Percutaneous CEUS In Localization And Qualitative Diagnosis Of Sentinel Lymph Nodes In Breast Cancer

Part I Study on Preoperative Contrast-enhanced Ultrasound Localization of Sentinel Lymph Nodes in Breast CancerObjective(s): To evaluate the application value of preoperative percutaneous contrast-enhanced ultrasound(CEUS)for locating the sentinel lymph node(SLN)in breast cancer.Method(s): 79 patients with pathologically confirmed breast cancer underwent SLN conventional ultrasound and percutaneous CEUS examination before surgery,real-time and continuous dynamic observation of sentinel lymphatic channel(SLC)and SLN,and localization and labeling of SLC and SLN on the body surface.The sentinel lymph node biopsy(SLNB)was selected after methylene blue injection.Using pathological results as the gold standard,the detection number and accuracy of SLN localization by percutaneous CEUS staining,methylene blue staining and the combination of the two methods were compared.The effect of SLC drainage mode on the detection rate of SLN in CEUS was analyzed.Result(s): In 79 patients,a total of 133 SLNS were detected by percutaneous CEUS before surgery,and 191 SLNS were detected by SLNB after methylene blue tracer,the difference was statistically significant(Z=-4.713,P <0.001).The accuracy of percutaneous CEUS in locating SLN in breast cancer was 89.87%(71/79).The localization accuracy of methylene blue staining was92.40%(73/79),and the localization accuracy of percutaneous CEUS combined methylene blue staining was 94.94%(75/79).There was no significant difference in localization accuracy between the percutaneous CEUS group,methylene blue staining group and percutaneous CEUS combined methylene blue staining(P >0.05).The false-negative rate of percutaneous CEUS localization was13.95%(6/43),and that of methylene blue staining was 4.65%(2/43).The false-negative rate of combined application of percutaneous CEUS and methylene blue staining was 2.33%(1/43).There was no significant difference in the false-negative rate of percutaneous CEUS,methylene blue staining and percutaneous CEUS combined methylene blue staining(P > 0.05).The detection failure rate of superficial sentinel lymphatic channel(SSLC)was 1.96%(1/51).The detection failure rate of penetrating sentinel lymphatic channel(PSLC)was21.74%(5/23),and the difference was statistically significant(P < 0.05).Conclusion(s):There is no significant difference between the results of preoperative localization of SLNS of breast cancer by percutaneous CEUS and those of intraoperative methylene blue staining,which can be used as an effective method for preoperative localization of SLNS of breast cancer.The combination of the two methods can optimize the detection rate of SLNS of breast cancer.The drainage mode of SLC and the number of SLNS were the factors affecting the detection of SLNS.Part II Study on Preoperative Contrast-enhanced Ultrasound Qualitative Assessment of Sentinel Lymph Nodes in Breast CancerObjective(s): To evaluate the application value of preoperative conventional ultrasound combined with percutaneous contrast-enhanced ultrasound(CEUS)for qualitative diagnosis of sentinel lymph node(SLN)in breast cancer.And analysis the risk factors of SLN metastasis in breast cancer.Method(s): Examination before surgery,real-time and continuous dynamic observation of lymphatic vessels and enhanced SLN pattern,and localization and labeling of SLN on the body surface.According to different enhancement patterns of SLN and conventional ultrasound characteristics,we scored the sample.After methylene blue injection,we underwent sentinel lymph node biopsy(SLNB).The pathological results were used as the gold standard to compare the efficacy of conventional ultrasound combined with percutaneous CEUS and the two methods combined alone in diagnosing SLN.The efficacy of sentinel lymphatic channel(SLC)for continuous diagnosis of SLN was analyzed.The clinicopathologic data of 79 patients with breast cancer were retrospectively analyzed,and the correlation between the site of primary tumor,Her-2,Ki-67,molecular typing,T stage of breast tumor,age and nationality of patients and SLN metastasis of breast cancer was analyzed.Result(s):The cut-off value of conventional ultrasound diagnosis of SLN was > 1 point,the area under the curve was 0.743,and the sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV)and accuracy were 65.38%,79.25%,60.71%,82.35% and 74.68%,respectively.The cut-off value of percutaneous CEUS for diagnosing metastatic was > 0 point,and the area under the curve was 0.878.The sensitivity,specificity,PPV,NPV and accuracy of the diagnosis of metastatic SLN were 88.46%,88.68%,79.31%,94.00% and 88.60%,respectively.The area under the curve of metastatic SLN assessed by conventional ultrasound combined with percutaneous CEUS was0.914,and the sensitivity,specificity,PPV,NPV and accuracy were 92.31%,90.57%,82.76%,96.00% and 91.14%,respectively.The sensitivity,specificity,accuracy,PPV and NPV of percutaneous CEUS in the diagnosis of SLN were higher than those of conventional ultrasound,and the differences were statistically significant(all P < 0.05).The diagnostic efficacy of conventional ultrasound and contrast-enhanced ultrasound combined is higher than that of its own use,but there was no significant statistical significance(all P > 0.05).The sensitivity,specificity,PPV,NPV and accuracy of SLC continuity interrupt diagnosis of metastatic SLN were enhanced to 4.17%,91.84%,20.00%,66.18%and 63.01%,respectively.There were significant differences in T stage of breast tumor,expression of HER-2 and molecular typing of breast cancer between SLN metastasis group and SLN non-metastasis group(P≤0.045).There were no significant differences in the primary site of breast tumor,the expression of Ki-67,the age and nationality of breast cancer patients between SLN metastasis group and non-metastasis group(all P > 0.05).Conclusion(s):Percutaneous CEUS can be used as an effective method for qualitative breast cancer SLN before surgery,and conventional ultrasound combined with percutaneous CEUS can optimize its diagnostic efficacy.The T stage of breast tumor,the expression of HER-2 and the molecular typing of breast cancer were correlated with the metastasis of SLN.Enhanced SLC continuity interruptions cannot be used as a single indicator for diagnosing metastatic SLNS.