Dual-modal Ultrasonic Diagnostic Value And Relevant Factors Analysis Of Axillary Lymph Node Metastasis In Breast Cancer

Objective:To compare the benign and malignant breast cancer patients with axillary lymph nodes of conventional ultrasound and contrast-enhanced ultrasound(CEUS)characteristics,and establish the Logistic regression model,the analysis of single ultrasound and dual-model ultrasound predicting axillary lymph nodes of breast cancer and diagnosis efficiency,at the same time probing into the conventional ultrasonic features of breast cancer primary tumors and the relationship between the axillary lymph node metastasis.Methods:Selected from January 2019 to August 2020 in our hospital treated 72 breast cancer with 76 ipsilateral axillary lymph nodes,all axillary lymph nodes were examined by conventional ultrasound and CEUS before operation,and compared with the pathological results of surgery or biopsy.The differences of conventional ultrasound and CEUS characteristics between benign and malignant axillary lymph nodes in breast cancer patients were screened.The model of conventional ultrasound,CEUS and their combination to predict the nature of axillary lymph nodes was established,and the receiver operating characteristic curve(ROC)was drawn to analyze the diagnostic efficiency of different examination methods.At the same time,the selection from January 2020 to December 2020,our hospital mammary gland surgical treated 128 cases of patients with breast cancer,all the cases of surgical procedure were radical or modified radical breast cancer and ipsilateral axillary lymph node dissection.The postoperative pathological results were taken as the gold standard to explore the relationship between the conventional ultrasonic characteristics of primary breast cancer and axillary lymph node metastasis.Results:(1)The conventional ultrasound features of malignant axillary lymph nodes in breast cancer patients were mostly L/S<2,lymphatic hilum disappeared,cortical thickness>3mm,blood flow characteristics were peripheral or mixed type,CEUS was uneven enhanced(P<0.05).(2)The sensitivity,specificity and accuracy of the diagnostic model of conventional ultrasound combined with CEUS in predicting the nature of axillary lymph nodes were 93.9%,85.2%and 90.8%,respectively,which were better than single conventional ultrasound(85.7%,66.7%and 78.9%)or CEUS(89.8%,85.2%and 88.2%).In addition,the area under the ROC curve of the combined diagnosis of axillary lymph node nature was 0.960(95%CI:0.920～1.000),which was greater than that of conventional ultrasound(95%CI:0.780～0.953)or CEUS(95%CI:0.790～0.971).(3)The analysis of the relationship between conventional ultrasound characteristics of primary breast cancer and axillary lymph node metastasis showed that the maximum diameter of primary breast cancer(OR=3.766,P=0.002),hyperechoic halo(OR=2.587,P=0.024)and microcalcification(OR=2.649,P=0.019)were independent risk factors for axillary lymph node metastasis.Conclusions:1.Axillary lymph nodes in breast cancer patients with conventional ultrasound showed L/S<2,lymph hilar disappearance,cortical thickness ≥3mm,peripheral or mixed blood flow characteristics,CEUS showed uneven enhancement and other signs highly suggest malignant lymph nodes.2.The diagnostic efficacy of conventional ultrasound combined with CEUS in benign and malignant axillary lymph nodes of breast cancer patients was better than single conventional ultrasound or CEUS.3.Patients with the maximum diameter of primary breast cancer>2cm,hyperechoic halo and microcalcification in the lesion are more likely to have axillary lymph node metastasis.