Validation of Contrast Enhanced Ultrasound Technique to Wire Localization of Sentinel Lymph Node in Patients with Early Breast Cancer

Abstract

Axillary staging is one of the primary steps in management of Breast cancer patients. Current standard methods including blue dye and radicolloid have limitations and disadvantages. In this study, the feasibility of visualization of lymph node pathways and localization of SLN with the help of CEUS was assessed. 50 patients with early breast cancer diagnosis underwent CEUS and wire localization, methylenblue dye, and isotope scan methods for SLN detection. The pathology findings of the wired SLN were compared with those obtained from, methylenblue dye, and isotope scan methods. Lymph node wiring was successfully performed in 48 patients.Radio-isotope technique detected SLN in all 50 patients while blue-dye succeeded in 48. Sensitivity of CEUS to detect SLN compared with radio-isotope and blue dye methods was 96 % and 100 %, respectively. Considering costs and facilities required to perform radio-isotope technique and complications of blue dye we may accept CEUS with the help of micro-bubble contrasts as a viable alternative. However, more studies with larger sample volumes, using various drugs, and including non-selective population are warranted to better clarify feasibility and accuracy of this technique in comparison with current methods.

Network meta‐analysis of novel and conventional sentinel lymph node biopsy techniques in breast cancer

“…Of 567 studies identified from the initial search, 35 cohort studies (4244 subjects) satisfied the inclusion and exclusion criteria, and were included in this meta‐analysis (Fig . , Table ).…”

“…, Table ). Among the studies included, 22 15,16,20–23,26,27,30–32,34,35,38–41,43–45,47,49 reported on the performance of ICG, eight on SPIO and five on CEUS. The mean age of included subjects was 57 years.…”

Contrast‐enhanced ultrasound for sentinel lymph node mapping in the routine staging of canine mast cell tumours: A feasibility study

“…In humans, lymphosonography also identifies at least one SLN in 89% to 97% of patients, which is not different from the traditional techniques. 30,[32][33][34] An average of 1.2 (74/62) SLNs per MCT was identified using CEUS, whereas an average of 1.6 (88/54) SLNs per MCT was identified with lymphoscintigraphy/ intraoperative methylene blue, when compiling the cases from two studies. 15,16 It is difficult to compare these figures, but it is possible that the dual-labelled technique truly identifies a higher number of LNs.…”

“…24 The potential of this technique was validated in canine models, [25][26][27][28] prior to application in human patients diagnosed with breast cancer and cutaneous melanoma. [29][30][31][32][33][34] The main advantages are the wide availability of CEUS, low cost, safety and rapid clearance of the contrast, 35 no requirement for general anaesthetic, quick contrast diffusion to the LNs in real-time, 27 the ability to view the fine details of the lymphatics and LNs, 36 and minimal spillover of the contrast to secondary nodes. 28,37 The main disadvantages are the need to select which lymphatic basins to scan, and inter-operator variability.…”

Accuracy of CEUS-guided sentinel lymph node biopsy in early-stage breast cancer: a study review and meta-analysis

“…Of the 16 selected studies, 9 used SonoVue as CEUS material [26][27][28][39][40][41][42][43][44], 6 used Sonazoid [23][24][25][45][46][47], and 1 used DEFINITY [48]. The administration sites and methods of contrast agents mainly include intradermal [23-28, 39-44, 47] and subcutaneous [45,46] injection around areola or peritumoral parenchyma injection approaching the axilla [48].…”