Huang Caixin, Luo Jia, Li Manying, Shan Zhen, Zhen Tiantian, Li Jiaping, Liang Jinyu, Xie Xiaoyan, Zheng Yanling
Department of Ultrasonic Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Quant Imaging Med Surg. 2025 Sep 1;15(9):8309-8319. doi: 10.21037/qims-2024-2631. Epub 2025 Aug 14.
The diagnostic performance of percutaneous contrast-enhanced ultrasound (P-CEUS) in classifying sentinel lymph nodes (SLNs) in breast cancer varies. This study aimed to evaluate the diagnostic value of P-CEUS in identifying SLNs and to explore the correlation between P-CEUS patterns and pathological characteristics of SLNs.
This retrospective study included consecutive breast cancer patients who underwent preoperative or axillary surgery between June 2019 and March 2021. Each patient underwent conventional ultrasound of the ipsilateral breast and axilla, and SLNs were localized and diagnosed via P-CEUS. Histopathological examination served as the gold standard to assess the diagnostic accuracy of P-CEUS classification based on lymph node structure. The relationship between P-CEUS patterns and pathological characteristics of SLNs was also examined.
A total of 238 breast cancer patients (including 1 male) with a mean age of 51.0±11.3 years were included. Five patients with bilateral breast cancer underwent P-CEUS on both sides. The SLN detection rate by P-CEUS was 96.29% (234/243). Pathology results indicated that 64 SLNs (21.8%) were metastatic and 229 SLNs (78.2%) were non-metastatic. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of P-CEUS in detecting SLNs were 76.56% (49/64), 97.38% (223/229), 89.09% (49/55), 93.70% (223/238), and 92.83% (272/293), respectively. SLNs with different P-CEUS patterns exhibited varying pathological characteristics. Pathology sections of non-metastatic lymph nodes revealed varying degrees of adipose tissue and fibrous tissue hyperplasia. The different enhancement patterns of metastatic lymph nodes were closely associated with the distribution of metastatic lesions within the lymph nodes.
The P-CEUS pattern of SLNs was closely correlated with their pathological characteristics. The P-CEUS classification of SLNs based on lymph node structure could aid in the diagnosis of SLNs in breast cancer.
经皮对比增强超声（P-CEUS）对乳腺癌前哨淋巴结（SLN）的分类诊断效能存在差异。本研究旨在评估P-CEUS对识别SLN的诊断价值，并探讨P-CEUS表现与SLN病理特征之间的相关性。
本回顾性研究纳入了2019年6月至2021年3月期间连续接受术前或腋窝手术的乳腺癌患者。每位患者均接受了同侧乳腺和腋窝的常规超声检查，并通过P-CEUS对SLN进行定位和诊断。组织病理学检查作为评估基于淋巴结结构的P-CEUS分类诊断准确性的金标准。同时还研究了P-CEUS表现与SLN病理特征之间的关系。
共纳入238例乳腺癌患者（包括1例男性），平均年龄51.0±11.3岁。5例双侧乳腺癌患者双侧均接受了P-CEUS检查。P-CEUS对SLN的检出率为96.29%（234/243）。病理结果显示，64枚SLN（21.8%）为转移灶，229枚SLN（78.2%）为非转移灶。P-CEUS检测SLN的灵敏度、特异度、阳性预测值、阴性预测值及准确性分别为76.56%（49/64）、97.38%（223/229）、89.09%（49/55）、93.70%（223/238）和92.83%（272/293）。具有不同P-CEUS表现的SLN呈现出不同的病理特征。非转移淋巴结的病理切片显示出不同程度的脂肪组织和纤维组织增生。转移淋巴结的不同增强模式与淋巴结内转移灶的分布密切相关。
SLN的P-CEUS表现与其病理特征密切相关。基于淋巴结结构对SLN进行P-CEUS分类有助于乳腺癌SLN的诊断。
