Contrast-enhanced Ultrasound: Differentiate The Metastatic And Inlfammatory In Enlarged Axillary Lymph Nodes

Object：1. To observe the contrast agent perfusion and detect characteristics ofcontrast-enhanced ultrasound imaging in sentinel lymph nodes (SLNS) ofpatients with breast cancer and mastitis.2. To evaluate the value of differential diagnosis of metastatic andinflammatory lymph nodes by contrast-enhanced ultrasound (CEUS).Methods：A total of40patients of the palpation of breast palpable masses withenlarged axillaries lymph nodes were recruited. These patients were clinicallysuspected primary breast cancer or mastitis.27cases were confirmed to breastcancer by fine needle aspiration biopsy and13patients were mastitis.Ultrasonic instruments were selected Philips iU22color Dopplerultrasonic diagnostic apparatus, which had L9-3broadband linear array probe(the probe is3~9MHZ) and built-in pulse inversion harmonic imaging(PIHI).40cases were detected by ordinary two-dimensional ultrasound beforesurgery. At first, they were observed the size, shape, internal echocharacteristics of mammary glands and its relationship with the surroundingtissues. And then, the patients were observed the distribution of blood flowsignals by color Doppler flow imaging(CDFI) and color Doppler energyimaging(CDEI) and were determinated the resistance index (RI) by pulsewave Doppler(PWD). Second, the lymph nodes of bilateral axillaries weredetected, including numbers and position, size, aspect ratio, boundary, internal echo, hilus lymph nodes, cortex. The lymph nodes were observed distributionof blood flow signal by CDFI and CDEI and were detected RI by the PWD.Last, the images were stored.After this, all patients agreed to contrast-enhanced sltrasonography byPIHI technology, mechanical index (Ml=0.20). The breast tumors’subcutaneous were injected0.5ml SonoVue respectively around3,6,9and12o ’clock directions and were massaged the injection sites3~5min, whichcould speed up the contrast agent into the lymphatic. The developments oflymphatic and lymph nodes were probed by CEUS. At the same time, weopened the built-in timer and used ultrasound workstation and built-inmagnetic disc record to scan process continuously of more than5min aftercontrast injection. The SLNs were detected in one or more of lymph nodeswhich contrast agents arrived firstly in the lymphatic vessels. We recorded theplace and number and tagged on the body. After imaging, we studied theperformance of CEUS of SLNs.After ultrasound examination,40patients were received breast lumpsbiopsy.27cases were confirmed to breast cancer, which all received breastcancer resection plus axillaries lymph node dissection (ALND). Intraoperative,the SLNS were tracked by Nano carbon, which were found out that whetherconsistent with the tagged SLNS by CEUS. The SLNS detected by twomethods were received sentinel lymph node biopsy (SLNB).13patients wereconfirmed to mastitis. The SLNS of13patients were received fine needleaspiration biopsy (FNAB).Results:1. In27cases of breast cancer,22patients were detected22SLNS byCEUS (each one showed1). Intraoperative, the Nano carbon tracer technique showed24SLNS (per patient showed1~2), including the tagged22SLNSby CEUS.5cases’ SLN were not displayed, while Nano carbon tracer showed6SLNS (each patients showed1~2).5patients were detected obviouslyenlargement of lymph node imaging by two-dimensional ultrasound. The rateof CEUS detected SLNS in patients with breast cancer (relative to the Nanocarbon tracer) was73%(22/30). Postoperative,22SLNS were confirmed tocancer metastasis.2. All of the13cases of mastitis patients were detected19SLNs (perpatient showed1~3).19SLNs were detected inflammatory cells infiltrationwithin lymph nodes.3. In all metastatic SLNs,21metastatic SLNs were characterized bydifferent extent of perfusion defect and the defect area always had not beenenhanced, and1metastatic SLN was of whole uniform enhancement echo. Allof19inflammatory SLNs showed rapid, uniform high enhancement echo. Thedifference in metastatic SLNs and inflammatory SLNs was statisticallysignificant (P=0.000).Conclusion:1. The injection of SonoVue in surrounding subcutaneous of breast masscan make the sentinel lymph node imaging.2. Percutaneous contrast-enhanced Lymphatic ultrasonography coulddistinguish between metastatic and inflammatory in enlarged lymph nodes.