Application Of Contrast-enhanced Ultrasound In Diagnosis Of Axillary Lymph Node With Benign Or Malignant And Using Relative Analysis Of Its Metastasis In Breast Cancer

Objective: To explore the value of contrast-enhanced ultrasound in the differentialdiagnosis of benign or malignant axillary lymph node in patients with breast cancer; and toanalyze the relation between primary breast cancer imaging characteristics and axillarylymph node metastasis.Methods: Forty six breast cancer patients with a total of82axillary lymph nodes werecollected from September2010to February2013in our hospital, all of the lymph nodeshad the pathological results.46patients were performed with routine ultrasonography, toobserve the size, shape, internal micro-calcification inside of breast masses, followed bythe measurements of the size, shape, long/short diameter ratio (L/S), internal structure ofaxillary lymph nodes with the two-dimensional gray-scale ultrasound. Then we observedblood flow distribution in lymph nodes and measured the blood flow resistance index (RI),arterial peak velocity (Vmax) with color Doppler flow imaging (CDFI). In46cases ofbreast cancer patients underwent axillary lymph node ultrasonography, we recorded andanalyzed the contrast enhancement pattern and compared with postoperative pathology. Wealso analyzed the correlation between the index and the axillary lymph node metastasis byusing correlation analysis.Results: Routine ultrasonography showed that75%of the metastatic lymph nodespresented L/S <2vs.18.1%non-metastatic lymph node presented L/S <2(P<0.01).72.5%metastatic lymph nodes showed cortical thickening,9.8%showed cortical stenosis,and17.7%showed non-hilar type. Non-metastatic lymph nodes with cortical stenosis typeaccounted for77.4%, cortical thickening type accounted for22.6%, and no non-hilar type(P<0.01). The lymph nodes with peripheral distribution of blood flow accounted for70.6%, while the non-metastatic lymph node with hilar type accounted for12.9%(P<0.01). Therewas no statistically significant difference between the two groups relating to blood flowresistance index (P>0.05). The results of contrast-enhanced ultrasound displayed thatmetastatic lymph nodes with uneven enhancement were accounted for82.4%, and benignlymph nodes with uniform enhancement were accounted for3.2%(P<0.01). Comparedwith the pathological results, routine ultrasonic diagnoses of benign and malignant axillarylymph nodes had a sensitivity of78.4%, specificity of75%, accuracy of76.8%;Contrast-enhanced ultrasound diagnoses of benign and malignant axillary lymph nodeswith a sensitivity of90.2%, a specificity of90.3%, accuracy of90.2%. Compared with theroutine ultrasound examination, there was statistically significant difference between thetwo groups (P<0.05), and contrast-enhanced ultrasound had higher valuable in thediagnosis of axillary lymph node. The correlation analysis showed that the size of theprimary breast cancer≥2cm, the L/S of lymph node <2, which have significant correlationwith breast cancer axillary lymph node metastasis (P<0.05).Conclusion:1. Contrast-enhanced ultrasound in the axillary lymph nodes to determine the value ofbenign and malignant aspects is superior to conventional ultrasound.2. The maximum diameter of the primary tumor is greater than or equal to2cm wereat high risk of axillary lymph node metastasis, the primary tumor with or without axillarylymph node metastases micro-calcifications no significant correlation.3. Axillary lymph node showed cortical thickening or without lymph node gatestructure, lymph node L/S<2, the non-door type blood, and other signs of non-homogeneous enhancement are highly suggestive of metastasis.