目的:通过与亚甲蓝(Methylene blue,MB)示踪法比较,探讨超声造影检测乳腺癌前哨淋巴结(Sentinel lymph node,SLN)的前景。方法:建立兔VX2乳腺癌模型24只,皮下注射SonoVue,超声造影显像SLN,观察其造影增强情况;再经皮下注射MB示踪;行腋窝淋巴结清扫术切除SLN并行AE1/AE3免疫组化染色。结果:24只瘤兔超声造影检出回声均匀性增强的SLN 12个,回声不均匀性增强和部分充盈缺损的SLN 22个;MB示踪法检出SLN 32个;术中腋窝淋巴结清扫SLN 38个。以手术切除为标准,超声造影的检出率(89.47%)与MB示踪法检出率(84.21%)比较无显著差异(P〉0.05);以免疫组化结果为标准,超声造影的敏感性(95.24%)与MB示踪法敏感性(91.30%)比较无显著差异(P〉0.05),但其特异性(84.62%)和准确性(91.18%)均明显高于MB示踪法特异性(26.67%)和准确性(65.79%)(P〈0.05)。结论:经皮下注射超声造影剂显像乳腺癌SLN有较高的检出率、特异性、准确性和敏感性,与MB示踪法比较有一定优势,有望成为检测SLN的常用方法。
Objective:To explore the prospects of contrast-enhanced ultrasound and methylene blue(MB)detection of breast cancer sentinel lymph node(SLN).Methods:Twenty-four rabbit models of VX2 breast cancer was set up with,subcutaneous injection of SonoVue,to get contrast-enhanced ultrasound imaging of SLN.The situation of contrast-enhanced SLN was observed.Thenubcutaneous injection of MB was performed to trace SLN.SLN was resected from axillary lymph nods,which underwent immuno-histochemistry of AE1/AE3.Results:Among the twenty-four rabbits,12 SLN homogeneous echo-enhanced.22 SLN enhanced non-uniformity were found by contrast-enhanced ultrasound.By MB tracer method 32 SLN were detected.38 SLN were resected from axillary lymph nodes.To make surgical resection as the standard,the detection rate of contrast-enhanced ultrasound(89.47%) and the MB tracer detection rate(84.21%) showed no significant difference(P0.05).To make the results of immunohistochemistry criteria as the standard,contrast-enhanced ultrasound sensitivity(95.24%) and the MB tracer method sensitivity(91.30%) showed no significant difference(P 0.05),but the specificity(84.62%) and accuracy(91.18%) were significantly higher from contrast-enhanced ultrasound sensitivity than those from tracer MB method-specificity(26.67%) and accuracy(65.79%)(P0.05).Conclusion:Contrast-enhanced ultrasound imaging indetecting SLN of breast cancer gets a higher detection rate,specificity,accuracy and sensitivity compared with the MB tracer method,which is expected to become the common method in detection of SLN.