Variation of sentinel lymphatic channels (SLCs) and sentinel lymph nodes (SLNs) assessed by contrast-enhanced ultrasound (CEUS) in breast cancer patients

Abstract

BackgroundThe objective of this study was to assess the feasibility of detecting the variation of sentinel lymphatic channels (SLCs) and sentinel lymph nodes (SLNs) in breast cancer patients using contrast-enhanced ultrasound (CEUS).MethodsA total of 46 breast cancer patients were prospectively recruited in the study. All the participants received intradermal and peritumoral injection of microbubbles as contrast agent, and SLCs and SLNs were assessed preoperatively. Blue dye was injected subareolarly and peritumorally during the surgery. The SLNs detected by CEUS and blue dye were sent to the pathology laboratory for histopathological analysis.ResultsAt least one SLC and SLN were detected by CEUS in all 46 cases. Three types of SLCs were detected, including superficial sentinel lymphatic channels (SSLCs), penetrating sentinel lymphatic channels (PSLCs), and deep sentinel lymphatic channels (DSLCs). Five lymphatic drainage patterns (LDPs) were found, including SSLC, PSLC, SSLC + PSLC, SSLC + DSLC, and SSLC + PSLC + DSLC. Only SSLC was detected on CEUS in 24 cases; only PSLC was detected in 3 cases; both SSLC and PSLC were detected in 8 cases; both SSLC and DSLC were detected in 7 cases; SSLC, PSLC, and DSLC were all detected in the remaining 4 cases. An actual LDP was defined on the combination of CEUS and dissection of the specimen. The accuracy rate of CEUS was 43/46. Interestingly, a bifurcated SLC was found in 8 patients. In 3 patients, a discontinuous SLC and non-enhanced SLN were found by CEUS. Also, no dyed SLNs were detected during the surgery. The axillary lymph nodes turned out tumor involved histologically.ConclusionCEUS is feasible to assess the variation of SLCs and SLNs preoperatively in breast cancer patients. SLNB is not suggested when a discontinuous SLC and non-enhanced SLN were detected by CEUS.

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.…”

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

“…Some studies showed that CEUS can further improve identification of SLN and reduce SLNB surgical trauma [23][24][25][26]. However, some studies suggested that the false negative rate of SLNB guided by CEUS alone is high and the diagnostic accuracy is low [27,28]. Since the difference in accuracy of assessing axillary status between CEUS-guided SLNB and conventional SLNB is not clear, this meta-analysis reviews the reported studies focusing on SLNB guided by CEUS, further analyzes the difference in the positive rate between SLNs identified by CEUS and SLNs identified not by CEUS, and also analyzes the accuracy of SLN identified by CEUS in diagnosing the pathological status of overall axillary sentinel nodes, in order to explore whether CEUS can further improve the accuracy of sentinel lymph node biopsy.…”

“…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].…”

“…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]. SLN localization methods are diversified, including skin labeling [23,27,41,42,[44][45][46][47], guidewire localization [25,26,40,43,48], labeled peptide clip localization [28], iodine-125 seed implantation [39], and ultrasound-guided fluorescent dye injection [24]. Seven studies used the isotope-dye dual tracer method as a comparator [23,27,39,43,45,46,48], while another nine studies were compared with the simple dye method [24-26, 28, 40-42, 44, 47].…”