摘要
目的探讨经淋巴管及经静脉超声造影联合应用诊断乳腺癌腋窝前哨淋巴结转移的临床价值。方法选取我院行手术治疗的乳腺癌患者108例,根据术后病理提示有无腋窝前哨淋巴结转移分为未转移组74例和转移组34例,比较术前经淋巴管及经静脉超声造影检查对两组前哨淋巴结增强模式(均匀、不均匀增强或无增强)、边界(清晰、模糊)、形态(规则、不规则)、范围是否较二维图像显示增大、较周围组织消退情况(早消退、晚消退)的检出率;比较经淋巴管及经静脉超声造影单独及联合应用对乳腺癌腋窝前哨淋巴结转移的诊断效能。结果未转移组中,经淋巴管超声造影对均匀增强、范围较二维图像显示未增大的检出率(81.08%、97.30%)均高于经静脉超声造影(64.86%、89.19%),对边界清晰的检出率(86.49%)低于经静脉超声造影(98.65%),差异均有统计学意义(均P<0.05)。转移组中,经淋巴管超声造影对不均匀增强或无增强的检出率(91.18%)高于经静脉超声造影(70.59%),对范围较二维图像显示增大的检出率(55.88%)低于经静脉超声造影(79.47%),差异均有统计学意义(均P<0.05)。经静脉超声造影对未转移组中较周围组织晚消退的检出率为95.95%,对转移组中较周围组织早消退的检出率为52.94%。经淋巴管及经静脉超声造影联合应用诊断乳腺癌腋窝前哨淋巴结转移的灵敏度、准确率(97.06%、99.07%)均高于二者单独应用(82.35%、91.67%和58.82%、83.33%),差异均有统计学意义(均P<0.05)。结论经淋巴管超声造影可清晰显示区域淋巴管及淋巴结增强情况,经静脉超声造影可显示较周围组织消退情况,二者联合应用在诊断乳腺癌腋窝前哨淋巴结转移中可获得更佳的诊断效能。
Objective To explore the clinical value of combined lymphatic and intravenous contrast-enhanced ultrasound(CEUS)in the diagnosis of sentinel lymph node(SLN)metastasis in breast cancer.Methods A total of 108 breast cancer patients who underwent surgical treatment in our hospital were enrolled and divided into two groups based on postoperative pathological results:74 cases without metastatic SLNs(non-metastasis group)and 34 cases with metastatic SLNs(metastasis group).Preoperative lymphatic and intravenous CEUS were performed to compare the following features of SLN between the two groups:enhancement patterns(homogeneous,heterogeneous,or no enhancement),boundaries(clear or blurred),shape(regular or irregular),whether the size was larger than that shown on two-dimensional imaging,and regression relative to surrounding tissues(early or late regression).The diagnostic performance of lymphatic and intravenous CEUS,both alone and in combination for SLN metastasis in breast cancer was analyzed.Results In the non-metastasis group,the detection rates of homogeneous enhancement and no size increase on two-dimensional imaging by lymphatic CEUS(81.08%and 97.30%,respectively)were significantly higher than those by intravenous CEUS(64.86%and 89.19%,respectively),while the detection rate of clear boundaries by lymphatic CEUS(86.49%)was significantly lower than that by intravenous CEUS(98.65%),with statistically significant differences(all P<0.05).In the metastasis group,the detection rates of heterogeneous or no enhancement by lymphatic CEUS(91.18%)were significantly higher than that by intravenous CEUS(70.59%),while the detection rate of size increase on two-dimensional imaging by intravenous CEUS(79.47%)was significantly higher than that by lymphatic CEUS(55.88%),with statistically significant differences(all P<0.05).Intravenous CEUS detected late regression in the nonmetastasis group at a rate of 95.95%and early regression in the metastasis group at a rate of 52.94%.The sensitivity and accuracy of combined lymphatic and intravenous CEUS in diagnosing SLN metastasis in breast cancer(97.06%and 99.07%,respectively)were significantly higher than those of either method alone(82.35%and 91.67%for percutaneous CEUS,58.82%and 83.33%for intravenous CEUS),with statistically significant differences(all P<0.05).Conclusion Lymphatic CEUS clearly demonstrates the enhancement of regional lymphatic vessels and lymph nodes,while intravenous CEUS effectively reveals regression relative to surrounding tissues.The combination of these two methods provides superior diagnostic performance in diagnosing SLN metastasis in breast cancer.
作者
李程
曾福强
邹斌
林勇平
陈华彬
陈文娟
张路生
韩小华
LI Cheng;ZENG Fuqiang;ZOU Bin;LIN Yongping;CHEN Huabin;CHEN Wenjuan;ZHANG Lusheng;HAN Xiaohua(Department of Ultrasound,Zhongshan Hospital of Traditional Chinese Medicine,Zhongshan 528400,China)
出处
《临床超声医学杂志》
2025年第10期827-832,共6页
Journal of Clinical Ultrasound in Medicine
基金
2022年度中山市第三批社会公益与基础研究项目(医疗卫生)(2022B3011)。
关键词
超声造影
经淋巴管
经静脉
乳腺癌
前哨淋巴结转移
Contrast-enhanced ultrasound,lymphatic,intravenous
Breast cancer
Sentinel lymph node metastasis
