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Zhu Y, Jia Y, Pang W, Duan Y, Chen K, Nie F. Ultrasound contrast-enhanced patterns of sentinel lymph nodes: predictive value for nodal status and metastatic burden in early breast cancer. Quant Imaging Med Surg 2023; 13:160-170. [PMID: 36620166 PMCID: PMC9816714 DOI: 10.21037/qims-22-234] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 10/07/2022] [Indexed: 11/21/2022]
Abstract
Background In the post-Z0011 era, sentinel lymph node (SLN) status and metastatic burden determine whether axillary management entails conservative sentinel lymph node biopsy (SLNB) or radical axillary lymph node dissection (ALND) in breast cancer patients. However, SLN status and metastatic burden cannot be evaluated preoperatively in clinical practice. This study explored the predictive value of contrast-enhanced ultrasound (CEUS) patterns of SLN to assess the nodal status and metastatic burden in early breast cancer patients. Methods A retrospective study was conducted on 88 consecutive patients who were diagnosed with clinical T1-2N0 breast cancer between December 2020 and November 2021 at the Lanzhou University Second Hospital and scheduled for SLNB. Preoperative CEUS was performed to confirm the location and enhancement pattern of the SLN, and the conventional ultrasonic characteristics of the primary breast lesions and SLN were recorded. Intraoperative localized SLN and postoperative pathological results were used as the gold standard for comparison with preoperative ultrasound findings. Results CEUS successfully identified at least 1 SLN in 88 patients, with a total of 118 SLNs identified in the entire cohort. Univariate analysis showed that lesion size, blood flow grade, SLN longitudinal diameter, cortical thickness, and enhancement pattern were significant predictive features of SLN metastasis. Further multiple regression analysis indicated that the enhancement pattern of the SLN was an independent risk factor for SLN metastasis, with a sensitivity and a specificity of 84.2% (32/38) and 80.0% (40/50), respectively. Meanwhile, the SLN enhancement pattern could predict the lymph node metastasis burden (P<0.001). In patients presenting with a type I (homogeneous enhancement) or type II (heterogeneous enhancement) SLN, 91.5% (65/71) had ≤2 positive SLNs, whereas in patients with a type III (no enhancement) SLN, 70.6% (12/17) had >2 metastatic nodes. Conclusions The contrast-enhanced pattern of the SLN is an independent risk factor for SLN status. Patients presenting with a type I or type II SLN enhanced pattern are unlikely to have high-burden metastases detected at their final surgical treatment and omission of ALND may be appropriate.
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Affiliation(s)
- Yangyang Zhu
- Ultrasound Medicine Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Yingying Jia
- Ultrasound Medicine Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Wenjing Pang
- Ultrasound Medicine Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Ying Duan
- Ultrasound Medicine Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Kundi Chen
- Ultrasound Medicine Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Fang Nie
- Ultrasound Medicine Center, Lanzhou University Second Hospital, Lanzhou, China;,Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
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Luo Y, Chen J, Feng L, Cao W, Wu H, Ma M, He F, Luo J, Wu C, Liu J, Chen Q, Luo J. Study on Sentinel Lymph Node and Its Lymphatic Drainage Pattern of Breast Cancer by Contrast-Enhanced Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2727-2737. [PMID: 35128699 PMCID: PMC9790426 DOI: 10.1002/jum.15957] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 01/19/2022] [Accepted: 01/27/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Sentinel lymph node (SLN) and its lymphatic drainage pattern (LDP) of breast cancer were studied by contrast-enhanced ultrasound (CEUS). METHODS From July 2017 to December 2019, patients with SLN localization of breast cancer in Sichuan Academy of Medical Sciences·Sichuan Provincial People's Hospital were selected. The sentinel lymph system of breast cancer was observed by CEUS before both operation and blue staining in the surgery. The location, number, and route of sentinel lymphatic channel (SLC) were recorded, along with the number, size, and the depth from skin of SLN. LDPs were summarized according to these basic characteristics of SLC and SLN. RESULTS A total of 368 cases were included; 465 SLCs and 423 SLNs were detected. Most of the SLCs were originated from the outer upper quadrant of areola. Eleven LDPs were found, including 31 subtypes of LDPs. There were 6 cases of type A (1.63%), 15 cases of type B (4.08%), 223 cases of type C (57.88%), 38 cases of type D (10.33%), 2 cases of type E (0.54%), 3 cases of type F (0.82%), 50 cases of type G (13.59%), 30 cases of type H (8.15%), 2 cases of type I (0.54%), 6 cases of type J (1.63%), and 3 cases of type K (0.82%). CONCLUSIONS The most common LDP of breast cancer was one SLC originated from the upper quadrant of areola with one SLN. CEUS can identify the LDP before surgery to reduce the false negative rate of SLN biopsy.
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Affiliation(s)
- Yunhao Luo
- Ultrasound Department, Qingbaijiang Maternal and Child Health Hospital, West China Second HospitalSichuan UniversityChengduChina
| | - Jie Chen
- Department of Breast Surgery, Sichuan Academy of Medical SciencesSichuan Provincial People's HospitalChengduChina
| | - Liting Feng
- Ultrasound Department, Sichuan Academy of Medical SciencesSichuan Provincial People's HospitalChengduChina
| | - Wenbin Cao
- Ultrasound Department, Sichuan Academy of Medical SciencesSichuan Provincial People's HospitalChengduChina
| | - Hao Wu
- Ultrasound Department, Sichuan Academy of Medical SciencesSichuan Provincial People's HospitalChengduChina
| | - Miao Ma
- Ultrasound DepartmentThe second people's Hospital in Xindu District of ChengduChengduChina
| | - Fangting He
- West China School of Public Health, West China Fourth HospitalSichuan UniversityChengduChina
| | - Jing Luo
- Department of Breast Surgery, Sichuan Academy of Medical SciencesSichuan Provincial People's HospitalChengduChina
| | - Chihua Wu
- Department of Breast Surgery, Sichuan Academy of Medical SciencesSichuan Provincial People's HospitalChengduChina
| | - Jinping Liu
- Department of Breast Surgery, Sichuan Academy of Medical SciencesSichuan Provincial People's HospitalChengduChina
| | - Qin Chen
- Ultrasound Department, Sichuan Academy of Medical SciencesSichuan Provincial People's HospitalChengduChina
| | - Jun Luo
- Ultrasound Department, Sichuan Academy of Medical SciencesSichuan Provincial People's HospitalChengduChina
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Li J, Li H, Guan L, Lu Y, Zhan W, Dong Y, Gu P, Liu J, Cheng W, Na Z, Tang L, Du Z, Yang L, Hai S, Yang C, Zheng Q, Zhang Y, Wang S, Li F, Fu J, Lu M. The value of preoperative sentinel lymph node contrast-enhanced ultrasound for breast cancer: a large, multicenter trial. BMC Cancer 2022; 22:455. [PMID: 35473499 PMCID: PMC9040273 DOI: 10.1186/s12885-022-09551-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 04/11/2022] [Indexed: 11/23/2022] Open
Abstract
Objective The study conducted a multicenter study in China to explore the learning curve of contrast enhanced ultrasound (CEUS) for sentinel lymph nodes (SLNs), the feasibility of using this technique for the localization of SLNs and lymphatic channels (LCs) and its diagnostic performance for lymph node metastasis. Method Nine hundred two patients with early invasive breast cancer from six tertiary class hospitals in China were enrolled between December 2016 and December 2019. Each patient received general ultrasound scanning and SLN-CEUS before surgery. The locations and sizes of LCs and SLNs were marked on the body surface based on observations from SLN-CEUS. These body surface markers were then compared with intraoperative blue staining in terms of their locations. The first 40 patients from each center were included in determining the learning curve of SLN-CEUS across sites. The remaining patients were used to investigate the diagnostic efficacy of this technique in comparison with intraoperative blue staining and pathology respectively. Result The ultrasound doctor can master SLN-CEUS after 25 cases, and the mean operating time is 22.5 min. The sensitivity, specificity, negative predictive value, and positive predictive value of SLN-CEUS in diagnosing lymph node metastases were 86.47, 89.81, 74.90, and 94.97% respectively. Conclusion Ultrasound doctors can master SLN-CEUS with a suitable learning curve. SLN-CEUS is a feasible and useful approach to locate SLNs and LCs before surgery and it is helpful for diagnosing LN metastases.
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Affiliation(s)
- Juan Li
- Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, No.55, Section 4, South Renmin Road, Chengdu, China
| | - Hui Li
- Breast Surgeons Department, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ling Guan
- Ultrasound Medical Center, Gansu Cancer Hospital, Lanzhou, China
| | - Yun Lu
- Ultrasound Medical Center, Gansu Cancer Hospital, Lanzhou, China
| | - Weiwei Zhan
- Ultrasound Medical Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yijie Dong
- Ultrasound Medical Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peng Gu
- Ultrasound Medical Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jian Liu
- Ultrasound Medical Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Wen Cheng
- Ultrasound Medical Center, the Affiliated Tumor Hospital of Harbin Medical University, Harbin, China
| | - Ziyue Na
- Ultrasound Medical Center, the Affiliated Tumor Hospital of Harbin Medical University, Harbin, China
| | - Lina Tang
- Ultrasound Medical Center, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, People's Republic of China
| | - Zhongshi Du
- Ultrasound Medical Center, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, People's Republic of China
| | - Lichun Yang
- Ultrasound Medical Center, Yunnan Cancer Hospital, Kunming, China
| | - Saiping Hai
- Ultrasound Medical Center, Yunnan Cancer Hospital, Kunming, China
| | - Chen Yang
- Ultrasound Medical Center, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Qingqiu Zheng
- Ultrasound Medical Center, Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Yuhua Zhang
- Ultrasound Medical Center, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Shan Wang
- Ultrasound Medical Center, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Fang Li
- Ultrasound Medical Center, Chongqing Cancer Hospital and Cancer Institute, Chongqing, China
| | - Jing Fu
- Ultrasound Medical Center, Chongqing Cancer Hospital and Cancer Institute, Chongqing, China
| | - Man Lu
- Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, No.55, Section 4, South Renmin Road, Chengdu, China.
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Duan Y, Zhu Y, Nie F, Guan L, Jia Y, Chen K, Wang W. Predictive value of combining clinicopathological, multimodal ultrasonic characteristics in axillary lymph nodal metastasis burden of patients with cT1-2N0 breast cancer. Clin Hemorheol Microcirc 2022; 81:255-269. [PMID: 35342081 DOI: 10.3233/ch-221398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Since the ACOSOG Z0011 trial, the clinical examination of axillary lymph node-negative early breast cancer patients (cT1-2N0) can be used to predict the burden of axillary lymph nodes (ALNs) by axillary ultrasound (AUS). To improving diagnosis of axillary lymph node metastasis (ALNM), we assessed the value of combining clinicopathological, conventional ultrasound, SWE features in the cT1-2N0 breast cancer patients. METHODS Retrospective analysis of 285 patients with cT1-2N0 breast cancer who underwent preoperative ultrasound examination of the lesion and axillary, with shear wave elastography (SWE) of the lesions. According to the postoperative pathological results, they were divided into ≤2 metastatic ALNs group (low nodal burden, LNB) and > 2 metastatic ALNs group (high nodal burden, HNB). Binary logistic regression analysis was used to screen independent risk factors and establish prediction models. The best cut-off value of continuous variables is determined by the receiver operating characteristic curve, and the performance of the prediction model is evaluated. RESULTS Presence of lymphovascular invasion (OR = 7.966, P = 0.010), tumor size (OR = 2.485, P = 0.019), Emean of intratumor (OR = 0.939, P = 0.002) and cortical thickness of lymph node (OR = 9.277, P < 0.001) were independent risk predictors for HNB of cT1-2N0 Group. The predictive model of combined method had better performance in predicting HNB of cT1-2N0 compared with models based on SWE and conventional ultrasound alone (area under the curve: 0.824 vs 0.658, P < 0.001; 0.824 vs 0.789, P = 0.035). CONCLUSIONS The predictive models of combined method obtained from significant clinicopathological and ultrasonographic features can potentially improve the diagnosis and individual treatment of ALNM in patients with cT1-2N0 breast cancer.
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Affiliation(s)
- Ying Duan
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, China.,Department of Ultrasound, Gansu Cancer Hospital, Lanzhou, China
| | - Yangyang Zhu
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, China
| | - Fang Nie
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, China
| | - Ling Guan
- Department of Ultrasound, Gansu Cancer Hospital, Lanzhou, China
| | - Yingying Jia
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, China
| | - Kundi Chen
- Department of Ultrasound, Lanzhou University Second Hospital, Lanzhou, China
| | - Weili Wang
- Department of Ultrasound, Gansu Cancer Hospital, Lanzhou, China
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Kurochkin MA, German SV, Abalymov A, Vorontsov DА, Gorin DA, Novoselova MV. Sentinel lymph node detection by combining nonradioactive techniques with contrast agents: State of the art and prospects. JOURNAL OF BIOPHOTONICS 2022; 15:e202100149. [PMID: 34514735 DOI: 10.1002/jbio.202100149] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/21/2021] [Accepted: 09/09/2021] [Indexed: 06/13/2023]
Abstract
The status of sentinel lymph nodes (SLNs) has a substantial prognostic value because these nodes are the first place where cancer cells accumulate along their spreading route. Routine SLN biopsy ("gold standard") involves peritumoral injections of radiopharmaceuticals, such as technetium-99m, which has obvious disadvantages. This review examines the methods used as "gold standard" analogs to diagnose SLNs. Nonradioactive preoperative and intraoperative methods of SLN detection are analyzed. Promising photonic tools for SLNs detection are reviewed, including NIR-I/NIR-II fluorescence imaging, photoswitching dyes for SLN detection, in vivo photoacoustic detection, imaging and biopsy of SLNs. Also are discussed methods of SLN detection by magnetic resonance imaging, ultrasonic imaging systems including as combined with photoacoustic imaging, and methods based on the magnetometer-aided detection of superparamagnetic nanoparticles. The advantages and disadvantages of nonradioactive SLN-detection methods are shown. The review concludes with prospects for the use of conservative diagnostic methods in combination with photonic tools.
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Affiliation(s)
| | - Sergey V German
- Skolkovo Institute of Science and Technology, Moscow, Russia
- Institute of Spectroscopy of the Russian Academy of Sciences, Moscow, Russia
| | | | - Dmitry А Vorontsov
- State Budgetary Institution of Health Care of Nizhny Novgorod "Nizhny Novgorod Regional Clinical Oncological Dispensary", Nizhny Novgorod, Russia
| | - Dmitry A Gorin
- Skolkovo Institute of Science and Technology, Moscow, Russia
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Contrast-Enhanced Ultrasound for Precise Sentinel Lymph Node Biopsy in Women with Early Breast Cancer: A Preliminary Study. Diagnostics (Basel) 2021; 11:diagnostics11112104. [PMID: 34829452 PMCID: PMC8624576 DOI: 10.3390/diagnostics11112104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 11/17/2022] Open
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.
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Liu YB, Xia M, Li YJ, Li S, Li H, Li YL. Contrast-Enhanced Ultrasound in Locating Axillary Sentinel Lymph Nodes in Patients with Breast Cancer: A Prospective Study. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1475-1483. [PMID: 33714619 DOI: 10.1016/j.ultrasmedbio.2021.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/30/2021] [Accepted: 02/03/2021] [Indexed: 06/12/2023]
Abstract
The objective was to explore the clinical value of contrast-enhanced ultrasound (CEUS) in locating the sentinel lymph node (SLN) in patients with early breast cancer. We screened 143 consecutive patients with breast cancer between July 2017 and August 2019. The number of SLNs identified by CEUS and dual labeling (blue dye and radiolabeled colloid) were recorded. The accuracy of CEUS plus fine-needle aspiration cytology (FNAC) was assessed. The rate of identification of SLNs with CEUS was 84.0% (121/144), and that of dual labeling was 97.92% (141/144). There was no significant association between non-enhancement (p = 0.060) or inhomogeneous enhancement (p = 0.468) and lymph node metastasis. The sensitivity and specificity of CEUS-SLNs plus FNAC was 78.38% and 100%, respectively. The technique of CEUS is a promising method for locating the axillary SLN. But it is hard to identify lymph node metastasis with CEUS alone. CEUS-SLNs plus FNAC is a sound technique for diagnosis of the metastasis of SLN.
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Affiliation(s)
- Yan-Bing Liu
- Department of Breast Surgery (First Breast Cancer Center), Shandong Cancer Hospital and Institute Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Mei Xia
- Shandong First Medical University (Shandong Academy of Medical Sciences), Jinan, Shandong, China
| | - Yun-Jie Li
- Logistics Support Department, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Sheng Li
- Department of Hepatobiliary Surgery, Shandong Cancer Hospital and Institute Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Hao Li
- Shandong Pharmaceutical Research Institute, Jinan, Shandong, China
| | - Yun-Ling Li
- Department of Special Diagnosis, Shandong Cancer Hospital and Institute Affiliated to Shandong First Medical University, Jinan, Shandong Province, China.
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Chen MY, Gillanders WE. Staging of the Axilla in Breast Cancer and the Evolving Role of Axillary Ultrasound. BREAST CANCER (DOVE MEDICAL PRESS) 2021; 13:311-323. [PMID: 34040436 PMCID: PMC8139849 DOI: 10.2147/bctt.s273039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/23/2021] [Indexed: 12/15/2022]
Abstract
Axillary lymph nodes have long been recognized as a route for breast cancer to spread systemically. As a result, staging of the axilla has always played a central role in the treatment of breast cancer. Anatomic staging was believed to be important for two reasons: 1) it predicts prognosis and guides medical therapy, and 2) it is a potential therapy for removal of disease in the axilla. This paradigm has now been called into question. Prognostic information is driven increasingly by tumor biology, and trials such as the ACOSOG Z0011 demonstrates removal of axillary disease is not therapeutic. Staging of the axilla has undergone a dramatic de-escalation; however, sentinel lymph node biopsy (SLNB) is still an invasive surgery and represents a large economic burden on the healthcare system. In this review, we outline the changing paradigms of axillary staging in breast cancer from emphasis on anatomic staging to tumor biology, and the evolving role of axillary ultrasound, bringing patients less invasive and more personalized therapy.
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Affiliation(s)
- Michael Y Chen
- Department of Surgery, Washington University, St Louis, MS, USA
| | - William E Gillanders
- Department of Surgery, Washington University, St Louis, MS, USA
- Siteman Cancer Center in St. Louis, St Louis, MS, USA
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Stan F, Gudea A, Damian A, Gal AF, Papuc I, Pop AR, Martonos C. Ultrasonographic Algorithm for the Assessment of Sentinel Lymph Nodes That Drain the Mammary Carcinomas in Female Dogs. Animals (Basel) 2020; 10:E2366. [PMID: 33321917 PMCID: PMC7763578 DOI: 10.3390/ani10122366] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/02/2020] [Accepted: 12/04/2020] [Indexed: 12/14/2022] Open
Abstract
The status of sentinel lymph nodes (SLNs) is decisive in staging, prognosis, and therapeutic approach. Using an ultrasonographic examination algorithm composed of B-mode, Doppler technique, contrast-enhanced ultrasound (CEUS) and elastography, this study aimed to determine the diagnostic performance of the four techniques compared to histopathological examination. 96 SLNs belonging to 71 female dogs with mammary gland carcinomas were examined. After examinations, mastectomy and lymphadenectomy were performed. Histopathological examination confirmed the presence of metastases in 54 SLNs. The elasticity score had the highest accuracy-89.71%, identifying metastases in SLNs with 88.9.9% sensitivity (SE) and 90.5% specificity (SP), ROC analysis providing excellent results. The S/L (short axis/long axis) ratio showed 83.3% SE and 78.6% SP as a predictor of the presence of metastases in SLN having a good accuracy of 81.2%. On Doppler examination, the resistivity index(RI) showed good accuracy of 80% in characterizing lymph nodes with metastases versus unaffected ones; the same results being obtained by CEUS examination. By assigning to each ultrasonographic parameter a score (0 or 1) and summing up the scores of the four techniques, we obtained the best diagnostic performance in identifying lymph node metastases with 92.2% accuracy. In conclusion, the use of the presented algorithm provides the best identification of metastases in SLNs, helping in mammary carcinoma staging and appropriate therapeutic management.
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Affiliation(s)
- Florin Stan
- Department of Comparative Anatomy, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine, 3-5 Manastur Street, 400372 Cluj Napoca, Romania; (A.G.); (A.D.); (C.M.)
| | - Alexandru Gudea
- Department of Comparative Anatomy, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine, 3-5 Manastur Street, 400372 Cluj Napoca, Romania; (A.G.); (A.D.); (C.M.)
| | - Aurel Damian
- Department of Comparative Anatomy, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine, 3-5 Manastur Street, 400372 Cluj Napoca, Romania; (A.G.); (A.D.); (C.M.)
| | - Adrian Florin Gal
- Department of Cell Biology, Histology and Embryology, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine, 3-5 Manastur Street, 400372 Cluj Napoca, Romania;
| | - Ionel Papuc
- Department of Semiology and Medical Imaging, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine, 3-5 Manastur Street, 400372 Cluj Napoca, Romania;
| | - Alexandru Raul Pop
- Department of Reproduction, Obstetrics and Reproductive Pathology, Biotechnologies in Reproduction, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine, 3-5 Manastur Street, 400372 Cluj Napoca, Romania;
| | - Cristian Martonos
- Department of Comparative Anatomy, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine, 3-5 Manastur Street, 400372 Cluj Napoca, Romania; (A.G.); (A.D.); (C.M.)
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Enhanced axillary assessment using intradermally injected microbubbles and contrast-enhanced ultrasound (CEUS) before neoadjuvant systemic therapy (NACT) identifies axillary disease missed by conventional B-mode ultrasound that may be clinically relevant. Breast Cancer Res Treat 2020; 185:413-422. [PMID: 33029707 DOI: 10.1007/s10549-020-05956-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study is to measure pre-treatment diagnostic yield of malignant lymph nodes (LN) using contrast-enhanced ultrasound (CEUS) in addition to B-mode axillary ultrasound and compare clinicopathological features, response to NACT and long-term outcomes of patients with malignant LN detected with B-mode ultrasound versus CEUS. METHODS Between August 2009 and October 2016, NACT patients were identified from a prospective database. Follow-up data were collected until May 2019. RESULTS 288 consecutive NACT patients were identified; 77 were excluded, 110 had malignant LN identified by B-mode ultrasound (Group A) and 101 patients with negative B-mode axillary ultrasound had CEUS with biopsy of sentinel lymph nodes (SLN). In two cases CEUS failed. Malignant SLN were identified in 35/99 (35%) of B-mode ultrasound-negative cases (Group B). Patients in Group A were similar to those in Group B in age, mean diagnostic tumour size, grade and oestrogen receptor status. More Group A patients had a ductal phenotype. In the breast, 34 (31%) Group A patients and 8 (23%) Group B patients achieved a pathological complete response (PCR). In the axilla, 41 (37%) and 13 (37%) Groups A and B patients, respectively, had LN PCR. The systemic relapse rate was not statistically different (5% and 16% for Groups A and B, respectively). CONCLUSIONS Enhanced assessment with CEUS before NACT identifies patients with axillary metastases missed by conventional B-mode ultrasound. Without CEUS, 22 (63%) of cases in Group B (negative B-mode ultrasound) may have been erroneously classed as progressive disease by surgical SLN excision after NACT.
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Xu H, Xu GL, Li XD, Su QH, Dong CZ. Correlation between the contrast-enhanced ultrasound image features and axillary lymph node metastasis of primary breast cancer and its diagnostic value. Clin Transl Oncol 2020; 23:155-163. [PMID: 32488804 DOI: 10.1007/s12094-020-02407-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/20/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE To analyze the correlation between contrast-enhanced ultrasound image features and axillary lymph node metastasis of primary breast cancer and its diagnostic value. METHODS In this study, 64 patients with axillary lymph node metastasis of primary breast cancer diagnosed and treated in our hospital from February 2011 to March 2013 were collected as an observation group, and 54 patients without axillary lymph node metastasis were collected as a control group. All patients underwent a contrast-enhanced ultrasound examination, and the correlation between the contrast-enhanced ultrasound image features and axillary lymph node metastasis and its diagnostic value were analyzed. They were divided into two groups according to their survival conditions: the group with good efficacy and group with poor efficacy, and the prognostic factors of breast cancer in the two groups were analyzed. RESULTS There were statistical differences in the peripheral acoustic halo, blood flow classification, ratio of length to diameter (L/D), maximum cortical thickness, and enhancement mode of lymph nodes between the two groups (p < 0.05). The area under ROC curve for diagnosis of axillary lymph node metastasis by contrast-enhanced ultrasound was 0.854, sensitivity was 83.33%, and specificity was 87.5%; L/D and enhancement mode were independent prognostic factors for breast cancer. CONCLUSIONS Contrast-enhanced ultrasound image features have diagnostic and prognostic value for axillary lymph node metastasis of breast cancer.
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Affiliation(s)
- H Xu
- Department of Echocardiography, The First Hospital of Jilin University, Changchun, 130021, People's Republic of China
| | - G L Xu
- Department of Cardiovascular Medicine, The Eastern Division of The First Hospital of Jilin University, Changchun,, 130031, People's Republic of China
| | - X D Li
- Department of Echocardiography, The First Hospital of Jilin University, Changchun, 130021, People's Republic of China
| | - Q H Su
- Department of Echocardiography, The First Hospital of Jilin University, Changchun, 130021, People's Republic of China
| | - C Z Dong
- Department of Abdominal Ultrasound, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, People's Republic of China.
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12
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Li J, Lu M, Cheng X, Hu Z, Li H, Wang H, Jiang J, Li T, Zhang Z, Zhao C, Ma Y, Tan B, Liu J, Yu Y. How Pre-operative Sentinel Lymph Node Contrast-Enhanced Ultrasound Helps Intra-operative Sentinel Lymph Node Biopsy in Breast Cancer: Initial Experience. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1865-1873. [PMID: 31101445 DOI: 10.1016/j.ultrasmedbio.2019.04.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 03/28/2019] [Accepted: 04/01/2019] [Indexed: 05/25/2023]
Abstract
We aimed to evaluate the value of sentinel lymph node contrast-enhanced ultrasound (SLN-CEUS) and surface tracing for the biopsy of intra-operative sentinel lymph nodes (SLNs). Between June 2015 and December 2017, a total of 453 patients with early invasive breast cancer were recruited. Patients received an intradermal injection of microbubble contrast agent around the areola on the day before surgery. The locations and sizes of lymphatic channels (LCs) and SLNs were marked on the body surface using gentian violet. Then, injection of double blue dye was performed half an hour before surgery. We compared the pathway of LCs and the location of SLNs obtained from SLN-CEUS and blue dye during surgery. Among the 453 patients, the mean numbers of LCs and SLNs detected by SLN-CEUS were 1.42 and 1.72, respectively, and the coincidence rate was 98.2% compared with blue dye during surgery. The median distance from the SLN to skin measured by pre-operative CEUS and blue dye was 1.95 ± 0.69 and 2.03 ± 0.87 cm (p = 0.35). There were three SLN enhancement in our research, including homogeneous enhancement, inhomogeneous enhancement and no enhancement, with the sensitivity, specificity, positive predictive value and negative predictive value of SLN-CEUS for the diagnosis of SLNs being 96.82%, 91.91%, 87.54% and 98.01%, respectively. SLN-CEUS with skin marking can identify the pathway of LCs and the location of the SLN before surgery, measure the distance from the SLN to skin and determine if the SLN is metastatic. SLN-CEUS can be used as an effective complement to the blue dye method.
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Affiliation(s)
- Juan Li
- Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Man Lu
- Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Xueqing Cheng
- Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ziyue Hu
- North Sichuan Medical College, Nanchong, China
| | - Hui Li
- Breast Surgeons Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hao Wang
- Breast Surgeons Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jingzhen Jiang
- Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Tingting Li
- Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhenqi Zhang
- Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Caihong Zhao
- Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yue Ma
- Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Bo Tan
- Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jingping Liu
- Breast Surgeons Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuan Yu
- Breast Surgeons Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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13
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Zhu J, Rowland EM, Harput S, Riemer K, Leow CH, Clark B, Cox K, Lim A, Christensen-Jeffries K, Zhang G, Brown J, Dunsby C, Eckersley RJ, Weinberg PD, Tang MX. 3D Super-Resolution US Imaging of Rabbit Lymph Node Vasculature in Vivo by Using Microbubbles. Radiology 2019; 291:642-650. [PMID: 30990382 DOI: 10.1148/radiol.2019182593] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Variations in lymph node (LN) microcirculation can be indicative of metastasis. The identification and quantification of metastatic LNs remains essential for prognosis and treatment planning, but a reliable noninvasive imaging technique is lacking. Three-dimensional super-resolution (SR) US has shown potential to noninvasively visualize microvascular networks in vivo. Purpose To study the feasibility of three-dimensional SR US imaging of rabbit LN microvascular structure and blood flow by using microbubbles. Materials and Methods In vivo studies were carried out to image popliteal LNs of two healthy male New Zealand white rabbits aged 6-8 weeks. Three-dimensional, high-frame-rate, contrast material-enhanced US was achieved by mechanically scanning with a linear imaging probe. Individual microbubbles were identified, localized, and tracked to form three-dimensional SR images and super-resolved velocity maps. Acoustic subaperture processing was used to improve image contrast and to generate enhanced power Doppler and color Doppler images. Vessel size and blood flow velocity distributions were evaluated and assessed by using Student paired t test. Results SR images revealed microvessels in the rabbit LN, with branches clearly resolved when separated by 30 µm, which is less than half of the acoustic wavelength and not resolvable by using power or color Doppler. The apparent size distribution of most vessels in the SR images was below 80 µm and agrees with micro-CT data, whereas most of those detected with Doppler techniques were larger than 80 µm in the images. The blood flow velocity distribution indicated that most of the blood flow in rabbit popliteal LN was at velocities lower than 5 mm/sec. Conclusion Three-dimensional super-resolution US imaging using microbubbles allows noninvasive nonionizing visualization and quantification of lymph node microvascular structures and blood flow dynamics with resolution below the wave diffraction limit. This technology has potential for studying the physiologic functions of the lymph system and for clinical detection of lymph node metastasis. Published under a CC BY 4.0 license. Online supplemental material is available for this article.
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Affiliation(s)
- Jiaqi Zhu
- From the Department of Bioengineering, Imperial College London, South Kensington Campus, London SW7 2AZ, England (J.Z., E.M.R., S.H., K.R., C.H.L., G.Z., P.D.W., M.X.T.); Department of Surgery, Maidstone and Tunbridge Wells NHS Trust, Maidstone, England (K.C.); Department of Imaging, Charing Cross Hospital, Fulham Palace Rd, London, England (A.L.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Science, Kings College London, London, England (K.C.J., J.B., R.J.E.); Department of Physics and Centre for Pathology, Imperial College London, London, England (C.D.); and Department of Imaging, Natural History Museum, London, England (B.C.)
| | - Ethan M Rowland
- From the Department of Bioengineering, Imperial College London, South Kensington Campus, London SW7 2AZ, England (J.Z., E.M.R., S.H., K.R., C.H.L., G.Z., P.D.W., M.X.T.); Department of Surgery, Maidstone and Tunbridge Wells NHS Trust, Maidstone, England (K.C.); Department of Imaging, Charing Cross Hospital, Fulham Palace Rd, London, England (A.L.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Science, Kings College London, London, England (K.C.J., J.B., R.J.E.); Department of Physics and Centre for Pathology, Imperial College London, London, England (C.D.); and Department of Imaging, Natural History Museum, London, England (B.C.)
| | - Sevan Harput
- From the Department of Bioengineering, Imperial College London, South Kensington Campus, London SW7 2AZ, England (J.Z., E.M.R., S.H., K.R., C.H.L., G.Z., P.D.W., M.X.T.); Department of Surgery, Maidstone and Tunbridge Wells NHS Trust, Maidstone, England (K.C.); Department of Imaging, Charing Cross Hospital, Fulham Palace Rd, London, England (A.L.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Science, Kings College London, London, England (K.C.J., J.B., R.J.E.); Department of Physics and Centre for Pathology, Imperial College London, London, England (C.D.); and Department of Imaging, Natural History Museum, London, England (B.C.)
| | - Kai Riemer
- From the Department of Bioengineering, Imperial College London, South Kensington Campus, London SW7 2AZ, England (J.Z., E.M.R., S.H., K.R., C.H.L., G.Z., P.D.W., M.X.T.); Department of Surgery, Maidstone and Tunbridge Wells NHS Trust, Maidstone, England (K.C.); Department of Imaging, Charing Cross Hospital, Fulham Palace Rd, London, England (A.L.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Science, Kings College London, London, England (K.C.J., J.B., R.J.E.); Department of Physics and Centre for Pathology, Imperial College London, London, England (C.D.); and Department of Imaging, Natural History Museum, London, England (B.C.)
| | - Chee Hau Leow
- From the Department of Bioengineering, Imperial College London, South Kensington Campus, London SW7 2AZ, England (J.Z., E.M.R., S.H., K.R., C.H.L., G.Z., P.D.W., M.X.T.); Department of Surgery, Maidstone and Tunbridge Wells NHS Trust, Maidstone, England (K.C.); Department of Imaging, Charing Cross Hospital, Fulham Palace Rd, London, England (A.L.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Science, Kings College London, London, England (K.C.J., J.B., R.J.E.); Department of Physics and Centre for Pathology, Imperial College London, London, England (C.D.); and Department of Imaging, Natural History Museum, London, England (B.C.)
| | - Brett Clark
- From the Department of Bioengineering, Imperial College London, South Kensington Campus, London SW7 2AZ, England (J.Z., E.M.R., S.H., K.R., C.H.L., G.Z., P.D.W., M.X.T.); Department of Surgery, Maidstone and Tunbridge Wells NHS Trust, Maidstone, England (K.C.); Department of Imaging, Charing Cross Hospital, Fulham Palace Rd, London, England (A.L.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Science, Kings College London, London, England (K.C.J., J.B., R.J.E.); Department of Physics and Centre for Pathology, Imperial College London, London, England (C.D.); and Department of Imaging, Natural History Museum, London, England (B.C.)
| | - Karina Cox
- From the Department of Bioengineering, Imperial College London, South Kensington Campus, London SW7 2AZ, England (J.Z., E.M.R., S.H., K.R., C.H.L., G.Z., P.D.W., M.X.T.); Department of Surgery, Maidstone and Tunbridge Wells NHS Trust, Maidstone, England (K.C.); Department of Imaging, Charing Cross Hospital, Fulham Palace Rd, London, England (A.L.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Science, Kings College London, London, England (K.C.J., J.B., R.J.E.); Department of Physics and Centre for Pathology, Imperial College London, London, England (C.D.); and Department of Imaging, Natural History Museum, London, England (B.C.)
| | - Adrian Lim
- From the Department of Bioengineering, Imperial College London, South Kensington Campus, London SW7 2AZ, England (J.Z., E.M.R., S.H., K.R., C.H.L., G.Z., P.D.W., M.X.T.); Department of Surgery, Maidstone and Tunbridge Wells NHS Trust, Maidstone, England (K.C.); Department of Imaging, Charing Cross Hospital, Fulham Palace Rd, London, England (A.L.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Science, Kings College London, London, England (K.C.J., J.B., R.J.E.); Department of Physics and Centre for Pathology, Imperial College London, London, England (C.D.); and Department of Imaging, Natural History Museum, London, England (B.C.)
| | - Kirsten Christensen-Jeffries
- From the Department of Bioengineering, Imperial College London, South Kensington Campus, London SW7 2AZ, England (J.Z., E.M.R., S.H., K.R., C.H.L., G.Z., P.D.W., M.X.T.); Department of Surgery, Maidstone and Tunbridge Wells NHS Trust, Maidstone, England (K.C.); Department of Imaging, Charing Cross Hospital, Fulham Palace Rd, London, England (A.L.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Science, Kings College London, London, England (K.C.J., J.B., R.J.E.); Department of Physics and Centre for Pathology, Imperial College London, London, England (C.D.); and Department of Imaging, Natural History Museum, London, England (B.C.)
| | - Ge Zhang
- From the Department of Bioengineering, Imperial College London, South Kensington Campus, London SW7 2AZ, England (J.Z., E.M.R., S.H., K.R., C.H.L., G.Z., P.D.W., M.X.T.); Department of Surgery, Maidstone and Tunbridge Wells NHS Trust, Maidstone, England (K.C.); Department of Imaging, Charing Cross Hospital, Fulham Palace Rd, London, England (A.L.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Science, Kings College London, London, England (K.C.J., J.B., R.J.E.); Department of Physics and Centre for Pathology, Imperial College London, London, England (C.D.); and Department of Imaging, Natural History Museum, London, England (B.C.)
| | - Jemma Brown
- From the Department of Bioengineering, Imperial College London, South Kensington Campus, London SW7 2AZ, England (J.Z., E.M.R., S.H., K.R., C.H.L., G.Z., P.D.W., M.X.T.); Department of Surgery, Maidstone and Tunbridge Wells NHS Trust, Maidstone, England (K.C.); Department of Imaging, Charing Cross Hospital, Fulham Palace Rd, London, England (A.L.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Science, Kings College London, London, England (K.C.J., J.B., R.J.E.); Department of Physics and Centre for Pathology, Imperial College London, London, England (C.D.); and Department of Imaging, Natural History Museum, London, England (B.C.)
| | - Christopher Dunsby
- From the Department of Bioengineering, Imperial College London, South Kensington Campus, London SW7 2AZ, England (J.Z., E.M.R., S.H., K.R., C.H.L., G.Z., P.D.W., M.X.T.); Department of Surgery, Maidstone and Tunbridge Wells NHS Trust, Maidstone, England (K.C.); Department of Imaging, Charing Cross Hospital, Fulham Palace Rd, London, England (A.L.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Science, Kings College London, London, England (K.C.J., J.B., R.J.E.); Department of Physics and Centre for Pathology, Imperial College London, London, England (C.D.); and Department of Imaging, Natural History Museum, London, England (B.C.)
| | - Robert J Eckersley
- From the Department of Bioengineering, Imperial College London, South Kensington Campus, London SW7 2AZ, England (J.Z., E.M.R., S.H., K.R., C.H.L., G.Z., P.D.W., M.X.T.); Department of Surgery, Maidstone and Tunbridge Wells NHS Trust, Maidstone, England (K.C.); Department of Imaging, Charing Cross Hospital, Fulham Palace Rd, London, England (A.L.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Science, Kings College London, London, England (K.C.J., J.B., R.J.E.); Department of Physics and Centre for Pathology, Imperial College London, London, England (C.D.); and Department of Imaging, Natural History Museum, London, England (B.C.)
| | - Peter D Weinberg
- From the Department of Bioengineering, Imperial College London, South Kensington Campus, London SW7 2AZ, England (J.Z., E.M.R., S.H., K.R., C.H.L., G.Z., P.D.W., M.X.T.); Department of Surgery, Maidstone and Tunbridge Wells NHS Trust, Maidstone, England (K.C.); Department of Imaging, Charing Cross Hospital, Fulham Palace Rd, London, England (A.L.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Science, Kings College London, London, England (K.C.J., J.B., R.J.E.); Department of Physics and Centre for Pathology, Imperial College London, London, England (C.D.); and Department of Imaging, Natural History Museum, London, England (B.C.)
| | - Meng-Xing Tang
- From the Department of Bioengineering, Imperial College London, South Kensington Campus, London SW7 2AZ, England (J.Z., E.M.R., S.H., K.R., C.H.L., G.Z., P.D.W., M.X.T.); Department of Surgery, Maidstone and Tunbridge Wells NHS Trust, Maidstone, England (K.C.); Department of Imaging, Charing Cross Hospital, Fulham Palace Rd, London, England (A.L.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Science, Kings College London, London, England (K.C.J., J.B., R.J.E.); Department of Physics and Centre for Pathology, Imperial College London, London, England (C.D.); and Department of Imaging, Natural History Museum, London, England (B.C.)
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Nonselective Lymph Node Dissection and Sentinel Lymph Node Mapping and Biopsy. Vet Clin North Am Small Anim Pract 2019; 49:793-807. [PMID: 31147188 DOI: 10.1016/j.cvsm.2019.04.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Clinical staging is important for determining the extent of disease in animals with malignant cancers. The status of the lymph node will help determine whether adjuvant treatment is indicated. Historically, the regional anatomic lymph node has been sampled to determine the presence or absence of metastatic disease, but there is increasing evidence that the regional anatomic lymph node is often different to the sentinel lymph node. As a result, several sentinel lymph node mapping techniques have been described for more accurate clinical staging of oncologic patients.
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Diagnosing and Managing the Malignant Axilla in Breast Cancer. CURRENT BREAST CANCER REPORTS 2019. [DOI: 10.1007/s12609-019-0299-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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