The Application Of Multimodal Ultrasonography In The Diagnosis Of Axillary Sentinel Lymph Nodes In Breast Cancer

ObjectivesTo explore the preoperative non-invasive or minimally invasive diagnosis of axillary sentinel lymph node(SLN)metastasis in patients with breast cancer by multimodal ultrasound imaging,so as to provide objective basis for clinical judgment of axillary staging and individualized treatment of breast cancer.MethodsSubcutaneous contrast-enhanced ultrasound(CEUS)via areola was performed in 129 breast cancer patients who met the inclusion and exclusion criteria.The direction of lymphatic vessels and the number of enhanced lymph nodes were marked on the body surface,and this enhanced lymph nodes were recorded as SLN.The enhancement modes of percutaneous contrast-enhanced SLN were recorded,which were divided into homogeneous enhancement(type I),inhomogeneous enhancement(type II)and no enhancement(type III).Conventional two-dimensional ultrasound was used to scan the multi-section of SLN,and recorded L,S,L/S,Whether the edge is smooth or not.Whether the cortex is thickened or not.Whether the boundary of cortex and medulla is clear or not.According to the above ultrasonic features,the morphological score of SLN can be divided into 0-5 points.The blood flow characteristics of SLN were classified into lymphatic type(type I),mixed type(type II)and peripheral type(type III)by color Doppler ultrasound.Intravenous contrast-enhanced ultrasound was performed on SLN and classified into concentric enhancement(type I),mixed enhancement(type II)and eccentric enhancement(type III)according to the enhancement mode.Multifactor binary Logistic regression analysis was carried out to obtain multi-parameter joint prediction and diagnosis data.Finally,according to the contrast-enhanced ultrasound results,ultrasound-guided core needle biopsy was performed on SLN,and the histopathological results were obtained as the gold standard.Results1.The ROC cutoff value of conventional two-dimensional ultrasound morphological score in the diagnosis of SLN metastatic state was ≥ 2,the area under the curve AUC was 0.821,Kappa value was 0.479,sensitivity(SEN),specificity(SPE),accuracy(ACC),positive predictive value(PPV),negative predictive value(NPV)is 83.6% 65.7% 73.7% 65.7% 83.6%respectively.2.The ROC cutoff value of color Doppler flow imaging in the diagnosis of SLN metastatic state is ≥ 2,type II and type III are at high risk of malignant SLN.The area under the curve AUC is 0.718,Kappa value is 0.429,SEN,SPE,ACC,PPV and NPV are 61.3%,82.1%,71.2%,79.2%,65.7% respectively.3.The ROC cutoff value of percutaneous CEUS in the diagnosis of SLN metastatic status is ≥2,type II and type III are at high risk of malignant SLN.The area under the curve AUC is0.840,Kappa value is 0.616,SEN,SPE,ACC,PPV and NPV are 85.5%,77.1%,77.1%,74.6%,87.1% respectively.4.The ROC cut-off value of intravenous CEUS in the diagnosis of SLN metastatic status is ≥2,type II and type III are at high risk of malignant SLN.The area under the curve AUC is0.836,the Kappa value is 0.656,SEN,SPE,ACC,PPV,NPV are 87.2%,78.3% 82.8%,80.4%,85.7%,respectively.5.The results of multivariate Logistic regression analysis showed that there was no statistical significance in short diameter S,conventional two-dimensional ultrasound morphological score,color Doppler flow imaging classification and percutaneous CEUS classification,but only intravenous CEUS had statistical significance.Multi-parameter joint prediction and diagnosis data are obtained by analysis.The AUC of multi-parameter joint prediction diagnosis is 0.896,and the Kappa value = 0.795 ACC SEN,SPE,ACC,PPV and NPV are93.5%,85.7%,89.8%,87.9%,92.3%,respectively.Conclusions:1.Conventional two-dimensional ultrasound diagnosis of breast cancer axillary SLN benign and malignant,morphological score has the highest sensitivity,accuracy,negative predictive value and the area under the ROC curve,L/S has the highest specificity in the differential diagnosis of benign and malignant SLN.2.Intravenous contrast-enhanced ultrasonography provides information from blood perfusion level for the evaluation of axillary SLN lymph nodes of breast cancer,which has the highest diagnostic value and provides a valuable basis for qualitative diagnosis.3.Multimodal ultrasound imaging combined with predictive diagnosis of benign and malignant SLN has a high diagnostic value,improve the ability of preoperative non-invasive(or minimally invasive)differential diagnosis of breast cancer axillary SLN benign and malignant,so as to provide a stronger basis for clinical judgment of breast cancer axillary stage and the choice of individualized treatment plan.