Feasibility Of Contrast-enhanced Ultrasound Used In Axillary Evaluation To The Early Stage Breast Cancer

Backgroud and Objectives: One of the important factors in determining the prognosis is to assess the condition of the axillary lymph nodes,and it is also one of the reference factors for the development of assisted treatment after surgery.In clinical practice,Sentinel lymph node biopsy(SLNB)is commonly used in early breast cancer patients instead of axillary lymph node clearance(ALND)as a surgical intervention method.ALND is still required after SLN involvement is found during or after surgery.Preoperative imaging evaluation of axillary lymph nodes is required in patients with suspected metastasis by palpation of the axilla.Patients with almost infiltrated axillary lymph nodes can be directly treated with ALND to avoid unnecessary SLNB,which has become a hot spot in breast cancer surgery research.This study retrospectively studied the clinical data of breast cancer patients.By analyzing the enhancement of axillary sentinel lymph node in patients with early breast cancer after intravenous contrast agent injection,the BI-RADS classification was conducted to study the accuracy of axillary evaluation in patients with early breast cancer.Materials and Methods: We analyzed 94 cases of breast cancer diagnosed in the breast center of the first affiliated hospital of Nanjing Medical University from January 2014 to April 2015.All the patients had been diagnosed with breast cancer by biopsy or excision.No distant metastasis was found in all patients during clinical examination and other auxiliary examinations.All the 94 patients received contrast-enhanced ultrasonography(CEUS)and SLNB as the initial surgical intervention for axillary.Information was collected including age,size of primary tumor,number of axillary lymph node metastases,ER,PR,HER2,ki-67 status,and preoperative CEUS BI-RADS classification.Result 1.The mean age of 94 breast cancer patients was 52(33-77)years.The mean number of sentinel lymph nodes was 1.8(1-4),among which 58 cases(61.7%)were axillary lymph nodes negative.All the 36 cases(38.3%)were treated with ALND.The tumor diameter was <2cm(p T1)in 55 patients(58.5%).Most patients were positive for ER(76.6%),PR(61.7%),and Her-2 factor(18.1%).2.The Positive predictive value(PPV)was used to evaluate the suspicious value of the lesions.PPV = Number of cases of cancer diagnosed by tissue biopsy / total number of cases.The results of this study showed 38 cases with BI-RADS-US level 3 and PPV = 15.8 %(6/38).55 cases of BI-RADS-US 4,PPV = 54.5 %(30/55),of which the highest positive prediction was BI-RADS-US 4C,and PPV = 92.8 %(13/14);3.The chi-square value of the two levels is 3.32 and the p-value is 0.345.This indicates that the correlation between ceus and the four types is not significant and there is no significant difference between the two levels.Conclusion 1.Contrast-enhanced ultrasound(CEUS)can better reveal the status of breast cancer axillary lymph odes before surgery.It is helpful to comprehensively evaluate breast cancer and whether it has axillary lymph node metastasis.2.CEUS has the characteristics of fast developing speed and easy operation.It can help us to recognize SLN in clinic,and it is expected to become the standard diagnosis and treatment method in breast clinic.3.Lymph node puncture is necessary before SLNB.If axillary lymph node metastasis has been confirmed by axillary puncture,SLNB preparation such as tracer injection can be avoided.