切换至 "中华医学电子期刊资源库"
高级检索
中华乳腺病杂志(电子版)

中华乳腺病杂志(电子版) ›› 2020, Vol. 14 ›› Issue (06) : 331 -336. doi: 10.3877/cma.j.issn.1674-0807.2020.06.002

所属专题： 文献；

论著

经皮对比增强超声在乳腺癌前哨淋巴结术前定位及转移风险评估中的临床应用价值
尹亮1, 张晴2, 肖秀娣1, 钱晓芹2,†()   
  1. 1. 212000　江苏　镇江，江苏大学附属人民医院乳腺外科
    2. 212000　江苏　镇江，江苏大学附属人民医院超声科
  • 收稿日期:2020-05-22 出版日期:2020-12-01
  • 通信作者: 钱晓芹
  • 基金资助:
    基金资助：国家自然科学基金面上项目(81971629); 江苏省妇幼保健协会科研课题(FYX202004)

Percutaneous contrast enhanced ultrasound for preoperative sentinel lymph node localization and metastasis risk evaluation in breast cancer

Liang Yin1, Qing Zhang2, Xiudi Xiao1, Xiaoqin Qian2,†()   

  1. 1. Department of Breast Surgery, People’s Hospital of Jiangsu University, Zhenjiang 212000, China
    2. Department of Ultrasound, People’s Hospital of Jiangsu University, Zhenjiang 212000, China
  • Received:2020-05-22 Published:2020-12-01
  • Corresponding author: Xiaoqin Qian
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

尹亮, 张晴, 肖秀娣, 钱晓芹. 经皮对比增强超声在乳腺癌前哨淋巴结术前定位及转移风险评估中的临床应用价值[J]. 中华乳腺病杂志(电子版), 2020, 14(06): 331-336.

Liang Yin, Qing Zhang, Xiudi Xiao, Xiaoqin Qian. Percutaneous contrast enhanced ultrasound for preoperative sentinel lymph node localization and metastasis risk evaluation in breast cancer[J]. Chinese Journal of Breast Disease(Electronic Edition), 2020, 14(06): 331-336.

目的

探讨经皮注射对比增强超声(CEUS)在乳腺癌前哨淋巴结(SLN)术前定位及转移风险评估中的临床应用价值。

方法

根据纳入及排除标准，选择2019年5～9月在江苏大学附属人民医院乳腺外科行手术治疗的21例女性乳腺癌患者进行前瞻性研究。术前根据经皮CEUS示踪结果，在皮肤表面标记SLN位置及数目，根据其增强模式评估SLN转移风险，并在术中联合亚甲蓝共同确认SLN的位置及数目。以亚甲蓝染色的病理检查结果为金标准，计算经皮CEUS预测SLN状态的敏感度、特异度、阳性预测值、阴性预测值及准确率。用Kappa一致性检验分析CEUS与SLN常规病理检查结果的一致性及2名超声科医师对SLN增强模式判读的一致性。用Fisher精确概率法分析不同临床病理特征患者CEUS评估SLN结果的差异。

结果

21例患者中，经皮CEUS共检出32枚SLN，亚甲蓝染色共检出71枚。经皮CEUS体表定位的SLN均为术中亚甲蓝染色的SLN,患者经皮CEUS检出(1.6±0.9)枚SLN,低于亚甲蓝染色检出的(3.4±1.4)枚(t＝5.017, P<0.001)。CEUS预测SLN转移风险：判定有SLN转移患者9例(病理证实SLN有转移7例，无转移2例)，判定无转移患者12例(病理证实SLN无转移11例，有转移1例)。CEUS评估SLN状态的敏感度7/8，特异度11/13，阳性预测值7/9，阴性预测值11/12，准确率85.7%(18/21)。CEUS与病理诊断结果具有较高一致性(Kappa ＝0.704，P＝0.001)。2名超声科医师对CEUS中32枚SLN增强模式的判读结果一致性较好(Kappa＝0.829，P<0.001)。不同组织学分级的患者，其CEUS预测结果比较，差异有统计学意义(P＝0.046)。

结论

经皮CEUS是乳腺癌患者SLN术前定位及转移风险评估的一种有效方法。

关键词: 乳腺肿瘤, 前哨淋巴结活组织检查, 超声检查, 亚甲蓝
Objective

To explore clinic value of contrast enhanced ultrasound (CEUS) for preoperative sentinel lymph node (SLN) localization and metastasis risk evaluation in patients with breast cancer.

Method

According to the inclusion and exclusion criteria, 21 female breast cancer patients who underwent surgical treatment in the Department of Breast Surgery, People’s Hospital of Jiangsu University from May to September 2019 were enrolled for a prospective study. Before surgery, the position and number of SLN were marked on the skin surface according to the results of percutaneous CEUS and the risk of SLN metastasis was evaluated based on the enhancement mode. The location and number of SLNs was confirmed by intraoperative methylene blue staining. The pathological results after methylene blue staining were used as the gold standard, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of percutaneous CEUS in predicting SLN status were calculated. The Kappa consistency test was used to analyze the consistency between CEUS and pathological examination and the consistency of the interpretation of SLN enhancement mode on CEUS by two sonographers. Fisher’s exact test was used to analyze the differences in CEUS assessment of SLN in patients with different clinicopathological characteristics.

Results

Among the 21 patients, 32 SLNs were detected by percutaneous CEUS and 71 SLNs were detected by methylene blue staining. All SLNs detected by percutaneous CEUS were confirmed by methylene blue staining during the operation. The number of detected SLNs was 1.6±0.9 by CEUS, significantly lower than 3.4±1.4 by methylene blue staining (t=5.017, P<0.001). Nine patients were diagnosed with SLN metastasis by CEUS (7 with SLN metastasis confirmed by pathology and 2 without). CEUS demonstrated 12 patients with no metastasis, in which 11 cases confirmed by pathology, but one had metastasis. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of percutaneous CEUS in the diagnosis of SLN were 7/8, 11/13, 7/9, 11/12 and 85.7 % (18/21), respectively. The results of CEUS and pathology showed a high consistency (Kappa=0.704, P=0.001). The interpretation of 32 SLNs on CEUS showed a high consistency between two sonographers (Kappa=0.829, P<0.001). There was a significant difference in the results of CEUS among patients with different histological grades (P=0.046).

Conclusion

Percutaneous CEUS is feasible for preoperative SLN localization and metastasis risk evaluation in patients with breast cancer.

Key words: Breast neoplasms, Sentinel lymph node biopsy, Ultrasonograph, Methylene blue
图1 乳腺癌患者前哨淋巴结均匀增强型(Ⅰ型)超声造影
图2 乳腺癌患者前哨淋巴结不均匀增强型(Ⅱ型)超声造影
图3 乳腺癌患者前哨淋巴结完整环状增强型(Ⅲ型)超声造影
图4 乳腺癌患者前哨淋巴结微弱增强或无增强型( Ⅳ型)超声造影
表1 经皮CEUS的4种增强模式与SLN病理检查结果的相关性(枚)
CEUS SLN病理检查结果 总计
阳性 阴性
Ⅰ型 1 17 18
Ⅱ型 8 2 10
Ⅲ型 1 0 1
Ⅳ型 3 0 3
总计 13 19 32
表2 2名超声医师通过CEUS判读SLN增强模式的一致性比较(枚)
医师1 医师2 总计
Ⅰ型 Ⅱ型 Ⅲ型 Ⅳ型
Ⅰ型 18 1 0 0 19
Ⅱ型 2 7 0 0 9
Ⅲ型 0 0 1 0 1
Ⅳ型 0 0 0 3 3
总计 20 8 1 3 32
表3 21例乳腺癌患者经皮CEUS与SLN病理检查结果的一致性比较(例)
CEUS SLN病理检查结果 总计
阳性 阴性
阳性 7 2 9
阴性 1 11 12
总计 8 13 21
表4 不同临床病理的患者经皮CEUS评估SLN结果比较(例)
临床病理特征 例数 CEUS P值
阳性 阴性
年龄        
  ≤50岁 15 9 6 1.000
  >50岁 6 3 3
体质量指数        
  <25 14 5 9 0.390
  ≥25 7 4 3
肿瘤大小        
  T1 7 2 5 0.640
  T2 14 7 7
月经状态        
  正常 6 3 3  
  绝经 15 6 9  
组织学分级        
  2级 15 4 11 0.046
  3级 6 5 1
ER        
  阳性 14 6 8 1.000
  阴性 7 3 4
HER-2        
  阳性 8 5 3 0.200
  阴性 13 4 9
[1]
Krag DN, Anderson SJ, Julian TB, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial[J]. Lancet Oncol，2010, 11(10): 927-933.
[2]
Kim T, Giuliano AE, Lyman GH. Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma[J]. Cancer，2006, 106(1): 4-16.
[3]
Bezu C, Coutant C, Salengro A, et al. Anaphylactic response to blue dye during sentinel lymph node biopsy[J]. Surg Oncol, 2011, 20(1): e55-59.
[4]
Gumus M, Gumus H, Jones SE, et al. How long will I be blue? Prolonged skin staining following sentinel lymph node biopsy using intradermal patent blue dye[J]. Breast Care (Basel), 2013, 8(3): 199-202.
[5]
Liu J, Liu X, He J, et al. Percutaneous contrast-enhanced ultrasound for localization and diagnosis of sentinel lymph node in early breast cancer[J]. Sci Rep，2019，9(1): 13545.
[6]
Bedi DG, Krishnamurthy R, Krishnamurthy S, et al. Cortical morphologic features of axillary lymph nodes as a predictor of metastasis in breast cancer: in vitro sonographic study[J]. AJR Am J Roentgenol，2008, 191(3): 646-652.
[7]
Donker M, van Tienhoven G, Straver ME, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial[J]. Lancet Oncol, 2014, 15(12): 1303-1310.
[8]
Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial[J]. JAMA, 2011, 305(6): 569-575.
[9]
Wang Y, Zhou W, Li C, et al. Variation of sentinel lymphatic channels (SLCs) and sentinel lymph nodes (SLNs) assessed by contrast-enhanced ultrasound (CEUS) in breast cancer patients [J]. World J Surg Oncol, 2017, 15(1): 127.
[10]
Liu J, Liu X, He J, et al. Percutaneous contrast-enhanced ultrasound for localization and diagnosis of sentinel lymph node in early breast cancer[J]. Sci Rep, 2019, 9(1): 13545.
[11]
Xie F, Zhang D, Cheng L, et al. Intradermal microbubbles and contrast-enhanced ultrasound (CEUS) is a feasible approach for sentinel lymph node identification in early-stage breast cancer [J]. World J Surg Oncol, 2015, 13: 319.
[12]
Cox K, Taylor-Phillips S, Sharma N, et al. Enhanced pre-operative axillary staging using intradermal microbubbles and contrast-enhanced ultrasound to detect and biopsy sentinel lymph nodes in breast cancer: a potential replacement for axillary surgery [J]. Br J Radiol, 2018, 91(1082): 20170626.
[13]
Qiao E, Yu X, Zhou L, et al. A prospective validation cohort study of a prediction model on non-sentinel lymph node involvement in early breast cancer [J]. Ann Surg Oncol, 2020, 27(5): 1653-1658.
[1] 魏淑婕, 惠品晶, 丁亚芳, 张白, 颜燕红, 周鹏, 黄亚波. 单侧颈内动脉闭塞患者行颞浅动脉-大脑中动脉搭桥术的脑血流动力学评估[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1046-1055.
[2] 张璇, 马宇童, 苗玉倩, 张云, 吴士文, 党晓楚, 陈颖颖, 钟兆明, 王雪娟, 胡淼, 孙岩峰, 马秀珠, 吕发勤, 寇海燕. 超声对Duchenne肌营养不良儿童膈肌功能的评价[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1068-1073.
[3] 朱连华, 费翔, 韩鹏, 姜波, 李楠, 罗渝昆. 高帧频超声造影在胆囊息肉样病变中的鉴别诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 904-910.
[4] 张梅芳, 谭莹, 朱巧珍, 温昕, 袁鹰, 秦越, 郭洪波, 侯伶秀, 黄文兰, 彭桂艳, 李胜利. 早孕期胎儿头臀长正中矢状切面超声图像的人工智能质控研究[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 945-950.
[5] 陈舜, 薛恩生, 叶琴. PDCA在持续改进超声危急值管理制度中的价值[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 974-978.
[6] 周钰菡, 肖欢, 唐毅, 杨春江, 周娟, 朱丽容, 徐娟, 牟芳婷. 超声对儿童髋关节暂时性滑膜炎的诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 795-800.
[7] 刘欢颜, 华扬, 贾凌云, 赵新宇, 刘蓓蓓. 颈内动脉闭塞病变管腔结构和血流动力学特征分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 809-815.
[8] 郏亚平, 曾书娥. 含鳞状细胞癌成分的乳腺化生性癌的超声与病理特征分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 844-848.
[9] 张丽丽, 陈莉, 余美琴, 聂小艳, 王婧玲, 刘婷. PDCA循环法在超声浅表器官亚专科建设中的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(07): 717-721.
[10] 罗刚, 泮思林, 陈涛涛, 许茜, 纪志娴, 王思宝, 孙玲玉. 超声心动图在胎儿心脏介入治疗室间隔完整的肺动脉闭锁中的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 605-609.
[11] 晏晴艳, 雍晓梅, 罗洪, 杜敏. 成都地区老年转移性乳腺癌的预后及生存因素研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 636-638.
[12] 李智铭, 郭晨明, 庄晓晨, 候雪琴, 高军喜. 早期乳腺癌超声造影定性及定量指标的对比研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 639-643.
[13] 孔博, 张璟, 吕珂. 超声技术在复杂腹壁疝诊治中的作用[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 670-673.
[14] 廖梅, 张红君, 金洁玚, 吕艳, 任杰. 床旁超声造影对肝移植术后早期肝动脉血栓的诊断价值[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 630-634.
[15] 杨天池, 韩威, 邱枫, 祁佳慧. 术中胰腺超声弹性成像在胰腺质地评估中的应用[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 646-650.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号