经皮超声造影提示前哨淋巴结性质对腋窝淋巴结良恶性评估的价值
Value of features of sentinel lymph node revealed by subcutaneous contrast-enhanced ultrasound for identifying malignant and benign axillary lymph nodes

目的 探索经皮超声造影可否提示前哨淋巴结（SLN）性质以及对腋窝淋巴结良、恶性评估的价值。方法 无菌条件下建立兔乳腺癌模型，于接种肿瘤后第6周对兔的乳腺肿块周围皮下注射造影剂，判断淋巴结的性质，并于体表进行标记；30 min后注射纳米活性炭，观察SLN超声造影表现，判断其良、恶性，并在兔体表进行标记；观察结束后处死实验动物，解剖出肿块并做腋窝淋巴结清扫，所有淋巴结送病理检查。结果 10只兔20个乳腺共产生16个肿瘤，这16侧中发生转移的有11侧，未发生转移的5侧。共送检了17枚SLN，超声造影发现了94.12%(16/17)。经皮超声造影诊断恶性淋巴结灵敏度为80.0%，特异度为71.42%，阳性预测值为80.0%，阴性预测值为71.42%，准确率为76.47%。超声造影诊断恶性SLN与病理诊断差异性检测（McNemar检测）P=0.688；Kappa值为0.514，P=0.034，两者具有较好的一致性。结论 经皮超声造影诊断乳腺癌恶性SLN具有较高的诊断价值，可提示腋窝淋巴结转移情况。
： Objective To investigate whether subcutaneous contrast-enhanced ultrasound can identify the features of sentinel lymph node (SLN) and the value for identifying malignant and benign axillary lymph nodes. Methods The rabbit model of breast cancer was established under sterile condition. Contrast enhanced agent was injected around the breast tumor subcutaneously after tumors were inoculated for six weeks. The features of lymph nodes were identified and marks were made on the skin. Activated nono-carbon particles were injected after 30 min. Results of contrast-enhanced ultrasound of SLNs were observed. Malignant and benign SLNs were identified and marks were made on the skin. Rabbits were sacrificed after observation and tumors were harvested. The axillary lymphadenectomy was conducted and pathological examination was performed for all lymph nodes. Results A total of 16 tumors were found in 20 breasts of 10 rabbits and 11 of them metastasized and 5 of them did not metastasize. The subcutaneous contrast-enhanced ultrasound detected 16 of 17 SLNs (94.12%). The sensitivity, specificity, PPV, NPV, and accuracy of subcutaneous contrast-enhanced ultrasound for diagnosing malignant lymph nodes were 80.0%, 71.42%, 80.0%, 71.42%, and 76.47% respectively. The P value between contrast-enhanced ultrasound and differential test of pathological diagnosis (McNemar test) for diagnosing malignant SLNs was 0.688. Two methods were consistent with Kapp=0.514 and P=0.034. Conclusion Subcutaneous contrast-enhanced ultrasound is valuable for diagnosing malignant SLNs of breast cancer and can reveal the metastasis of axillary lymph nodes