Lymphatic and Vascular Dual-System Super-Resolution Ultrasound for Diagnosing Sentinel Lymph Node Metastasis in...

To develop and validate a non-invasive diagnostic model for sentinel lymph node (SLN) metastasis in breast cancer using lymphatic and vascular dual-system super-resolution ultrasound (SRUS).

In this prospective study, 54 patients scheduled for SLN biopsy underwent conventional axillary ultrasound followed by dual-system SRUS, including lymphatic contrast-enhanced SRUS (L-CESRUS) and vascular contrast-enhanced SRUS (V-CESRUS). Quantitative parameters were extracted, and variables with p < 0.05 in univariate analysis were included in multivariate logistic regression to construct three models: L-CESRUS, V-CESRUS, and an integrative dual-system model. Diagnostic performance was evaluated against histopathology using AUC, sensitivity, specificity, and accuracy.

Among 58 SLNs (from 54 patients), 24 (41.4%) were metastatic. Independent predictors included: in the lymphatic system, lower cortical lymphatic sinus density ratio (p = 0.003), larger maximum and mean cortical sinus distances (p = 0.022, p = 0.024); in the vascular system, higher cortical blood volume (p = 0.027), higher maximum cortical vessel density ratio (p = 0.037), and lower whole-node mean blood flow velocity (p = 0.007). The dual-system model achieved an AUC of 0.962 (95% CI: 0.920-1.000, p < 0.001), with 95.83% sensitivity and 82.35% specificity, significantly outperforming L-CESRUS (AUC = 0.880), V-CESRUS (AUC = 0.801), and conventional ultrasound.

The integrative dual-system SRUS model enables highly accurate, non-invasive preoperative diagnosis of SLN metastasis in breast cancer.