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目的探讨超声造影技术在显示乳腺癌前哨淋巴通道(SLC)及前哨淋巴结(SLN)多样性中的应用价值。方法女性乳腺癌患者26例,术前均接受乳晕及深层腺体内注射超声造影剂行超声造影探查SLC和SLN。术中于乳晕及深层腺体内注射亚甲蓝,术后解剖蓝染的SLC和SLN,并进一步将超声造影探及的SLN及蓝染的SLN送病理检查。结果用超声造影技术,26例患者探及至少1条SLC及1个SLN。探及到3种类型的SLC,分别为浅层前哨淋巴通道(SSLC)、穿支前哨淋巴通道(PSLC)和深层前哨淋巴通道(DSLC)。探及到5种淋巴引流模式(LDP),分别为SSLC、PSLC、SSLC+PSLC、SSLC+DSLC和SSLC+PSLC+DSLC。超声造影探及的LDP与手术LDP相一致的患者为24例(92.31%)。6例患者探及到分叉的SLC;3例患者探及到中断的SLC,且相对应的SLN没有强化;术后病理证实该3例患者腋窝淋巴结均有癌转移。结论超声造影在术前评估乳腺癌SLC和SLN多样性中具有一定的可行性,并且对进一步SLN活检具有指导意义。
Objective To investigate the value of contrast-enhanced ultrasound in the display of the diversity of sentinel lymph node (SLC) and sentinel lymph node (SLN) in breast cancer. Methods Twenty-six women with breast cancer were enrolled in this study. All patients underwent both areola and deep glandular injection of contrast-enhanced ultrasound for SLC and SLN. During surgery, methylene blue was injected into the areola and deep glands. SLC and SLN were dissected blue after operation, and SLN and blue stained SLN detected by ultrasonography were further sent for pathological examination. Results With contrast-enhanced ultrasound, 26 patients were screened for at least 1 SLC and 1 SLN. Three types of SLC were explored, which are superficial sentinel lymph node (SSLC), sentinel lymph node (PSLC) and deep sentinel lymph node (DSLC). Explore five kinds of lymphatic drainage patterns (LDP), respectively SSLC, PSLC, SSLC + PSLC, SSLC + DSLC and SSLC + PSLC + DSLC. Twenty-four patients (92.31%) were found to be consistent with LDP of surgical exploration by contrast-enhanced ultrasound. Six patients were probed into bifurcated SLC. Three patients were probed into the interrupted SLC, and the corresponding SLNs were not strengthened. Postoperative pathology confirmed the axillary lymph node metastasis in the three patients. Conclusion Contrast-enhanced ultrasound (CEUS) is a feasible method for the preoperative evaluation of SLC and SLN diversity in breast cancer, and is of guiding significance for further SLN biopsy.