目的 探讨对比增强超声(CEUS)“环靶征”强化特征联合微泡动力学参数对乳腺癌腋窝转移性淋巴结的鉴别诊断价值,并分析其与血管生成及免疫微环境的相关性。方法 前瞻性纳入2025年1月至12月130例乳腺癌患者(转移组与非转移组,各65例),所有患者术前接受腋窝淋巴结CEUS检查,记录“环靶征”等定性特征及峰值强度(PI)、达峰时间(TTP)等定量参数。以术后病理为金标准,比较两组间影像学、微血管密度(MVD)及免疫指标差异,采用多因素Logistic回归筛选独立预测因素。结果 转移组“环靶征”检出率显著高于非转移组(P＜0.001),且其PI更高(P＜0.001)、TTP更短(P＜0.001)。多因素分析显示“环靶征”(OR=6.42)、PI升高及TTP缩短是淋巴结转移的独立影响因素。转移组MVD显著增高(P＜0.001),且PI与MVD呈正相关(r=0.62)。 联合指标诊断效能显著提升(AUC=0.92,敏感度86.2%,特异度89.2%)。结论 CEUS“环靶征”与微泡动力学参数(PI增高、TTP缩短)可作为乳腺癌腋窝淋巴结转移的敏感影像学标志,其与肿瘤血管生成及免疫微环境改变密切相关,二者结合有助于提升诊断精准度。
Abstract
Objective To investigate the differential diagnostic value of contrast-enhanced ultrasound (CEUS) "ring-target sign" enhancement characteristics combined with microbubble kinetic parameters for breast cancer metastatic axillary lymph nodes, and to analyze their correlation with angiogenesis and the immune microenvironment. Methods A total of 130 breast cancer patients (65 each in the metastatic and non-metastatic groups) were prospectively enrolled from January to December,2025. All patients underwent preoperative CEUS examination of axillary lymph nodes. Qualitative features such as the "ring-target sign" and quantitative parameters including peak intensity (PI) and time to peak (TTP) were recorded. Using postoperative pathology as the gold standard, differences in imaging features, microvessel density (MVD), and immune markers between the two groups were compared. Multivariate logistic regression was used to screen independent predictive factors. Results The detection rate of the "ring-target sign" was significantly higher in the metastatic group than in the non-metastatic group (P<0.001). Furthermore, the metastatic group exhibited higher PI (P<0.001) and shorter TTP (P<0.001). Multivariate analysis identified the "ring-target sign" (OR=6.42), elevated PI, and shortened TTP as independent factors influencing lymph node metastasis. MVD was significantly increased in the metastatic group (P<0.001), and PI showed a positive correlation with MVD (r=0.62). The diagnostic efficacy of the combined indicators has been significantly improved (AUC=0.92, sensitivity 86.2%, specificity 89.2%). Conclusion The CEUS "ring-target sign" combined with microbubble kinetic parameters (elevated PI, shortened TTP) can serve as sensitive imaging markers for breast cancer metastatic axillary lymph nodes. These markers are closely associated with tumor angiogenesis and alterations in the immune microenvironment. Their combined application contributes to enhanced diagnostic accuracy.
关键词
对比增强超声 /
环靶征 /
微泡动力学参数 /
乳腺癌 /
腋窝淋巴结转移 /
微血管密度 /
肿瘤免疫微环境 /
诊断效能
Key words
Contrast-enhanced ultrasound /
Ring-target sign /
Microbubble kinetic parameters /
Breast cancer /
Axillary lymph node metastasis /
Microvascular density /
Tumor immune microenvironment /
diagnostic efficacy
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