摘要
目的评估淋巴超声造影定性诊断乳腺癌前哨淋巴结是否转移的诊断效率,分析乳腺癌前哨淋巴结转移的超声造影表现。方法选取2017年5月至2019年3月上海交通大学附属第一人民医院的61例怀疑乳腺癌的患者,经皮注射超声造影剂,超声造影模式显示腋窝前哨淋巴结,测量淋巴结的纵径(前后径)、横径、纵横比及距体表的距离。观察前哨淋巴结的显影特征,并进行分型:Ⅰ型,均匀高增强;Ⅱ型,周边高增强;Ⅲ型,弥漫性不均匀;Ⅳ型,局部灌注缺失;Ⅴ型,无造影剂灌注。金属导丝定位,手术后病理证实淋巴结是否转移。结果淋巴超声造影对乳腺癌前哨淋巴结的检出率为95.08%(58/61)。58例患者显示77枚腋窝淋巴结,转移21枚,未转移56枚。转移组淋巴结纵径和横径显著大于未转移组(P=0.001,0.003)。以Ⅳ型和Ⅴ型为转移征像,诊断敏感性为85.71%,特异性为96.43%,阳性预测值为90.00%,阴性预测值为94.70%,准确性为93.51%,ROC曲线下面积为0.911。结论淋巴超声造影分型定性分析乳腺癌前哨淋巴结有无转移诊断效率高,局部灌注缺失和无造影剂灌注是转移淋巴结的影像特征。
Objective To evaluate the diagnostic efficiency in differential diagnosis for breast sentinel lymph nodes,and to analyze the imaging characteristics of involved breast sentinel lymph node in lymphatic contrast enhanced ultrasound.Methods Sixty-one patients suspected with breast cancer from May 2017 to March 2019 in Shanghai General Hospital,Shanghai Jiao Tong University were included in the study.Ultrasound contrast agent was injected subcutaneously,and axillary lymph nodes were displayed under contrast enhanced ultrasound mode.The longitudinal diameter(anteroposterior diameter),transverse diameter,longitudinal/transverse ratio and the distance from skin surface were measured.Five types were concluded according to the imaging characteristics in lymphatic contrast enhanced ultrasound:typeⅠ,uniform enhancement;typeⅡ,ring-shape enhancement;typeⅢ,ununiform enhancement;typeⅣ,regional filling defect;typeⅤ,total filling defect.Sentinel lymph nodes were guided by wire guides and verified in pathology after excision in the operation.Results The detection rate of sentinel lymph nodes was 95.08%(58/61).Seventy-seven lymph nodes,including 21 involved nodes and 56 uninvolved nodes were detected by lymphatic contrast enhanced ultrasound in 58 patients.The longitudinal diameters and transverse diameters of involved lymph nodes were larger than those of uninvolved ones(P=0.001,0.003).When typeⅣ(regional filling defect)and typeⅤ(total filling defect)were classified as involved,the sensitivity,specificity,positive-predictive value,negative-predictive value,accuracy and the area under ROC curve of predicting sentinel lymph node metastases were 85.71%,96.43%,90.00%,94.70%,93.51%and 0.911,respectively.Conclusions Lymphatic contrast enhanced ultrasound reaches a high diagnostic efficiency in qualitative analysis of breast sentinel lymph nodes.Regional filling defect and total filling defect are the imaging characteristics of involved sentinel lymph nodes in lymphatic contrast enhanced ultrasound.
作者
金利芳
庄玲玲
夏祯
贾超
刘俊
金宇飚
史秋生
杜联芳
Jin Lifang;Zhuang Lingling;Xia Zhen;Jia Chao;Liu Jun;Jin Yubiao;Shi Qiusheng;Du Lianfang(Department of Ultrasound,Shanghai General Hospital,Shanghai Jiao Tong University,Shanghai 200080,China;Department of Breast-Thyroid-Vascular Surgery,Shanghai General Hospital,Shanghai Jiao Tong University,Shanghai 200080,China;Department of Pathology,Shanghai General Hospital,Shanghai Jiaotong University,Shanghai 200080)
出处
《中华超声影像学杂志》
CSCD
北大核心
2019年第11期986-989,共4页
Chinese Journal of Ultrasonography
基金
上海申康促进市级医院临床技能与临床创新能力三年行动计划项目(16CR3093B)。
关键词
超声造影
乳腺癌
前哨淋巴结
鉴别诊断
诊断效率
Contrast-enhanced ultrasound
Breast cancer
Sentinel lymph node
Differential diagnose
Diagnostic efficiency
