A Study Of Super Microvascular Imaging Technologies For Blood Flow Image Of Axillary Lymph Node In Breast Cancer

Objectives: The objectives of the study were to explore the values of 2D grayscale ultrasound and super microvascular imaging(SMI)in identifying axillary lymph node metastases of breast carcinoma,assess the advantages and values of SMI in judging the blood stream and distribution pattern in lymph nodes,and provide a new thought for identifying the nature of lymph nodes.Methods: 67 axillary lymph nodes of breast cancer patients who met the inclusion criteria were obtained.We used Toshiba Aplio 500 color Doppler ultrasound device,with a 14L5 linear array probe(14.0MHz)and built-in SMI software.First,conventional 2D grayscale ultrasonic examination was performed.Based on 2D ultrasonic examination,color Doppler flow imaging(CDFI)was used to display vessels in lymph nodes.The section with the greatest vascular distribution density in lymph nodes,the most branches and the most abundant blood flow was selected to observe the vascular distribution and record the dynamic images for analysis.Finally,contrast-enhanced ultrasonography(CEUS)was performed to save the dynamic images for further analysis offline.With the pathological examination results as the golden standard for qualitative diagnosis,the sensitivities,specificity,positive prediction rates,negative predication rates and accuracy rates of 2D grayscale ultrasonic examination + CDFI,2D grayscale ultrasonic examination + SMI,and 2D grayscale ultrasonic examination + CEUS for the differential diagnosis of lymph node(benign or malignant)were calculated respectively.By using CEUS as the standard forjudging the result of the type of vascular distribution within lymph nodes,the consistencies between CDFI,SMI and CEUS for the type of vascular distribution within lymph nodes were analyzed.At last,multi-factor logistics regression was conducted on 2D ultrasonography features,the blood distribution type of axillary lymph nodes and spiral vessel evaluated by SMI.Results:(1)With the pathological examination results as the golden standard,the accuracy rate of 2D grayscale ultrasonic examination + CDFI for differentiating malignant from benign lesions were 73.1%,86.6% and89.6%.There was a statistically significant difference in accuracy between2D+CEUS and 2D+CDFI(?2=5.950,P <0.01),between 2D+SMI and2D+CDFI(?2=3.757,P <0.05),and between 2D+CEUS and 2D+SMI(?2=0.284,P >0.05).(2)With the result of microvascular distribution pattern in lymph nodes determined by CEUS as the standard,the consistency of the vascular distributions in lymph nodes between CDFI and CEUS was relatively high(Kappa=0.707<0.75),while that between SMI and CEUS was rather high(Kappa=0.858>0.75).Statistical analysis found that CDFI,SMI and CEUS were highly consistent in terms of judging type II-lymph hilus vascular distribution in lymph nodes,followed by type IV-mixed type.(3)The detection rate of SMI mode for specific spiral vessels in metastatic lymph nodes was 51.6%(16/31),but no such specific spiral vessels were found in benign lymph nodes.(4)The result of multi-factor logistics regression analysis showed that under SMI the OR value of the four blood distribution types in axillary lymph nodes was 24.332,the OR value of spiral vessels in axillary lymph nodes was 23.044,the prediction curve AUC of the regression equations of the two was 0.815(95% CI 0.709~0.921)Conclusion:(1)Both 2D grayscale ultrasonic examination + SMI and 2D grayscale ultrasonic examination + CEUS show statistically significant differences in the accuracy rate of evaluating the nature of axillary lymphnodes when compared with CDFI,but there is no statistically significant difference between SMI and CEUS,suggesting that SMI and CEUS is more advantageous in evaluating the nature of axillary lymph nodes.(2)The consistency between CDFI and SMI in judging vascular distribution in axillary lymph nodes is relatively high,while SMI(Kappa>0.75)achieves higher consistency,suggesting that SMI is more reliable in evaluating vascular distribution in lymph nodes.(3)SMI can clearly display specific spiral vessels in metastatic lymph nodes and the OR value of the univariate logistics regression analysis of spiral vessels under SMI was 18.133,suggesting that SMI in detecting spiral vessels may become an independent risk factor for evaluating the nature of lymph node by ultrasonography.(4)The evaluation on the blood distribution types in axillary lymph nodes under SMI and the multi-factor logistics regression analysis of spiral vessels in axillary lymph nodes suggest that the detection of the two were important factors of predicting the nature of axillary lymph nodes.And the predictive effect is good.