Clinical Value Of Multimodal Ultrasound In The Evaluation Of Metastatic Axillary Sentinel Lymph Nodes In Patients With Breast Cancer

Objectives:To investigate the clinical value of multimodal ultrasound imaging in evaluating ipsilateral ASLN metastasis of breast cancer.Methods:A total of 90 samples were included with breast cancer confirmed by pathology The perfusion pattern of SLN was recorded.RrecordedL,S,L/S ratio,echo of parenchyma by gray scale ultrasound.After observing the SLN with color CDFI,the AP mode was turned on.The blood flow patterns were classified and the hemodynamic parameters such as PSV and RI of the three microcirculations were measured.After obtaining the stable elastic image,SWE pattern classification was carried out.Selected Q-box trace to get the elastic modulus parameters Emax,Emin,Emean and SD.Ultrasonographic character of metastatic SLN in breast cancer were analyzed based on pathology.Results:There were differences between groups in the classification of CEUS.The cut-off value of ROC>1 indicated that type Ⅱ,Ⅲ and Ⅳ were high risk of metastatic lymph nodes.According to ROC of the morphology score suggested that the risk of metastatic SLN with 3 and 4 points was higher.Compared with CDFI,AP could obtain higher AUC and kappa value.The cut-off value of AP classification indicated that the risk of metastatic lymph nodes of type Ⅲ was higher.The hardness of SLN increased in metastasis group.According to ROC of SWF classification,Type Ⅱ,Ⅲ andⅣ were more likely to be metastatic lymph nodes and the AUC(0.823)was the highest among the above univariate indexes.Logistic regression model was used to establish ASLN-RADS:1 point:morphology score 3 or 4,CEUS type Ⅱ,Ⅲ and Ⅳ,AP typeⅢ,2 points:SWE type Ⅱ,Ⅲ and Ⅳ.The model was applied to the validation group and the sensitivity,specificitywere as follows:90.5%,92.0%,0.95.Conclusion:SWEcan be used as a promising new method to determine the nature of lymph nodes.There were specific performances in SLN metastatic lymph nodes.Compared with CDFI,AP can more truly restore the blood flow perfusion status of SLN so that it helpful to identify the nature of lymph nodes.Multimodal ultrasound evaluation can improve the ability to identify SLN metastasis of breast cancer that may provide objective imaging basis for clinical decision-making.