Yao Jundong, Li Husha, Wang Hailong, Liu Binbin, Cui Shuai, Liu Qifan, Chang Chang, Deng Miao, Chen Shengjiang
Department of Ultrasound, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China.
Department of Surgery, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China.
Ann Surg Oncol. 2025 Jun 23. doi: 10.1245/s10434-025-17705-y.
Sentinel lymph node biopsy (SLNB) using radioisotopes/blue dye remains limited by radiation exposure and logistical constraints. This study prospectively evaluates lymphatic contrast-enhanced ultrasound (L-CEUS) for SLN mapping and metastasis detection in early-stage breast cancer.
A total of 251 consecutive patients underwent L-CEUS-guided SLN biopsy. Enhancement patterns (Types I-V) and filling defects were correlated with histopathology. Diagnostic performance was compared to conventional ultrasound parameters and surgical SLNB (n = 102).
L-CEUS successfully localized SLNs in 98.4% (247/251) of cases. Using Types III-V enhancement as metastatic criteria, L-CEUS demonstrated 99.0% sensitivity and 88.1% specificity (AUC 0.935). Incorporating filling defects improved specificity to 95.4% (AUC 0.967). Cortical thickness (>3.0 mm) outperformed nodal short-axis in metastasis prediction (AUC 0.874 vs. 0.702, p < 0.001). Compared with blue dye, L-CEUS identified fewer SLNs/patient (3.11 ± 0.81 vs. 3.59 ± 1.2, p = 0.001) with shorter procedural time (4.09 ± 0.25 vs. 12.12 ± 2.75 min, p < 0.001). Eight false-negatives involved micro-metastases (n = 3) and skip lesions (n = 5).
L-CEUS provides high diagnostic accuracy for SLN evaluation while eliminating radiation exposure. Its real-time imaging capability and rapid procedural time support integration into standard axillary staging protocols, particularly where radioisotopes are unavailable. Prospective validation of long-term outcomes is warranted.
使用放射性同位素/蓝色染料的前哨淋巴结活检（SLNB）仍然受到辐射暴露和后勤限制的制约。本研究前瞻性评估淋巴造影增强超声（L-CEUS）在早期乳腺癌前哨淋巴结定位和转移检测中的应用。
共有251例连续患者接受了L-CEUS引导下的前哨淋巴结活检。增强模式（I-V型）和充盈缺损与组织病理学相关。将诊断性能与传统超声参数和手术前哨淋巴结活检（n = 102）进行比较。
L-CEUS在98.4%（247/251）的病例中成功定位了前哨淋巴结。以III-V型增强作为转移标准，L-CEUS的敏感性为99.0%，特异性为88.1%（AUC 0.935）。纳入充盈缺损后，特异性提高到95.4%（AUC 0.967）。皮质厚度（>3.0 mm）在转移预测方面优于淋巴结短轴（AUC 0.874对0.702，p < 0.001）。与蓝色染料相比，L-CEUS识别出的每位患者前哨淋巴结数量更少（3.11±0.81对3.59±1.2，p = 0.001），操作时间更短（4.09±0.25对12.12±2.75分钟，p < 0.001）。8例假阴性涉及微转移（n = 3）和跳跃性病变（n = 5）。
L-CEUS在前哨淋巴结评估中具有较高的诊断准确性，同时消除了辐射暴露。其实时成像能力和快速的操作时间支持将其纳入标准腋窝分期方案，特别是在无法使用放射性同位素的情况下。有必要对长期结果进行前瞻性验证。
