Contrast Analysis Between Contrast-guided Puncture And Intraoperative Resection Biopsy In Pathological Evaluation Of Sentinel Lymph Nodes In Breast Cancer

Objective: In recent years,the incidence of breast cancer in women has increased year by year,accounting for the first incidence of malignant tumors in women,is the most common malignant tumor in women in the world,and has become the largest killer affecting women’s health.With the improvement of people’s economic income and the strengthening of medical examination consciousness,and the replacement of medical equipment,breast cancer patients are diagnosed before metastasis occurs.There is no doubt that the mortality rate of breast cancer does not increase with the increase of morbidity.On the contrary,the mortality rate is decreasing gradually,which is closely related to the comprehensive treatment and individualized treatment of breast cancer.Comprehensive treatment of axillary lymph nodes(axillary lymph node,ALN)pathological state of breast cancer is an important basis for breast cancer staging.It has important reference value for guiding doctors’ treatment plan,operation method and postoperative comprehensive treatment to evaluate the prognosis of patients.Sentinel lymph node(sentinel lymph node,SLN)metastasis determines the management of axillary lymph nodes.Based on this theory,sentinel lymph node biopsy(sentinel lymph node biopsy,SLNB)emerged.If pathological confirmation SLN no metastasis occurs,breast cancer patients can be exempted from axillary lymph node dissection(axillary lymph node dissection,ALND),which can greatly reduce the probability of edema,movement and sensory abnormalities caused by ALND,thus greatly improving the quality of life of breast cancer patients after operation.If the SLN pathological state can be accurately judged before operation,it can also save the operation time under the guidance of ultrasound.The real-time and dynamic tracking of lymph nodes and lymph nodes enhanced by contrast agent under the guidance of ultrasound is called contrast enhancement(contrast-enhanced ultrasound,CEUS)technique.It is a new technique with minimally invasive and efficient advantages to evaluate the pathological state of breast cancer SLN and has great development prospect.At present,Sulphur Hexafluoride Microbubbles(Sono Vue)are the most common ultrasound contrast agents in clinic.The purpose of this study was to obtain the optimal scheme for determining the pathological status of SLN by comparing the preoperative puncture pathology with postoperative paraffin pathology.Methods: 40 patients with early breast cancer(T1-2N0M0)at the breast clinic of Harrison International Peace Hospital from January 2019 to December 2020 were selected.Each patient was treated with Sulfur Hexafluoride Microbubble contrast agent combined with ultrasound to guide preoperative SLNB and intraoperative frozen pathology.Finally,the consistency between preoperative puncture pathology and paraffin pathology and intraoperative frozen pathology and paraffin pathology were compared.Results:1.A total of 40 cases were enrolled in the experiment,of which 2 cases were not developed and 38 cases were developed during preoperative puncture.Preoperative puncture SLNS see cancer metastasis detected in 3 cases,35 cases no cancer metastasis,consistent with the postoperative paraffin in 33 cases,diagnosis coincidence rate 87%(33/38),inconsistent has 5 cases including preoperative biopsy did not see cancer metastasis and paraffin pathology see transfer carcinoma,3 cases of preoperative biopsy in abnormal cells in paraffin pathology in cancer metastasis in 2 cases.The Kappa value of preoperative puncture was 0.48 by Kappa consistency test analysis,suggesting that preoperative puncture and postoperative paraffin pathology were moderately consistent.2.SLN was not developed in 1 case and 39 cases during freezing during operation.Intraoperative frozen SLNS see cancer metastasis is detected in 5cases,34 cases no cancer metastasis,consistent with the postoperative paraffin in 37 cases,diagnosis coincidence rate 94%(37/39),inconsistent with 2 cases including intraoperative frozen pathological no cancer metastasis and paraffin pathology see cancer metastasis in 1 case,intraoperative frozen heterotypic cells in 1 case and paraffin pathology in cancer metastasis.Kappa consistency test analysis showed that the intraoperative freezing Kappa value was 0.80,suggesting that preoperative puncture and postoperative paraffin pathology were highly consistent.Conclusions:1.The consistency between preoperative puncture and postoperative paraffin pathology was lower than that between intraoperative freezing and postoperative paraffin pathology.2.Preoperative puncture and intraoperative freezing were compared with postoperative paraffin pathology to a certain extent.Microvesicle contrastenhanced ultrasound guided preoperative puncture is also an option for SLNB.It is not only limited to early breast cancer SLNB,but also can be used in SLNB before neoadjuvant therapy for locally advanced breast cancer,to provide a basis for clinical treatment decisions.3.Whether microbubble ultrasound-guided SLNB can become a more efficient,more accurate and ultra-micro creative new technology for clinical application still needs a large number of high-quality prospective studies with large samples to provide a more convincing answer.