The application value of ultrasound guided wire-localization of suspicious lymph nodes in detecting sentinel lymph node status in breast cancer
Objective To explore the value of ultrasound guided wire-localization of suspicious lymph nodes combined with sentinel lymph node biopsy(SLNB)in detecting axillary lymph node(ALN)metastasis in early breast cancer.Methods A total of 313 breast cancer patients from Junurary 2015 to April 2021 were enrolled in this study.The patients were applied with ultrasound guided wire-localization of suspicious lymph nodes before operation.SLNB and ultrasound-localized suspicious lymph node biopsies were performed during surgery.The sentinel lymph node(SLN)and suspicious lymph nodes were divided into two groups for pathological diagnosis.The difference of node status prediction between SLNB and SLNB with axillary suspicious lymph node biopsy was compared.Results All 313 patients underwent ultrasound guided wire localization of suspicious lymph nodes and methylene blue staining before surgery.Ultrasound guided wire localization was successful in 312 cases,with a detection rate of 99.7%(312/313).Two hundred and seventy-nine cases were successfully stained with methylene blue,with a detection rate of 89.1%(279/313).The pathology proved that 166 suspected lymph nodes were confirmed as SLN during surgery,with a coincidence rate of 53.0%(166/313).There were 258 cases with pathological diagnosis of negative ALN,and 55 cases of ALN were positive.Among them,44 cases were SLNB positive,and 55 cases were SLNB combined with positive suspicious metastatic lymph nodes.There were 11 cases of false negatives in SLNB,the false negative rate was 20.0%(11/55),the sensitivity was 80.0%(44/55),and the accuracy rate was 96.1%(268/279).By contrast,SLNB with axillary suspicious node biopsy showed the false-negative rate of 0,the sensitivity of 100.0%(55/55)and the accuracy rate of 100.0%(313/313).SLNB combined with suspicious lymph node biopsy could significantly reduce the occurrence of false negative result(P<0.001).The Kappa value for consistency testing between the two methods was 0.865(P<0.001).Conclusion Ultrasound guided wire-localization of suspicious lymph nodes combined with SLNB is better than simple SLNB in predicting the ALN status of early breast cancer,and methylene blue in combination with ultrasound guided wire-localization of suspicious lymph nodes is easy to operate,which has better security and application prospects.
Breast cancerSuspicious lymph node biopsyUltrasound guided wire-localizationSentinel lymph node biopsy
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