超声造影引导下前哨淋巴结穿刺活检对乳腺癌早期患者的诊断效能  

The Diagnostic Performance of Contrast-Enhanced Ultrasound-Guided Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer Patients

作　　者：刘紫洁 曾子珊 刘婷[1] 聂小艳 张丽丽[1] LIU Zi-jie;ZENG Zi-shan;LIU Ting;NIE Xiao-yan;ZHANG Li-li(Department of Ultrasonic Medicine,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院超声医学科,南昌330006

出　　处：《实用临床医学(江西)》2025年第1期72-75,99,共5页Practical Clinical Medicine

基　　金：江西省卫健委科技计划项目(202310299)。

摘　　要：目的 研究经皮超声造影(CEUS)联合细针抽吸细胞学检查(FNAC)评估腋窝淋巴结状态的诊断效能,并探讨常规超声(US)联合CEUS-FNAC筛查SLN高负荷状态的效能。方法 回顾性收集121例单侧可行手术的乳腺癌患者,所有患者均行临床触诊及US检查,其中70例行CEUS,67例显影SLN并在其引导下行FNAC,另51例患者未行经皮CEUS检查,以术中病理为金标准,计算临床触诊、US-FNAC、CEUS-FNAC诊断效能,并探讨筛查高负荷淋巴结状态的效果。结果 CEUS-FNAC检出SLN的灵敏度、特异度、阳性预测值、阴性预测值、准确性分别为88.9%、97.5%、96.0%、92.9%、94.0%,与术后病理结果一致性较好(Kappa值=0.87)。与临床检查相比,US检出SLN的灵敏度及特异性均有所提高,但与术后病理结果一致性一般。US联合CEUS-FNAC诊断腋窝转移淋巴结高负荷状态(3枚以上的淋巴结转移)灵敏度、特异度、阳性预测值、阴性预测值、准确性分别83.3%、92.6%、71.4%、96.1%、90.1%。结论 CEUS-FNAC检查是术前评估腋窝淋巴结状态的高效、可靠方法,联合US可有效筛选出腋窝淋巴结高负荷状态患者,辅助临床决策。Objective To evaluate the diagnostic performance of percutaneous contrast-enhanced ultrasound(CEUS)combined with fine-needle aspiration cytology(FNAC)in assessing axillary lymph node status,and to explore the efficacy of conventional ultrasound combined with CEUS-FNAC for screening high-burden sentinel lymph node(SLN)metastasis.Methods A retrospective cohort of 121 patients with unilateral operable breast cancer was analyzed.All patients underwent clinical palpation and conventional ultrasound.Among these,70 received CEUS,with 67 demonstrating visualized SLNs that subsequently underwent CEUS-guided FNAC;51 patients did not undergo percutaneous CEUS.Using intraoperative pathology as the gold standard,diagnostic performance metrics were calculated for clinical palpation,US-FNAC,and CEUS-FNAC.The screening efficacy for high-burden nodal status was explored.Results CEUS-FNAC demonstrated superior diagnostic parameters:sensitivity 88.9%,specificity 97.5%,positive predictive value 96.0%,negative predictive value 92.9%,accuracy 94.0%,with substantial agreement with postoperative histopathology(κ=0.87).Conventional ultrasound improved SLN detection sensitivity/specificity versus clinical palpation but showed moderate histopathologic concordance.The combined conventional ultrasound and CEUS-FNAC approach achieved 83.3%sensitivity,92.6%specificity,71.4%positive predictive value,96.1%negative predictive value,and 90.1%accuracy in identifying high-burden axillary metastasis(≥3 metastatic nodes).Conclusion The CEUS-FNAC examination may serve as an efficient and feasible modality for preoperative assessment of axillary lymph node status.When combined with conventional ultrasonography,this integrated approach demonstrates considerable efficacy in identifying patients with potentially high metastatic burden,which could inform clinical decision-making processes.

关 键 词：乳腺癌 腋窝淋巴结 经皮超声造影 细针抽吸细胞学检查 

分 类 号：R737.9[医药卫生—肿瘤]