The value of contrast‐enhanced ultrasound in determining the location of sentinel lymph nodes in breast cancer

Abstract

Background This study aimed to explore the sentinel lymph node (SLN) identification rate in breast cancer by subcutaneous and intradermal injection of ultrasound contrast agent in the mammary areola region, compared to the results achieved with methylene blue (MB). Methods A total of 390 breast cancer patients with planned sentinel lymph node biopsy from our breast surgery department from July 2017 to February 2019 were enrolled. All patients were subjected to preoperative contrast-enhanced ultrasound (CEUS), that involved an intracutaneous injection of 1 mL ultrasonic contrast agent (UCA) at 3 and 6 o ‘clock, as well as a subcutaneous injection of 1 mL UCA at 9 and 12 o’clock. The enhanced lymph nodes along the enhanced lymphatic vessels from the mammary areola were traced. The number of enhanced lymph nodes were recorded, and an ultrasound-guided injection of 1:10 diluted carbon nanoparticles were used to mark all first site enhanced lymph nodes (i.e., SLNs). An intraoperative dye method (MB) was used to track the SLNs and the results were compared with the CEUS findings. Results Among the 390 cases of breast cancer, enhanced SLNs were observed in 373 patients after an injection of UCA with an identification rate of 95.64 % (373/390), compared to the identification rate of 92.05 % (359/390) using the intraoperative MB. The difference between the two methods was statistically significant (P = 0.016). And among the 390 patients, a total of 808 enhanced lymph nodes were traced by preoperative CEUS, with a median of 2 (1,3). A total of 971 blue-stained lymph nodes were traced using the intraoperative MB, with a median of 2 (2,3), indicating a statistically significant difference (p < 0.001). Conclusions Intradermal and subcutaneous injections of UCA in the mammary areola region may have clinical application value for the identification and localization of SLNs in breast cancer patients. The identification rate is higher than that of blue dye method, which can be used as a new tracer of sentinel lymph node biopsy and complement other staining methods to improve the success rate.

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

“…In our study, the average number of SLNs identified by CEUS per patient was significantly less than those detected by MB (Z = −11.37, p < 0.001), which is also reflected in the results of other related studies [18,20]. MB, as small molecules, tend to diffuse into secondary lymph nodes, or dye spillage causes blue staining of the tissue and lymph nodes around SLNs, making it difficult to distinguish real SLN from non-SLN.…”

“…Therefore, we hypothesized that patients who failed to trace SLN with CEUS had little chance of successful intraoperative tracing. Meanwhile, it has been shown that CEUS could identify SLN that could not be detected by blue staining, further proving that CEUS is a simple and highly reproducible SLN tracer technology [20].…”

Study on Sentinel Lymph Node and Its Lymphatic Drainage Pattern of Breast Cancer by Contrast‐Enhanced Ultrasound

“…However, many studies have confirmed that CEUS could be used to identify and locate SLN of breast cancer safely 14–20 . Besides, our previous research also confirmed its feasibility 21 …”

“…[14][15][16][17][18][19][20] Besides, our previous research also confirmed its feasibility. 21 At present, there are many studies on the evaluation of breast cancer SLN metastasis by CEUS, but only few studies have been done on lymphatic drainage pattern (LDP). 16,22,23 This study focuses on analyzing the basic characteristics of SLN and SLC in breast cancer and summarizing the LDP to improve the accuracy of SLNB.…”

Diagnostic Significance of 3D Automated Breast Volume Scanner in a Combination with Contrast-Enhanced Ultrasound for Breast Cancer

“…Studies on the effectiveness of the ABUS in the prediction of breast cancer have been conducted in recent years. These results showed that the detection rate, sensitivity, and specificity of ABUS in the diagnosis of breast cancer are more than that of MTR, but whether it is higher than HHUS is still controversial [6][7][8]. Some studies showed that ABUS and HHUS did not show considerable differences in prediction of cancer in breast and specificity, detection rate, and sensitivity [9].…”