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中华临床医师杂志(电子版) ›› 2024, Vol. 18 ›› Issue (11) : 993 -999. doi: 10.3877/cma.j.issn.1674-0785.2024.11.004

临床研究

经皮超声造影引导下导丝定位在早期乳腺癌前哨淋巴结的临床应用
杨艳1, 邢长洋1, 杨瑞静1, 苏小佩1, 周永刚1, 金京兰1,()   
  1. 1.710038 西安,空军军医大学第二附属医院唐都医院超声诊断科
  • 收稿日期:2024-11-23 出版日期:2024-11-15
  • 通信作者: 金京兰
  • 基金资助:
    空军军医大学第二附属医院唐都医院社会人才基金项目(2021SHRC035)空军军医大学第二附属医院唐都医院新技术新业务资助项目(XJSXYW202129)

Clinical application of lymphatic contrast-guided guidewire positioning for localization of sentinel lymph nodes in early-stage breast cancer

Yan Yang1, Changyang Xing1, Ruijing Yang1, Xiaopei Su1, Yonggang Zhou1, jinglan Jin1,()   

  1. 1.Department of Ultrasound Medicine,the Second Affiliated Hospital of Air Force Medical University, Xi’an 710038, China
  • Received:2024-11-23 Published:2024-11-15
  • Corresponding author: jinglan Jin
引用本文:

杨艳, 邢长洋, 杨瑞静, 苏小佩, 周永刚, 金京兰. 经皮超声造影引导下导丝定位在早期乳腺癌前哨淋巴结的临床应用[J/OL]. 中华临床医师杂志(电子版), 2024, 18(11): 993-999.

Yan Yang, Changyang Xing, Ruijing Yang, Xiaopei Su, Yonggang Zhou, jinglan Jin. Clinical application of lymphatic contrast-guided guidewire positioning for localization of sentinel lymph nodes in early-stage breast cancer[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(11): 993-999.

目的

探讨应用经皮超声造影(LCEUS)引导下导丝定位对早期乳腺癌前哨淋巴结(SLN)的定位价值。

方法

纳入2023 年3 月~2024 年5 月于空军军医大学第二附属医院唐都医院行LCEUS 引导下导丝定位及纳米碳染色法标记SLN 的59 例早期乳腺癌患者,以术后病理为金标准,统计两种方法识别SLN 的数量,判断两种方法标记SLN 的一致性;计算两种方法定位SLN 的敏感度、特异性、阳性预测值、阴性预测值。

结果

59 例早期乳腺癌患者两种检测方法SLN 均显影。LCEUS法共检出68 个SLN,纳米碳法共检测到356 个SLN。LCEUS 导丝标记法检测总SLN 数及非转移SLN 数均显著少于纳米碳法,[1(1,1)vs 6(5,7);1(1,1) vs 6(5,7),均P<0.001]。10 例患者共计12 个SLN 发生转移,两种方法标记SLN 术后病理结果具有较高的一致性(Kappa=0.865,P<0.001)。LCEUS 导丝标记SLN 的阳性率显著高于纳米碳染色法[14.7%(10/68)vs 3.0%(11/356),P<0.001]。同时,LCEUS 导丝定位法定位前哨淋巴结的特异度及阳性预测值均高于纳米碳染色法,差异均有统计学意义[(84.6% vs 8.7%);(14.7% vs 3.0%)均P<0.001]。但两种方法定位SLN 的敏感度无统计学差异(83.3% vs 91.6%,P>0.05)。

结论

LCEUS 引导下导丝定位SLN 操作简单,定位准确,可以减少非SLN 被手术切除,减少术后并发症,提高了SLN 的定位效能,值得临床推广应用。

Objective

To evaluate the effectiveness of lymphatic contrast-enhanced ultrasound(LCEUS)-guided guidewire positioning for the localization of sentinel lymph nodes in patients with earlystage breast cancer.

Methods

A total of 59 patients with early breast cancer who underwent sentinel lymph node identification using LCEUS-guided guidewire positioning and nano-carbon staining techniques in Tangdu Hospital, the Second Affiliated Hospital of Air Force Medical University were enrolled from March 2023 to May 2024. The definitive assessment was conducted through postoperative pathological analysis,which served as the gold standard for evaluation. The study quantified the number of sentinel lymph nodes(SLNs) identified by two different methods and evaluated the concordance of SLN labeling between these techniques. Furthermore, the sensitivity, specificity, positive predictive value, and negative predictive value of the two methods for SLN localization were calculated and compared.

Results

SLNs were identified using both methods in 59 breast cancer patients. A total of 68 SLNs were detected by the LCEUS method ,whereas the nano-carbon staining method identified 356 SLNs. The total number of SLNs and the number of nonmetastatic SLNs identified using LCEUS was significantly less compared to those detected by the nanocarbon method [1 (1, 1) vs 6 (5, 7) and 1 (1, 1) vs 6 (5, 7); P<0.001 for both]. In total, 12 SLN metastases were identified in 10 patients. The postoperative pathological results of SLN labeling using both methods exhibited high concordance (Kappa=0.865, P<0.001). Nonetheless, the positive rate of SLN labeling via the LCEUS-guided guidewire technique was significantly higher than that achieved through nano-carbon staining[14.7% (10/68) vs 3.0% (11/356), P<0.001]. At the same time, the specificity and positive predictive value of SLN labeling via the LCEUS-guided guidewire technique were significantly higher than those of nanocarbon staining (84.6% vs 8.7% and 14.7% vs 3.0%, P<0.001 for both). However, there was no significant difference in the sensitivity for SLN localization between the two methods (83.3% vs 91.6%, P>0.05).

Conclusion

The utilization of LCEUS-guided guidewire localization for SLNs is simple and accurate, which can minimize the surgical resection of non-SLNs, decrease postoperative complications, and improve the efficacy of SLN localization.

表1 入组患者临床基线特征
图1 实时双帧超声对比图像。超声造影前,SLN 与周围组织回声强度几乎无差异,难以识别(白色三角形)。经皮超声造影后,SLN 明显增强(白色箭头)。 注:SLN 为前哨淋巴结
表2 两种方法均成功标记SLN 的数量[MP25P75)]
图2 女性,57 岁,左侧乳腺癌。图a 为增强的淋巴管(黑色箭头);图b 为检测到的第一个增强淋巴结(白色*)被确定为SLN;图c 为术中切除带有导丝但未被黑染的SLN;图d 为前哨淋巴结被膜下查见孤立性肿瘤细胞(白色箭头)(苏木精-伊红,10×20) 注:SLN 为前哨淋巴结
表3 两种方法标记SLN 术后病理结果
表4 59 例乳腺癌术中SLN 超声造影下导丝定位情况分析
表5 59 例乳腺癌术中SLN 纳米碳染色法情况分析
表6 不同定位方法下乳腺癌SLN 定位效能比较(%)
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