超声造影在乳腺癌原发灶切除后前哨淋巴结的价值  

Value of Contrast-enhanced Ultrasound in Sentinel Lymph Node after Primary Breast Cancer Resection

作　　者：马清梅 罗佳[1] 李家平[1] 黄彩欣 韦来娜 林颖[2] 邵楠[2] 郑艳玲[1] MA Qing-mei;LUO Jia;LI Jia-ping;HUANG Cai-xin;WEI Lai-na;LIN Ying;SHAO Nan;ZHENG Yan-ling(Department of Ultrasound,The First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510000,China;Department of Thyroid and Breast Surgery,The First Affiliated Hospital of Sun Yat-sen University,Guangzhou510000,China)

机构地区：[1]中山大学附属第一医院超声科,广东广州510000 [2]中山大学附属第一医院甲乳外科,广东广州510000

出　　处：《中山大学学报（医学科学版）》2023年第4期663-667,共5页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：国家自然科学基金(92059201)。

摘　　要：【目的】探讨早期乳腺癌原发灶切除术后经皮与经静脉超声造影(P-Ⅳ-CEUS)的联合使用在前哨淋巴结中的应用价值。【方法】回顾性分析42例外院早期乳腺癌原发灶切除术后患者的临床-影像资料,所有患者均在我院进行再次手术。术前行前哨淋巴结P-Ⅳ-CEUS检查,术中采用亚甲蓝示踪剂进行前哨淋巴结切除活检,分析超声造影和前哨淋巴结活检的检出率和假阴性率,以手术病理结果为金标准,探讨超声造影对前哨淋巴结的诊断效能。【结果】前哨淋巴结经皮超声造影(P-CEUS)的检出率和假阴性率分别为92.9%(39/42)和7.1%(3/42),亚甲蓝染色的检出率为100%(41/41),1例因穿刺证实为转移性进行新辅助治疗;P-Ⅳ-CEUS的敏感性、特异性、阳性预测值、阴性预测值、准确率分别为66.7%(2/3)、100%(37/37)、100%(2/2)、97.3%(36/37)、97.4%(38/39)。【结论】早期乳腺癌原发灶切除术后P-Ⅳ-CEUS的联合使用可精准检出前哨淋巴结并准确判断其性质,为术前减少有创前哨淋巴结活检提供可靠依据。【Objective】To investigate the value of percutaneous and intravenous contrast-enhanced ultrasound(P-Ⅳ-CEUS)in sentinel lymph nodes(SLNs)after resection of early-stage primary breast cancer.【Methods】A retrospective analysis was done on the clinical and imaging data of 42 early breast cancer patients.Following primary tumor resection,all these patients underwent reoperation in our hospital.SLNs were examined by preoperative P-Ⅳ-CEUS and intraopera⁃tive sentinel lymph node biopsy(SLNB)was performed by using Methylene blue as a tracer.Then we analyzed the detec⁃tion and false-negative rate in CEUS and SLNB respectively.By using the surgical pathological results as the gold stan⁃dard,the diagnostic efficacy of CEUS for SLNs was explored.【Results】The detection rate and false negative rate of SLNs in percutaneous contrast-enhanced ultrasound(P-CEUS)were 92.9%(39/42)and 7.1%(3/42),respectively.The detec⁃tion rate in methylene blue staining was 100%(41/41)and one patient underwent neoadjuvant therapy due to biopsy-con⁃firmed metastasis.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of P-Ⅳ-CEUS were 66.7%(2/3),100%(37/37),100%(2/2),97.3%(36/37)and 97.4%(38/39),respectively.【Conclu⁃sions】P-Ⅳ-CEUS after resection of early-stage primary breast cancer can accurately detect SLNs and characterize their status,which is a reliable clinical basis for reducing invasive SLNB.

关 键 词：前哨淋巴结 乳腺癌 超声造影 

分 类 号：R445.1[医药卫生—影像医学与核医学]