Percutaneous Sonazoid-enhanced ultrasonography combined with in vitro verification for detection and characterization of sentinel lymph nodes in early breast cancer
Open Access
- 27 January 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in European Radiology
- Vol. 31 (8), 5894-5901
- https://doi.org/10.1007/s00330-020-07639-2
Abstract
Objectives: To assess the efficacy of percutaneous Sonazoid-enhanced ultrasound and in vitro verification for identification sentinel lymph nodes (SLNs) and diagnosis of metastatic SLNs in patients with early breast cancer (BC). Methods: Sixty-eight patients with early BC were enrolled finally. After the induction of general anesthesia, 0.4 ml of Sonazoid (SNZ), a new second-generation tissue-specific ultrasound contrast agent (UCA), mixed with 0.6 ml of methylene blue, was injected intradermally. The lymphatic vessels and connected SLNs were immediately observed and marked. After being resected, these SLNs were soaked in saline water and examined still in the mode of contrast-enhanced ultrasound (CEUS) in vitro. This procedure could ensure that all the enhanced nodes had been removed as much as possible. The numbers of SLNs detected by UCA and blue dye were recorded. The enhancement patterns of SLNs were compared with the final pathological results. Results: SLNs detection rate by SNZ-CEUS was 100%, which was higher than that by blue dye (95.59%). CEUS identified a median of 1.5 nodes, while blue dye identified a median of 1.9 nodes per case (p = 0.0012). When homogeneous high perfusion and complete annular high perfusion were regarded as negative nodes, the sensitivity and negative predictive value were 92.31% and 96.79% respectively, while the specificity was 84.21%. Conclusions: Percutaneous SNZ-enhanced ultrasonography combined with in vitro verification is a feasible and reliable method for SLNs identification intraoperatively. Enhancement patterns can be helpful in determining the status of SLNs. Key Points: • CEUS with percutaneous injection of Sonazoid can successfully identify SLNs with the rate of 100% in early breast cancer patients, higher than 95.59% of blue dye. • Sonazoid, with high affinity with reticuloendothelial cells, increases the imaging time of SLNs and facilitates biopsy intraoperatively better than Sonovue as a lymphatic tracer. • Homogenous high and complete annular high perfusions have a sensitivity of 92.31% and a negative predictive value of 96.79% in the prediction of uninvolved SLNs.Keywords
Funding Information
- National Major Science and Technology Projects of China (2016YFC0105003)
- Hospital clinical key project incubation project (BYSY2018017)
This publication has 37 references indexed in Scilit:
- Validation of a technique using microbubbles and contrast enhanced ultrasound (CEUS) to biopsy sentinel lymph nodes (SLN) in pre-operative breast cancer patients with a normal grey-scale axillary ultrasoundEuropean Journal of Surgical Oncology, 2013
- Gray-scale contrast-enhanced utrasonography in detecting sentinel lymph nodes: An animal studyEuropean Journal of Radiology, 2010
- Preoperative localization of sentinel lymph nodes using intradermal microbubbles and contrast-enhanced ultrasonography in patients with breast cancerBritish Journal of Surgery, 2009
- Microbubble Stability is a Major Determinant of the Efficiency of Ultrasound and Microbubble Mediated in vivo Gene TransferJapanese Journal of Clinical Oncology, 2009
- Physicochemical Characteristics of Sonazoid™, A New Contrast Agent for Ultrasound ImagingJapanese Journal of Clinical Oncology, 2008
- Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomised phase III trialThe Lancet Oncology, 2007
- Surgical Complications Associated With Sentinel Lymph Node Dissection (SLND) Plus Axillary Lymph Node Dissection Compared With SLND Alone in the American College of Surgeons Oncology Group Trial Z0011Journal of Clinical Oncology, 2007
- Phagocytosis of ultrasound contrast agent microbubbles by Kupffer cellsJapanese Journal of Clinical Oncology, 2007
- Sentinel node detection in breast cancer using contrast‐enhanced sonography with 25% albumin—Initial clinical experienceJournal of Clinical Ultrasound, 2006
- Breast Cancer in Limited-Resource Countries: An Overview of the Breast Health Global Initiative 2005 GuidelinesThe Breast Journal, 2006