661；95%CI：0.596 - 0.726）（p < 0.001）。SRUS与常规超声联合检查的AUC最高（0.844；95%CI：0.785 - 0.904），显著高于单独的常规超声（p < 0.001），但与单独的SRUS无显著差异（p = 0.2）。
通过SRUS对淋巴窦进行成像有潜力预测乳腺癌患者的转移性SLN。
问题 用于可视化结内淋巴窦以预测前哨淋巴结（SLN）转移的超分辨率超声（SRUS）尚未得到研究。发现 SRUS以十微米尺度对SLN的微淋巴循环进行成像。SRUS在预测转移性SLN方面比常规超声表现更好。临床意义 SRUS是一种可靠的工具，可对淋巴窦进行成像并对乳腺癌患者的转移性SLN进行特征描述。它有助于乳腺癌淋巴结状态的诊断和临床决策。
