探讨超声造影（CEUS）联合声触诊组织成像定量（VTIQ）技术在术前评估乳腺癌前哨淋巴结（SLN）转移中的临床价值。

收集2019年6月至2020年1月因乳腺癌收住哈尔滨医科大学附属第一医院的患者，共72例患者的72个SLN纳入研究。所有患者均行手术治疗并取得病理结果，术前均行常规超声、CEUS及剪切波弹性成像检查。根据术后病理结果将SLN分为转移组21个和非转移组51个。比较2组SLN的超声造影模式及VTIQ剪切波速度（SWV）值。绘制ROC曲线比较超声造影、SWV及联合诊断预测乳腺癌SLN转移的效能。

转移性SLN与非转移性SLN的CEUS增强模式比较，差异有统计学意义（χ²=25.53，P=0.000），2组VTIQ的SWV最大、最小、平均值比较，差异均有统计学意义（t=7.79、7.12、8.75，P均=0.000）。CEUS判断SLN转移的ROC曲线下面积（AUC）为0.829，最佳截断值为1.5，即I型增强模式为非转移性，II、III、IV型增强模式为转移性。以最佳截断值为SLN转移的判定标准，敏感度、特异度、阳性预测值、阴性预测值分别为85.71%、70.59%、54.54%、92.31%。绘制SWV最大值、最小值及平均值诊断SLN转移的ROC曲线，AUC分别为0.910、0.873、0.937，最佳截断值分别为3.06、2.23、2.64 m/s。以SWV平均值2.64 m/s为判定标准，敏感度、特异度、阳性预测值和阴性预测值分别为76.19%、94.23%、88.89%和90.74%。联合CEUS与VTIQ诊断SLN转移的敏感度、特异度、阳性预测值、阴性预测值分别为95.24%、96.08%、90.91%、96.08%。绘制CEUS与VTIQ联合方法诊断SLN转移的ROC曲线，AUC为0.957。

CEUS联合VTIQ技术可以提高乳腺癌淋巴结转移的诊断效能，为乳腺癌术前腋窝淋巴结评估提供可靠依据。

To explore the clinical value of contrast-enhanced ultrasound (CEUS) combined with virtual?touch?tissue?imaging?and?quantification (VTIQ) in the preoperative evaluation of sentinel lymph node (SLN) metastasis inbreast cancer.

Seventy-two patients with 72 SLNs admitted to the First Affiliated Hospital of Harbin Medical University from June 2019 to January 2020 were included in the study. All patients underwent surgical treatment to obtain pathological results. All patients underwent routine ultrasound, CEUS, and shear wave elastography before operation. According to the postoperative pathological results, SLNs were divided into either a metastatic group (n=21) or a non-metastatic group (n=51). Contrast-enhanced ultrasound mode and VTIQ shear wave velocity (SWV) of SLNs were compared between the two groups. ROC curve analysis was performed to compare the performance of CEUS, SWV, and combined diagnosis in predicting SLN metastasis in breast cancer.

The CEUS enhancement mode differed significantly between metastatic and non-metastatic SLNs (χ²=25.53, P=0.000), and the differences in the maximum, minimum, and average SWV of VTIQ between the two groups were statistically significant (t=7.79, 7.12, 8.75, P=0.000). The area under ROC curve (AUC) of CEUS for the diagnosis of SLN metastasis was 0.829, and the best cut-off value was 1.5, that is, type I enhancement mode suggested non-metastatic SLN and types II, III, and IV enhancement modes suggested metastatic SLN. The sensitivity, specificity, positive predictive value, and negative predictive value of CEUS were 85.71%, 70.59%, 54.54%, and 92.31%, respectively. ROC curves of maximum, minimum and average SWV for diagnosing SLN metastasis were drawn. The AUCs of maximum, minimum and average SWV for diagnosing SLN metastasis were 0.910, 0.873, and 0.937, respectively, and the best cutoff values were 3.06, 2.23, and 2.64 m/s, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of SWV were 76.19%, 94.23%, 88.89% and 90.74%. The sensitivity, specificity, positive predictive value, and negative predictive value of CEUS combined with VTIQ in diagnosing SLN metastasis were 95.24%, 96.08%, 90.91%, and 96.08%, respectively; the AUC was 0.957.

CEUS combined with VTIQ technique can improve the diagnostic efficiency for lymph node metastasis of breast cancer and provide a reliable basis for axillary lymph node assessment before breast cancer operation.