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

doi:10.3877/cma.j.issn.1674-0785.2024.11.004

Abstract

Abstract:

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.

Key words: Breast cancer, Lymph nodes, Contrast-enhanced ultrasound, Nano-carbon

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]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(11): 993-999.

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References 19

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基线特征	例（%）
更年期状态
未绝经	39（66.1）
绝经	20（33.9）
BMI
＜19	2（3.4）
19～25	25（42.3）
≥25	32（54.2）
肿瘤的位置
外上象限	23（38.9）
内上象限	14（23.7）
外下象限	6（10.1）
内下象限	16（27.1）
肿瘤大小
Tis	6（10.1）
T1	37（62.7）
T2	16（27.1）
组织学
导管原位癌	9（15.2）
浸润性小叶癌	6（10.2）
浸润性非特殊型癌	40（67.8）
其他	4（6.8）
分期
I	35（50.7）
II	24（49.3）
分子亚型
Luminal A	10（16.9）
Luminal B	16（27.1）
Her-2 阳性	33（55.69）
三阴性	0

基线特征	例（%）
更年期状态
未绝经	39（66.1）
绝经	20（33.9）
BMI
＜19	2（3.4）
19～25	25（42.3）
≥25	32（54.2）
肿瘤的位置
外上象限	23（38.9）
内上象限	14（23.7）
外下象限	6（10.1）
内下象限	16（27.1）
肿瘤大小
Tis	6（10.1）
T1	37（62.7）
T2	16（27.1）
组织学
导管原位癌	9（15.2）
浸润性小叶癌	6（10.2）
浸润性非特殊型癌	40（67.8）
其他	4（6.8）
分期
I	35（50.7）
II	24（49.3）
分子亚型
Luminal A	10（16.9）
Luminal B	16（27.1）
Her-2 阳性	33（55.69）
三阴性	0

标记方法	SLNB后病理		总计
标记方法	转移	未转移	总计
LCEUS+导丝标记法	1（1，1）	1（1，1）	1（1，1）
纳米碳染色法	1（1，1.5)	6（5，7）	6（5，7）
z值	-0.577	-6.713	-6.716
P值	0.564	＜0.001	＜0.001

标记方法	SLNB后病理		总计
标记方法	转移	未转移	总计
LCEUS+导丝标记法	1（1，1）	1（1，1）	1（1，1）
纳米碳染色法	1（1，1.5)	6（5，7）	6（5，7）
z值	-0.577	-6.713	-6.716
P值	0.564	＜0.001	＜0.001

LCEUS+导丝标记SLN病理	纳米碳染色标记SLN病理（例）		总计
LCEUS+导丝标记SLN病理	阳性	阴性	总计
阳性	8	1	9
阴性	1	49	50
合计	9	50	59

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