Differential diagnostic study of CEUS &quot;ring-target sign&quot; enhancement characteristics and microbubble kinetic parameters in breast cancer metastatic axillary lymph nodes

Qiao Yuting; Zhong Jifeng

doi:10.16689/j.cnki.cn11-9349/r.2026.02.011

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Electronic Journal of Metabolism and Nutrition of Cancer ›› 2026, Vol. 13 ›› Issue (2) : 251-260. DOI: 10.16689/j.cnki.cn11-9349/r.2026.02.011

Original Articles

Differential diagnostic study of CEUS "ring-target sign" enhancement characteristics and microbubble kinetic parameters in breast cancer metastatic axillary lymph nodes

Qiao Yuting, Zhong Jifeng

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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.

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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Qiao Yuting, Zhong Jifeng. Differential diagnostic study of CEUS "ring-target sign" enhancement characteristics and microbubble kinetic parameters in breast cancer metastatic axillary lymph nodes[J]. Electronic Journal of Metabolism and Nutrition of Cancer. 2026, 13(2): 251-260 https://doi.org/10.16689/j.cnki.cn11-9349/r.2026.02.011

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