经皮超声造影引导下导丝定位在早期乳腺癌前哨淋巴结的临床应用  

Clinical application of lymphatic contrast-guided guidewire positioning for localization of sentinel lymph nodes in early-stage breast cancer

作　　者：杨艳 邢长洋 杨瑞静 苏小佩 周永刚 金京兰 Yang Yan;Xing Changyang;Yang Ruijing;Su Xiaopei;Zhou Yonggang;Jin jinglan(Department of Ultrasound Medicine,the Second Affiliated Hospital of Air Force Medical University,Xi’an 710038,China)

机构地区：[1]空军军医大学第二附属医院唐都医院超声诊断科,西安710038

出　　处：《中华临床医师杂志(电子版)》2024年第11期993-999,共7页Chinese Journal of Clinicians(Electronic Edition)

基　　金：空军军医大学第二附属医院唐都医院社会人才基金项目(2021SHRC035);空军军医大学第二附属医院唐都医院新技术新业务资助项目(XJSXYW202129)

摘　　要：目的探讨应用经皮超声造影(LCEUS)引导下导丝定位对早期乳腺癌前哨淋巴结(SLN)的定位价值。方法纳入2023年3月~2024年5月于空军军医大学第二附属医院唐都医院行LCEUS引导下导丝定位及纳米碳染色法标记SLN的59例早期乳腺癌患者,以术后病理为金标准,统计两种方法识别SLN的数量,判断两种方法标记SLN的一致性;计算两种方法定位SLN的敏感度、特异性、阳性预测值、阴性预测值。结果59例早期乳腺癌患者两种检测方法SLN均显影。LCEUS法共检出68个SLN,纳米碳法共检测到356个SLN。LCEUS导丝标记法检测总SLN数及非转移SLN数均显著少于纳米碳法,[1(1,1)vs 6(5,7);1(1,1)vs 6(5,7),均P<0.001]。10例患者共计12个SLN发生转移,两种方法标记SLN术后病理结果具有较高的一致性(Kappa=0.865,P<0.001)。LCEUS导丝标记SLN的阳性率显著高于纳米碳染色法[14.7%(10/68)vs 3.0%(11/356),P<0.001]。同时,LCEUS导丝定位法定位前哨淋巴结的特异度及阳性预测值均高于纳米碳染色法,差异均有统计学意义[(84.6%vs 8.7%);(14.7%vs 3.0%)均P<0.001]。但两种方法定位SLN的敏感度无统计学差异(83.3%vs 91.6%,P>0.05)。结论LCEUS引导下导丝定位SLN操作简单,定位准确,可以减少非SLN被手术切除,减少术后并发症,提高了SLN的定位效能,值得临床推广应用。Objective To evaluate the effectiveness of lymphatic contrast-enhanced ultrasound(LCEUS)-guided guidewire positioning for the localization of sentinel lymph nodes in patients with earlystage breast cancer.Methods A total of 59 patients with early breast cancer who underwent sentinel lymph node identification using LCEUS-guided guidewire positioning and nano-carbon staining techniques in Tangdu Hospital,the Second Affiliated Hospital of Air Force Medical University were enrolled from March 2023 to May 2024.The definitive assessment was conducted through postoperative pathological analysis,which served as the gold standard for evaluation.The study quantified the number of sentinel lymph nodes(SLNs)identified by two different methods and evaluated the concordance of SLN labeling between these techniques.Furthermore,the sensitivity,specificity,positive predictive value,and negative predictive value of the two methods for SLN localization were calculated and compared.Results SLNs were identified using both methods in 59 breast cancer patients.A total of 68 SLNs were detected by the LCEUS method,whereas the nano-carbon staining method identified 356 SLNs.The total number of SLNs and the number of nonmetastatic SLNs identified using LCEUS was significantly less compared to those detected by the nanocarbon method[1(1,1)vs 6(5,7)and 1(1,1)vs 6(5,7);P<0.001 for both].In total,12 SLN metastases were identified in 10 patients.The postoperative pathological results of SLN labeling using both methods exhibited high concordance(Kappa=0.865,P<0.001).Nonetheless,the positive rate of SLN labeling via the LCEUS-guided guidewire technique was significantly higher than that achieved through nano-carbon staining[14.7%(10/68)vs 3.0%(11/356),P<0.001].At the same time,the specificity and positive predictive value of SLN labeling via the LCEUS-guided guidewire technique were significantly higher than those of nanocarbon staining(84.6%vs 8.7%and 14.7%vs 3.0%,P<0.001 for both).However,there was no significant difference in the sensitivity f

关 键 词：乳腺癌 淋巴结 超声造影 纳米碳 

分 类 号：R737.9[医药卫生—肿瘤]