目的

探讨超声造影对诊断乳腺癌腋窝淋巴结转移的应用价值。

方法

对141例浸润型乳腺癌患者行乳腺病灶及腋窝淋巴结常规超声检查后,再对腋窝淋巴结进行超声造影,先用目测法观察淋巴结超声造影增强模式,再用QontraXt软件分析超声造影时间-强度曲线参数。根据超声造影灌注特点,将腋窝淋巴结分为淋巴结转移组(有转移组)和无淋巴结转移组(无转移组),并与病理检查结果相比较。增强模式之间的对比采用χ² 检验,造影参数用单因素方差分析。

结果

淋巴结有转移组灌注模式表现为不均匀增强型或无增强,淋巴结无转移组表现为均匀型增强,两组灌注模式之间的差异有统计学意义(P=0.000)。两组造影剂到达时间、达峰时间、峰值强度之间的差异无统计学意义(P 值分别为0.129、0.094、0.140)。淋巴结实质内高灌注区与低灌注区的差值(SI_max-SI_min)有转移组大于无转移组(P=0.000)。以SI_max- SI_min 值大于28 为最佳临界点,鉴别的灵敏度为93.3%,特异度为80.8%。

结论

超声造影对鉴别乳腺癌腋窝淋巴结转移有一定的临床价值。

Objective

To investigate the value of contrast-enhanced ultrasonography(CEUS)in detection of metastatic axillary lymph nodes in patients with breast carcinoma.

Methods

The breasts and axillae of 141 patients with breast carcinoma were examined with Ultrasound scans,followed by ultrasonography and CEUS of axillary lymph nodes.The perfusion patterns were assessed by direct visualization method.QontraXt software was subsequently used to determine the wash-in and wash-out parameters of each node.The axillary lymph nodes were divided into metastatic and nonmetastatic groups according to the perfusion features and were compared with the histopathologic diagnosis.The correlation of CEUS patterns with histopathology was analyzed by chi-square test.One-way analysis of variance was used to assess differences in perfusion parameters among the nodes.

Results

Homogeneous enhancement patterns were more frequently associated with non-metastasis of nodes,while heterogeneous enhancement patterns or avascular patterns were mostly suggestive of metastasis of nodes,with statistical difference between the two groups.No statistically significant difference was found in the arrival time,time to peak intensity,and peak signal intensity between the two groups(P=0.129,0.094,and 0.140,respectively).The difference between the maximum signal intensity and minimum signal intensity(SI_max- SI_min)were more obvious in metastatic nodes than in nonmetastatic ones(P=0.000).And histopathologic diagnosis could be predicted with a sensitivity of 93.3%and a specificity of 80.8%by the standardized value of SI_max-SI_min above 28.

Conclusion

Contrast-enhanced ultrasonography play a role in clinically discriminating metastatic from nonmetastatic lymph nodes in patients with invasive breast cancer.