Analysis Of Factors Related To Axillary Lymph Node Metastases Of Breast Cancer In The Early Stages And Preliminary Study On The Diagnostic Efficacy Of Ultrasound In Sentinel Lymph Nodes

With the continuous development of medical science and technology,the treatment of breast cancer has gradually entered the era of precise therapy.Axillary lymph node status of breast cancer is an important factor affecting the survival and prognosis of patients,and also plays an important role in the selection of clinical treatment.Accurate judgment of axillary lymph node status of breast cancer is the key information to achieve accurate medical treatment.Current sentinel lymph node biopsy（Sentinel lymph node biopsy SLNB）has become an important standard for the stage of breast cancer patients.But there is no axillary lymph node metastasis in a significant number of patients with early breast cancer,applying SLNB to these patients is unnecessary,and SLNB is an invasive examination,overtreatment can bring about some postoperative complications and affect The quality of patients’life after operation.If the status of axillary lymph nodes can be determined before operation,this part of patients can avoid SLNBs,thus reducing treatment time,pain and postoperative complications.As a noninvasive preoperative imaging diagnosis technique,ultrasound can predict the status of axillary lymph node metastasis,and ultrasound examination is simple,cheap,non-invasive and painless.It has been widely used in the diagnosis of breast mass and axillary lymph node status.Objective:Analysis of the relevance of clinical data,pathological features and axillary lymph nodes in patients with breast cancer（Sentinel lymph node,non sentinel lymph node）.To explore the diagnostic value of ultrasound test in predicting axillary lymph node status in the early breast cancer patients.Methods:1 Case collection:From July 2014 to February 2016,238 cases of breast cancer diagnosed pathologically in Department of Breast surgery were collected,all of them were unilateral breast cancer.143 cases were treated with SLNB alone and mastectomy,95 cases with axillary lymph node dissection（Axillary Lymph Node Dissection,ALND）and mastectomy after SLNB.Grouping criteria:（1）The clinical stage of the tumor was cT1-2N0M0 breast cancer.（2）Axillary lymph nodes without biopsy and radiotherapy;（3）Inpatients with primary breast cancer,and all patients were treated with SLNB;（4）Breast ultrasonography was performed before operation.2 Observation indicators:Collect the following clinical data for each grouping patient:（1）Menstrual state,pre-menopausal and post-menopausal;（2）Tumor location,including the outer superior quadrant,the outer lower quadrant,the inner lower quadrant,the inner upper quadrant,the upper quadrant,the outer quadrant,the lower quadrant,the inner quadrant and the areola region;（3）Tumor size,divided into T1 according to the maximum diameter of the tumor（≤2cm）and T2（>2cm and≦5cm）;（4）Ultrasonic images of metastatic lymph nodes:（1）Round or length diameter ratio is no longer than2;（2）The irregular narrowing and disappearance of lymph node hilum and the disappearance or deviation of strong echo of lymph node hilum;（3）Cortical thickening is greater than or equal to 3mm;（4）Medulla disappeared;（5）Lymphoid blood flow was of marginal mixed type.3 SLNB detection method:Indocyanine green was used with methylene blue as a tracer for sentinel lymph node biopsy,the gross location of sentinel lymph nodes was located by 9 points method before operation,such as using indocyanine green as tracer and infrared probe during operation.Clusters of tissue can be seen in the lateral margin of the mammary gland near the axillary front,and the sentinel lymph nodes are located at the brightest point here.After the sentinel lymph nodes were detected,rapid frozen pathological examination was performed during operation,such as intraoperative frozen pathology indicating SLN（-）,only SLNB and simple mastectomy;After prompting SLN（+）,continuing axillary dissection and radical mastectomy.SLN was stained with intraoperative frozen and routine pathological paraffin sections after operation.4 To evaluate the authenticity of imaging examination in predicting the metastasis of sentinel lymph node carcinoma.Being pathological results of examination of axillary lymph nodes by HE staining after operation（Including sentinel lymph nodes）as"golden standard"（Gold standard）",to evaluate the effectiveness of B-ultrasonography in the diagnosis of sentinel lymph node carcinoma metastasis.5 Statistical methods:Chi-square test and logistic regression analysis of two independent samples was carried out with spss19.0 software,and the test standard was P<0.05.Counting data results were denoted by frequency（N）and rate（%）.Results:1 Sentinel lymph node statusSLNB was performed in 238 patients.SLN（+）including 95 Cases（39.9%）,SLN（-）143 Cases（60.1%）.In 238 cases of surgery,95 Cases was performed with SLNB（+）+ALND.In 95 Cases of SLN（+）undergoing ALND,NSLN node metastasis occurred in 37 patients with breast cancer（38.9%）.2 Clinical factors,pathological features and axillary lymph node metastasis of patientsBy statistical analysis,it can be seen that the size of tumor（χ²=4.857,P=0.028）,pathological grading（χ²=38.736,P=0）and Ki-67（χ²=4.509,P=0.034）were the main factors affecting axillary lymph node metastasis（P<0.05）.However,age,menstrual status,tumor location,HER-2 and p53were not significantly associated with sentinel lymph node metastasis.The significant relationship among sentinel lymph node metastasis,Ki-67,tumor size and pathological grade in 238 cases with breast cancer was as follows:Pathological grading is an independent risk factor for SLN metastasis（OR=6.014,95 CI=3.308-10.932）,Ki-67 more than 14 is the independent risk factor for SLN metastasis（OR=2.502,95 CI=1.282-4.883）and tumor size more than 2cm is the independent risk factor for SLN metastasis（OR=1.346,95 CI=1.005-1.802）.3 The relationship between clinic pathological factors and positive NSLNIn 95 cases with SLN positive breast cancer,37 cases were non-sentinel lymph node metastasis and 58 cases were no non-sentinel lymph node metastasis.Univariate analysis shows:The number of SLN（+）and tumor size were correlated with NSLN positive.Number of SLN negative,HER-2,Ki-67and p53 were no significant correlation with non NSLN positive.（all P>0.05）Multivariate Logistic regression analysis showed that the number of SLN（+）and the size of tumor were independent risk factors for the metastasis of NSLN.4 Predicting correlation analysis of value of sentinel lymph nodes by ultrasonographyThere were 191 cases with axillary lymph node metastasis,47 cases without metastasis,accounting for 80.3%and 19.7%of the total number respectively.95 Cases of metastasis and 143 cases of non-metastasis were confirmed by pathology.The number of cases with positive B-ultrasound and pathological results of SLN was 56 cases,negative results of B-ultrasound and pathology of SLN in 8 cases.135 Cases were positive for ultrasonic metastasis while negative for pathology results,39 cases were positive for pathology while negative for ultrasonic metastasis.The accuracy of axillary lymph node metastasis is 80.21%,sensitivity is 58.95%,specificity is 94.41%,positive predictive value is 87.50%,and negative predictive value is 77.59%judged by B-ultrasound.Authenticity analysis of Yi value between SLN B-mode ultrasonography and pathological diagnosis is 0.53,which indicates that B-mode ultrasound can judge axillary lymph node metastasis.In ultrasonic examination,Univariate analysis showed that lymph node aspect ratio,cortical thickness,medullary boundary,cortical homogeneity and blood flow signal were correlated with SLN metastasis.（P<0.05）.The transfer rates of aspect ratio being more than 2 and the aspect ratio being less than or equal to 2were 35.8%and 61.7%,P=0.004;The metastatic rate of cortical inhomogeneity of the lymph nodes was significantly higher than that of cortical inhomogeneity,and the metastasis rates were respectively 71.4%and26.8%,P<0.001,and the thickening of the lymph node cortex（Critical point was 3.0mm）was a important acoustic index in judging SLN positive,the metastatic rate of SLN cortical thickness more than 3mmwas greater than that of cortical thickness less than 3mm,the transfer rates were respectively 51.9%and 30.3%,P=0.001;lymph blood flow center edge mixed transfer rate was significantly higher than that of lymph node type,metastasis rates were 44.2%and 30.7%,P=0.048.When the disintegration of the medulla of the lymph nodes was unclear,the lymph node metastasis rate was 100%,statistical analysis,P<0.001.Conclusion:1 Tumor size,pathological type and Ki-67 were correlated with sentinel lymph node metastasis.The patients with tumor size more than 2cm,the higher the tissue grade in invasive ductal carcinoma and cT_1-2N₀M₀ of Ki-67more than14%were more susceptible to SLN transfer.2 There was significant difference between tumor size,the number of SLN metastasis and NSLN metastasis in patients（P<0.05）,Tumor diameter more than 2cm and the more the number of SLN transfer,the higher the probability of NSLN transfer.3 B-Ultrasound has a certain predictive value for the sentinel lymph node of breast cancer and provides important information for the scanning of anterior lymph nodes.4 Univariate analysis showed that lymph node cortex thickness more than or equal to 3mm,the aspect ratio less than or equal to 2,bad cortical homogeneity,unclear dermoid boundary and mixed blood flow signal around the center of lymph node can be used to diagnose SLN metastasis.The unclear dermoid boundary is the most important parameter for SLN metastasis.