Contrast-Enhanced Ultrasound for Precise Sentinel Lymph Node Biopsy in Women with Early Breast Cancer: A Preliminary Study

Abstract

Background: Sentinel lymph node biopsy (SLNB), as a common method for axillary staging of early breast cancer, has gradually attracted people’s attention to the false-negative rate and postoperative complications. The aim of the study is to investigate the clinical value of preoperative contrast-enhanced ultrasound (CEUS) for intraoperative SLNB in early breast cancer patients. Methods: A total of 201 patients scheduled for SLNB from September 2018 to April 2021 were collected consecutively. Preoperative CEUS was used to identify sentinel lymph nodes (SLN) and lymphatic drainage in breast cancer patients. Results: The SLN identification rate of CEUS was 93.0% (187/201) and four lymphatic drainage patterns were found: single LC to single SLN (70.0%), multiple LCs to single SLN (8.0%), single LC to multiple SLNs (10.2%), and multiple LCs to multiple SLNs (11.8%). The Sen, Spe, PPV, NPV, AUC of CEUS, US and CEUS + US in diagnosis of SLNs were 82.7%, 80.4%, 73.8%, 87.4%, 0.815; 70.7%, 77.7%, 68.0%, 79.8%, 0.742; and 86.7%, 77.7%, 72.2%, 89.7%, 0.822, respectively. There was no statistically significant difference between the diagnostic performance of CEUS and CEUS + US (p = 0.630). Conclusions: CEUS can be used to preoperatively assess the lymphatic drainage patterns and the status of the SLNs in early breast cancer to assist precision intraoperative SLNB.

The Value of Percutaneous Contrast‐Enhanced Ultrasound in Sentinel Lymph Node Identification, Metastatic Status and Burden Diagnosis in Early Breast Cancer

“…However, it has been demonstrated that preoperative knowledge of the drainage route of the SLC is critical for successful SLNB. 18,20 Drainage patterns of SLC were summarized in our study: In all patients included, we found 4 drainage patterns and 5 drainage subtypes, of which single SLN-single SLC was the most common, which is consistent with the previous study. 20,21 The results of Luo et al provide a more detailed summary of the drainage patterns of SLC, and they classified it into 11 LDPS and 31 subtypes.…”

“…18,20 Drainage patterns of SLC were summarized in our study: In all patients included, we found 4 drainage patterns and 5 drainage subtypes, of which single SLN-single SLC was the most common, which is consistent with the previous study. 20,21 The results of Luo et al provide a more detailed summary of the drainage patterns of SLC, and they classified it into 11 LDPS and 31 subtypes. 22 PCEUS combined with body surface markers showed SLN and LC more visually on the skin surface.…”

Ultrasound contrast-enhanced patterns of sentinel lymph nodes: predictive value for nodal status and metastatic burden in early breast cancer

“…Our study shows that CEUS is a feasible preoperative localization method for SLN, with a detection rate of 95.7% (88/92). However, consistent with other studies, the average number of SLNs per patient identified by CEUS (1.23) was significantly less than that of SLNs identified by MB/ICG (2.63) (19,20). This finding may be related to the inherent properties of commonly used intraoperative SLN tracers, such as MB.…”

“…First, a lowfrequency linear probe (3-9 MHz) was used for all ultrasound examinations. Although this probe provides the best SLN visualization on the Philips iU22 scanner (18,19), a higher resolution ultrasound probe could further improve the reliability of our results when initially recruiting patients using B-mode ultrasound. Second, the surface markers were used in the CEUS identification SLN procedure.…”

“…Although there is currently no consensus on the number of SLNs that should be resected, the larger the number of lymph nodes removed intraoperatively, the higher the risk of developing complications post-surgically (8). Translymphatic CEUS makes it easier to identify true SLNs by displaying them in real-time, and it can avoid damaging draining lymphatic channels by guiding the selection of surgical incisions, which could potentially reduce the false-negative rates of SLNB (19).…”