The Diagnostic Value Of Contrast-enhanced Ultrasonography Combining With Conventional Ultrasound For Sentinel Lymph Node Of Breast Cancer

ObjectiveTo compare the diagnostic value of conventional ultrasound (B Mode ultrasound combined with color doppler imaging) and contrast enhanced ultrasound (CEUS) by intradermal injection combining with conventional ultrasound in diagnosing sentinel lymph node (SLN) of the breast cancer. MethodsConventional ultrasound was performed on forty-two patients with breast cancer, in order to master situation of breast masses and sentinel lymph nodes, and then each patient was injected intracutaneously with SonoVue beside the areola, after injecting SonoVue, the lymphatic channels and SLNs were observed, after the SLNs being shown by CEUS, SLNs were obersved by conventional ultrasoud when switching into fundamental mode. The results of conventional ultrasound and CEUS combining with conventional ultrasound for SLN of forty-two patients with breast cancer were recorded with five-score method (level1, definitely benign; level2, probably benign; level3, indetermination; level4, probably malignant; and level5, definitely malignant), and then the two results were compared. The changes of the diagnosis for CEUS combining with conventional ultrasound were recorded by three-point scale (0, no gain,1, mild gain,2, significant gain), compared to conventional ultrasound. Taking the pathologic results as the golden standard, the accuracy, sensitivity and specificity of the conventional ultrasound and CEUS combining with conventional ultrasound in diagnosing SLN of breast cancer were compared. Receiver operating characteristic curve (ROC) was used to evaluate the diagnositic value of SLN of breast cancer by conventional ultrasound and CEUS combining with conventional ultrasound. Results1. According to the pathologic results, in this study of42breast cancer patients, there were24patients without SLN metastasis and18patients with SLN metastasis. Among these42patients, with CEUS, there were34SLNs identified in29patients, inculding that23SLNs were benign,11SLNs were malignant; while there were no SLNs detected in13patients, inculding that SLNs in5patients were benign and SLNs in8patients were malignant. Among these42patients, with the conventional ultrasound, there were43SLNs identified in38patients, inculding that21SLNs were benign,17SLNs were malignant; while there were no SLNs detected in4patients, inculding that SLNs in3patients were benign and SLNs in1patients were malignant.2. According to the result of SLN by CEUS, in this study of42breast cancer patients, there were no SLNs detected in13patients, and there were34SLNs identified in29patients, inculding that only one SLN was visualized in24patients, two SLNs were visualized in5patients. The ratio of SLN detection was72.3%(34/47). There was statistic significance at the differences of enhanced patterns between the metastasis group and the nonmetastasis group(P<0.05), the metastasis group showed no contrast enhancement or component enhancement, while the nonmetastasis group showed homogeneous enhancement. There were no statistic significances at differences of the transverse diameter, anteroposterior diameter, vertical diameter, shape, the lymphatic channels appearing time of contrast enhancement, the inspection time of contrast-enhanced ultrasound and the dose of contrast agent of SLN between the metastasis group and the nonmetastasis group (P>0.05)3. According to the results of SLN by conventional ultrasound, in this study of42breast cancer patients, there were no SLNs detected in4patients, and there were43SLNs identified in38patients, inculding that only one SLN was visualized in33patients, two SLNs were visualized in5patients. The anteroposterior diameter of the metastasis group (7.83±2.40mm) was longer than the nonmetastasis group (5.21±1.55mm), and the length diameter/short diameter (L/S) of the metastasis group(1.90±0.66) was shorter than the nonmetastasis group(2.41±1.20), significantly (P<0.05). There were statistics significances at the differences of the condition of corticomedullary and blood distribution of SLN between the metastasis group and the nonmetastasis group (P<0.05). The metastasis group showed thicker cortex.blurry corticomedullary demarcation and nonhilar vascularity,while the nonmetastasis group showed clear corticomedullary demarcation and hilus vascularity. There were no statistics significances at differences of the transverse diameter, vertical diameter, shape and hilus of SLN between the diagnostic method of conventional ultrasound and CEUS combining with conventional ultrasound (P>0.05).4. There were no statistics significances at differences of the breast masses locations, anteroposterior diameter, transverse diameter, vertical diameter, color doppler flow imaging, resistance, index, pathologic type, estrogen receptor, progesterone receptor, HER-2between the metastasis group and the nonmetastasis group (P>0.05)5. The accuracy, sensitivity, and specificity of conventional ultrasound in diagnosing SLN of breast cancer were61.2%%36.8%、78.6%respectively, and that of CEUS were72.3%%57.9%、82.1%, and that of CEUS combining with conventional ultrasound were83.0%%、63.1%、96.4%.There was statistic difference between conventional ultrasound and CEUS combining with conventional ultrasound in diagnosing SLN of breast cancer (P<0.05).There was no statistic difference in diagnosing SLN of breast cancer between CEUS and CEUS combining with conventional ultrasound (P>0.05).There was no statistic difference in diagnosing SLN of breast cancer between conventional ultrasound and CEUS (P>0.05)6. The area under the ROC curve (AUC) of conventional ultrasound, CEUS, CEUS combining with conventional ultrasound in diagnosing SLN of breast cancer were0.70、0.72、0.89. There was statistic difference of AUC between conventional ultrasound and CEUS combining with conventional ultrasound (P<0.05). There was statistic difference of AUC between CEUS and CEUS combining with conventional ultrasound (P<0.05) There was no statistic difference of AUC between conventional ultrasound and CEUS (P>0.05)7. Comparing with conventional ultrasound, additional value of CEUS combining with conventional ultrasound was about48.9%(23/47) in diagnosing SLN of breast cancer. Comparing with conventional ultrasound, there were additional values of CEUS combining with conventional ultrasound in diagnosing SLN of breast cancer for different locations, pathological types, sizes, molecular subtypes, and there were no statistic differences (P>0.05). Conclusion 1. The accuracy, sensitivity, specificity, and AUC of CEUS combining with conventional ultrasound in diagnosing SLN of breast cancer is higher than single application of the two methods.2. Comparing with conventional ultrasound, there are additional values of CEUS combining with conventional ultrasound in diagnosing SLN of breast cancer, which improve the diagnostic confidence.