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Machado P, Tahmasebi A, Fallon S, Liu JB, Dogan BE, Needleman L, Lazar M, Willis AI, Brill K, Nazarian S, Berger A, Forsberg F. Characterizing Sentinel Lymph Node Status in Breast Cancer Patients Using a Deep-Learning Model Compared With Radiologists' Analysis of Grayscale Ultrasound and Lymphosonography. Ultrasound Q 2024; 40:e00683. [PMID: 38958999 DOI: 10.1097/ruq.0000000000000683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
ABSTRACT The objective of the study was to use a deep learning model to differentiate between benign and malignant sentinel lymph nodes (SLNs) in patients with breast cancer compared to radiologists' assessments.Seventy-nine women with breast cancer were enrolled and underwent lymphosonography and contrast-enhanced ultrasound (CEUS) examination after subcutaneous injection of ultrasound contrast agent around their tumor to identify SLNs. Google AutoML was used to develop image classification model. Grayscale and CEUS images acquired during the ultrasound examination were uploaded with a data distribution of 80% for training/20% for testing. The performance metric used was area under precision/recall curve (AuPRC). In addition, 3 radiologists assessed SLNs as normal or abnormal based on a clinical established classification. Two-hundred seventeen SLNs were divided in 2 for model development; model 1 included all SLNs and model 2 had an equal number of benign and malignant SLNs. Validation results model 1 AuPRC 0.84 (grayscale)/0.91 (CEUS) and model 2 AuPRC 0.91 (grayscale)/0.87 (CEUS). The comparison between artificial intelligence (AI) and readers' showed statistical significant differences between all models and ultrasound modes; model 1 grayscale AI versus readers, P = 0.047, and model 1 CEUS AI versus readers, P < 0.001. Model 2 r grayscale AI versus readers, P = 0.032, and model 2 CEUS AI versus readers, P = 0.041.The interreader agreement overall result showed κ values of 0.20 for grayscale and 0.17 for CEUS.In conclusion, AutoML showed improved diagnostic performance in balance volume datasets. Radiologist performance was not influenced by the dataset's distribution.
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Affiliation(s)
- Priscilla Machado
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA
| | - Aylin Tahmasebi
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA
| | - Samuel Fallon
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA
| | - Basak E Dogan
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
| | | | - Melissa Lazar
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Alliric I Willis
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Kristin Brill
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Susanna Nazarian
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Adam Berger
- Chief, Department of Melanoma and Soft Tissue Surgical Oncology, Rutgers University, New Brunswick, NJ
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA
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Jang S, Rames JD, Hesley GK, Brinkman NJ, Tran NV, Fahradyan V, Lee CU. Randomized Feasibility Study Evaluating Multiple FDA-approved Microbubbles for CEUS Lymphography. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5985. [PMID: 39022529 PMCID: PMC11254111 DOI: 10.1097/gox.0000000000005985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/31/2024] [Indexed: 07/20/2024]
Abstract
Prior studies on contrast-enhanced ultrasound (CEUS) lymphography for preoperative mapping before lymphaticovenous anastomosis surgery in patients with extremity lymphedema have been limited to using only Lumason and Sonazoid as microbubble contrast agents. The purpose of this study was to determine the feasibility of using two other Food & Drug Administration-approved microbubble agents, Optison and Definity, for imaging lymphatic vessels in the upper extremities. Nine female adults with unilateral upper extremity lymphedema anticipating lymphaticovenous anastomosis surgery underwent CEUS lymphography of the unaffected upper extremity randomized to either Lumason, Definity, or Optison. Lymphatic vessels were visualized in all but one case when undilated Definity was used. In the eight upper extremities where lymphatic vessels were visualized, an average of eight intradermal injections of microbubbles were performed in the extremity. Lymphatic vessels could be identified in 57% (36 of 63) of the injections. The effective dilution for each of the microbubble agents is provided. This was the first successful demonstration of lymphatic vessel visualization using either Definity or Optison. Broadening the range of available microbubble agents for CEUS lymphography could improve accessibility to the procedure and provide potentially safer alternatives.
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Affiliation(s)
- Samuel Jang
- From the Department of Radiology, Mayo Clinic, Rochester, Minn
| | - Jess D. Rames
- Department of Plastic Surgery, Mayo Clinic, Rochester, Minn
| | - Gina K. Hesley
- From the Department of Radiology, Mayo Clinic, Rochester, Minn
| | | | - Nho V. Tran
- Department of Pharmacy, Mayo Clinic, Rochester, Minn
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Mori N, Li L, Matsuda M, Mori Y, Mugikura S. Prospects of perfusion contrast-enhanced ultrasound (CE-US) in diagnosing axillary lymph node metastases in breast cancer: a comparison with lymphatic CE-US. J Med Ultrason (2001) 2024:10.1007/s10396-024-01444-w. [PMID: 38642268 DOI: 10.1007/s10396-024-01444-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/18/2024] [Indexed: 04/22/2024]
Abstract
Accurate diagnosis of lymph node (LN) metastasis is vital for prognosis and treatment in patients with breast cancer. Imaging 1modalities such as ultrasound (US), MRI, CT, and 18F-FDG PET/CT are used for preoperative assessment. While conventional US is commonly recommended due to its resolution and sensitivity, it has limitations such as operator subjectivity and difficulty detecting small metastases. This review shows the microanatomy of axillary LNs to enhance accurate diagnosis and the characteristics of contrast-enhanced US (CE-US), which utilizes intravascular microbubble contrast agents, making it ideal for vascular imaging. A significant focus of this review is on distinguishing between two types of CE-US techniques for axillary LN evaluation: perfusion CE-US and lymphatic CE-US. Perfusion CE-US is used to assess LN metastasis via transvenous contrast agent administration, while lymphatic CE-US is used to identify sentinel LNs and diagnose LN metastasis through percutaneous contrast agent administration. This review also highlights the need for future research to clarify the distinction between studies involving "apparently enlarged LNs" and "clinical node-negative" cases in perfusion CE-US research. Such research standardization is essential to ensure accurate diagnostic performance in various clinical studies. Future studies should aim to standardize CE-US methods for improved LN metastasis diagnosis, not only in breast cancer but also across various malignancies.
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Affiliation(s)
- Naoko Mori
- Department of Radiology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan.
| | - Li Li
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan
| | - Masazumi Matsuda
- Department of Radiology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan
| | - Yu Mori
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8575, Japan
| | - Shunji Mugikura
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan
- Division of Image Statistics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
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Zhuang L, Liu J, Xu X, Sun X, Li F, Shi Q, Zhang W, Du L, Jin L. Predicting axillary metastasis in breast cancer using lymphatic contrast-enhanced ultrasound-guided fine-needle aspiration of one lymph node. Br J Radiol 2024; 97:363-370. [PMID: 38265292 PMCID: PMC11027278 DOI: 10.1093/bjr/tqad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/09/2023] [Accepted: 12/04/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVES Fine-needle aspiration (FNA) is a microinvasive method to diagnose lymph nodes. This study aims to determine the capability of lymphatic contrast-enhanced ultrasound (LCEUS)-guided FNA in predicting the axillary metastasis with the target of one lymph node (LN) in patients with breast cancer. METHODS LCEUS was prospectively performed in 105 patients with breast cancer. The most suspicious LN was targeted based on the characters of LCEUS. FNA was performed in the LN, followed by localization using a guide wire. The detection of lymph cells and/or tumour cells was recognized as a puncture success. Cytologic diagnosis was compared with histologic diagnosis of wire-marked LN for diagnosing accuracy and compared with histologic diagnosis of axillary LNs for predicting accuracy. RESULTS LCEUS-guided FNA was performed in all 105 female patients who underwent axillary dissection. The puncture success rates were 74.3%, 91.4%, and 97.1% for three sequential groups (P = .010). In diagnosing LN metastasis, the sensitivity, specificity, and accuracy values of LCEUS-guided FNA were 89.7%, 100%, and 95.7%, respectively. In predicting axillary metastasis, the sensitivity, specificity, and accuracy values of LCEUS-guided FNA were 81.4%, 100%, and 91.3%, respectively. CONCLUSIONS The microinvasive LCEUS-guided FNA of one lymph node can be an accurate method and may help predict axillary metastasis in patients with breast cancer. ADVANCES IN KNOWLEDGE This study presented that LCEUS combined with FNA would be practical in clinic. The characters of LCEUS could indicate the suspicious LNs and promote the accuracy in predicting axillary metastasis.
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Affiliation(s)
- Lingling Zhuang
- Department of Medical Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 201620, China
| | - Jun Liu
- Department of Breast-Thyroid-Vascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 201620, China
| | - Xiaoxiao Xu
- Department of Pathology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 201620, China
| | - Xing Sun
- Department of Breast-Thyroid-Vascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 201620, China
| | - Fan Li
- Department of Medical Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 201620, China
| | - Qiusheng Shi
- Department of Medical Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 201620, China
| | - Weituo Zhang
- Hongqiao International Institute of Medicine, Shanghai Tong Ren Hospital and School of Public Health, Shanghai Jiao Tong University, School of Medicine, Shanghai 200336, China
| | - Lianfang Du
- Department of Medical Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 201620, China
| | - Lifang Jin
- Department of Medical Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 201620, China
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Omoto K, Futsuhara K, Watanabe T. Sentinel lymph node identification using contrast-enhanced ultrasound in breast cancer: review of the literature. J Med Ultrason (2001) 2023:10.1007/s10396-023-01313-y. [PMID: 37423960 DOI: 10.1007/s10396-023-01313-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/10/2023] [Indexed: 07/11/2023]
Abstract
Before breast cancer surgery, sentinel lymph node (SLN) identification and biopsy using blue dye, radioisotope (RI) with a gamma probe, or a combination of the two are mainly performed. The dye-guided method requires skilled technique to make an incision in the skin and identify SLNs without damaging the lymphatic vessels. In addition, dye-induced anaphylactic shock has been reported. To use the γ-probe-guided method, the facility must be able to handle RI. However, to overcome the drawbacks of these methods, Omoto et al. developed a new identification modality using contrast-enhanced ultrasound with an ultrasound contrast agent (UCA) in 2002. Since then, many basic experiments and clinical studies using various UCA have been reported. In particular, a number of studies in SLN detection using Sonazoid have been reported and are herein reviewed.
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Affiliation(s)
- Kiyoka Omoto
- Department of Laboratory Medicine, Jichi Medical University, Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan.
| | - Kazushige Futsuhara
- Department of Surgery, Jichi Medical University, Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
| | - Tamami Watanabe
- Department of Laboratory Medicine, Jichi Medical University, Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
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Machado P, Liu JB, Needleman L, Lazar M, Willis AI, Brill K, Nazarian S, Berger A, Forsberg F. Sentinel Lymph Node Identification in Post Neoadjuvant Chemotherapy Breast Cancer Patients Undergoing Surgical Excision Using Lymphosonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1509-1517. [PMID: 36591785 PMCID: PMC10277221 DOI: 10.1002/jum.16164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/09/2022] [Accepted: 12/10/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES This study evaluated the efficacy of lymphosonography in the identification of sentinel lymph nodes (SLNs) in post neoadjuvant chemotherapy patients with breast cancer scheduled to undergo surgical excision. METHODS Seventy-nine subjects scheduled for breast cancer surgery with SLN excision completed this IRB-approved study, out of which 18 (23%) underwent neoadjuvant chemotherapy before surgery. Subjects underwent percutaneous Sonazoid (GE Healthcare) injections around the tumor area for a total of 1.0 mL. Lymphosonography was performed using CPS on an S3000 HELX scanner (Siemens Healthineers) with a linear probe. Subjects received blue dye and radioactive tracer as part of their standard of care. Excised SLNs were classified as positive or negative for the presence of blue dye, radioactive tracer and Sonazoid. The results were compared between methods and pathology findings. RESULTS Seventy-two SLNs were surgically excised from 18 subjects, 29 were positive for blue dye, 63 were positive for radioactive tracer and 57 were positive for Sonazoid. Comparison with blue dye showed that both radioactive tracer and lymphosonography achieved an accuracy of 53% (P > .50). Comparison with radioactive tracer showed that blue dye had an accuracy of 53%, while lymphosonography achieved an accuracy of 67% (P < .01). Of the 72 SLNs, 15 were determined malignant by pathology; the detection rate was 47% for blue dye (7/15), 67% for radioactive tracer (10/15) and 100% for lymphosonography (15/15) (P < .001). CONCLUSIONS Lymphosonography achieved similar accuracy as radioactive tracer and higher accuracy than blue dye for identifying SLNs. The 15 SLNs positive for malignancy were all identified by lymphosonography.
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Affiliation(s)
- Priscilla Machado
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Laurence Needleman
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Melissa Lazar
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alliric I. Willis
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kristin Brill
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Susanna Nazarian
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Adam Berger
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
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Machado P, Liu JB, Needleman L, Lee C, Forsberg F. Anatomy Versus Physiology: Is Breast Lymphatic Drainage to the Internal Thoracic (Internal Mammary) Lymphatic System Clinically Relevant? J Breast Cancer 2023; 26:286-291. [PMID: 37272244 PMCID: PMC10315328 DOI: 10.4048/jbc.2023.26.e16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/21/2023] [Accepted: 03/18/2023] [Indexed: 06/06/2023] Open
Abstract
Approximately 15%-25% of breast lymphatic drainage passes through the internal thoracic (internal mammary) lymphatic system, draining the inner quadrants of the breast. This study aimed to use lymphosonography to identify sentinel lymph nodes (SLNs) in the axillary and internal thoracic lymphatic systems in patients with breast cancer. Seventy-nine patients received subcutaneous ultrasound contrast agent injections around the tumor. Lymphosonography was used to identify SLNs. In 14 of the 79 patients (17.7%), the tumor was located in the inner quadrant of the breast. Lymphosonography identified 217 SLNs in 79 patients, averaging 2.7 SLNs per patient. The 217 identified SLNs in the 79 patients were located in the axillary lymphatic system; none were located in the internal thoracic (internal mammary) lymphatic system, although it was expected in two to four patients (i.e., 4-11 SLNs). These results implied that SLNs associated with breast cancer are predominantly located in the axillary lymphatic system.
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Affiliation(s)
- Priscilla Machado
- Department of Radiology, Thomas Jefferson University, Philadelphia, USA.
| | - Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University, Philadelphia, USA
| | | | - Christine Lee
- Department of Radiology, Mayo Clinic, Rochester, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, USA
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Machado P, Liu JB, Needleman L, Lazar M, Willis AI, Brill K, Nazarian S, Berger A, Forsberg F. Sentinel Lymph Node Identification in Patients With Breast Cancer Using Lymphosonography. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:616-625. [PMID: 36446688 PMCID: PMC9943072 DOI: 10.1016/j.ultrasmedbio.2022.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/27/2022] [Accepted: 10/30/2022] [Indexed: 06/06/2023]
Abstract
The objective of the work described here was to evaluate the efficacy of lymphosonography in identifying sentinel lymph nodes (SLNs) in patients with breast cancer undergoing surgical excision. Of the 86 individuals enrolled, 79 completed this institutional review board-approved study. Participants received subcutaneous 1.0-mL injections of ultrasound contrast agent (UCA) around the tumor. An ultrasound scanner with contrast-enhanced ultrasound (CEUS) capabilities was used to identify SLNs. Participants were administered with blue dye and radioactive tracer to guide SLN excision as standard-of-care. Excised SLNs were classified as positive or negative for the presence of blue dye, radioactive tracer and UCA, and sent for pathology. Two hundred fifty-two SLNs were excised; 158 were positive for blue dye, 222 were positive for radioactive tracer and 223 were positive for UCA. Comparison with blue dye revealed accuracies of 96.2% for radioactive tracer and 99.4% for lymphosonography (p > 0.15). Relative to radioactive tracer, blue dye had an accuracy of 68.5%, and lymphosonography achieved 86.5% (p < 0.0001). Of 252 SLNs excised, 34 were determined to be malignant by pathology; 18 were positive for blue dye (detection rate = 53%), 23 for radioactive tracer (detection rate = 68%) and 34 for UCA (detection rate = 100%) (p < 0.0001). Lymphosonography was similar in accuracy to radioactive tracer and higher in accuracy than blue dye in identifying SLNs. All 34 malignant SLNs were identified by lymphosonography.
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Affiliation(s)
- Priscilla Machado
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Laurence Needleman
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Melissa Lazar
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alliric I Willis
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kristin Brill
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Susanna Nazarian
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Adam Berger
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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Priscilla MMD, Ji-Bin LMD, Flemming FP. Sentinel Lymph Node Identification Using Contrast Lymphosonography: A Systematic Review. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2023. [DOI: 10.37015/audt.2023.230001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Niu Z, Gao Y, Xiao M, Mao F, Zhou Y, Zhu Q, Jiang Y. Contrast-enhanced lymphatic US can improve the preoperative diagnostic performance for sentinel lymph nodes in early breast cancer. Eur Radiol 2023; 33:1593-1602. [PMID: 36152038 PMCID: PMC9510155 DOI: 10.1007/s00330-022-09139-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/20/2022] [Accepted: 09/05/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the preoperative diagnostic value of contrast-enhanced lymphatic ultrasound (CEUS) for the sentinel lymph node (SLN) status in early breast cancer. MATERIALS AND METHODS We prospectively recruited 102 consecutive patients with clinically node-negative early breast cancer from July 2021 to October 2021. All patients underwent conventional US and percutaneous CEUS examinations. The CEUS of SLNs were classified into four enhancement patterns: homogeneous (I), featured inhomogeneous (II), focal defect (III), and no enhancement (IV). The diagnostic performance of conventional US and CEUS for SLN metastasis was assessed by receiver operating characteristic (ROC) curves and decision curves. RESULTS A total of 78 women were enrolled in this study, including 55, 18, and 5 patients with negative axilla, 1-2, and ≥ 3 metastastic SLNs pathologically, respectively. The identification rate of SLNs by CEUS was 100%. Patterns I and II can select 91.7% (44/48) of patients with disease-free axilla, while patterns III and IV had higher percentages of metastasis (65.2%, p < 0.001 and 57.1%, p < 0.002, respectively). For the SLN metastatic burden, 100% (48/48) of patients with pattern I/II had ≤ 2 metastatic SLNs. Compared with conventional US, the CEUS enhancement patterns showed significant improvement in diagnosing metastatic SLNs (0.813 vs 0.601, p < 0.001). CEUS had greater clinical benefits and correctly reclassified 48% of metastatic SLNs (p < 0.001) without sacrificing the classification accuracy of negative SLNs (p = 0.25), and could improve prediction accuracy by 0.42 (p < 0.001). CONCLUSIONS CEUS demonstrated better diagnostic performance and greater clinical benefits than conventional US for the preoperative diagnosis of SLNs, showing its potential to select candidates for precluding axillary surgery in early breast cancer. KEY POINTS • The homogeneous and featured inhomogeneous enhancement of SLNs are highly suggestive of negative LNs, while focal defect (p < 0.001) and no enhancement (p < 0.002) patterns had higher percentages of metastasis. • The proportion of SLNs with highly suspicious signs on conventional US increases as the type of enhancement pattern increases (no suspicious signs in pattern I/II, 34.8% in pattern III, and 85.7% in pattern IV). • Compared with conventional US, CEUS improved the area under the receiver operating characteristic curve (0.813 vs. 0.601, p < 0.001) and had greater clinical benefits (IDI = 0.42, p < 0.001) for the diagnosis of axillary metastasis.
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Affiliation(s)
- Zihan Niu
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Yuanjing Gao
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Mengsu Xiao
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Feng Mao
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Yidong Zhou
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Qingli Zhu
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China.
| | - Yuxin Jiang
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China.
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Avry F, Mousset C, Oujagir E, Bouakaz A, Gouilleux-Gruart V, Thépault RA, Renault S, Marouillat S, Machet L, Escoffre JM. Microbubble-Assisted Ultrasound for Imaging and Therapy of Melanoma Skin Cancer: A Systematic Review. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:2174-2198. [PMID: 36050232 DOI: 10.1016/j.ultrasmedbio.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 06/15/2023]
Abstract
Recent technological developments in ultrasound (US) imaging and ultrasound contrast agents (UCAs) have improved diagnostic confidence in echography. In the clinical management of melanoma, contrast-enhanced ultrasound (CEUS) imaging complements conventional US imaging (i.e., high-resolution US and Doppler imaging) for clinical examination and therapeutic follow-up. These developments have set into motion the combined use of ultrasound and UCAs as a new modality for drug delivery. This modality, called sonoporation, has emerged as a non-invasive, targeted and safe method for the delivery of therapeutic drugs into melanoma. This review focuses on the results and prospects of using US and UCAs as dual modalities for CEUS imaging and melanoma treatment.
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Affiliation(s)
- François Avry
- UMR 1253, iBrain, Université de Tours, INSERM, Tours, France
| | - Coralie Mousset
- UMR 1253, iBrain, Université de Tours, INSERM, Tours, France; GICC EA 7501, Université de Tours, Tours, France
| | - Edward Oujagir
- UMR 1253, iBrain, Université de Tours, INSERM, Tours, France
| | - Ayache Bouakaz
- UMR 1253, iBrain, Université de Tours, INSERM, Tours, France
| | | | | | | | | | - Laurent Machet
- UMR 1253, iBrain, Université de Tours, INSERM, Tours, France; Department of Dermatology, Tours University Hospital, Tours, France
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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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Huang J, Wu SS, Zheng S, Gao H, Wu ZY, Xu JW. Trans-lymphatic contrast-enhanced ultrasound with sentinel lymph node biopsy for detecting cervical skip metastasis to lymph nodes in early-stage oral tongue squamous cell carcinoma. Dentomaxillofac Radiol 2022; 51:20210107. [PMID: 34613749 PMCID: PMC8802708 DOI: 10.1259/dmfr.20210107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES The purpose of this study was to assess whether trans-lymphatic contrast-enhanced ultrasound (CEUS) combined with sentinel lymph node biopsy can be used to assess the status of cervical lymph nodes and skip metastasis in patients with early squamous cell carcinoma (SCC) of the oral tongue. METHODS This study included 21 subjects with early oral tongue SCC who received multiple intramucosal peritumoral injections of Sonazoid. CEUS examinations were performed immediately after Sonazoid injection to identify sentinel lymph nodes (SLNs). The SLNs were excised for histological examination to determine if the lymph nodes has metastases. RESULTS Thirty-five SLNs were detected by CEUS after Sonazoid injection in the subjects. SLNs were identified in 20 of the total 21 subjects. Four participants had metastasis to lymph nodes, and one had skip metastasis in level Ⅲ. In one subject, SLNs were successfully detected in level Ⅳ without skip metastasis. CONCLUSIONS Trans-lymphatic CEUS combined with sentinel lymph node biopsy showed high accuracy for evaluating cervical lymph node status. This could be a reliable approach for detecting cervical skip metastases of lymph nodes in early-stage oral cancer patients.
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Affiliation(s)
- Jian Huang
- Department of Oral and Maxillofacial Surgery, Fujian Provincial Hospital, 134 Dongjie, Fuzhou, China
| | - Song-song Wu
- Department of Ultrasonography, Fujian Provincial Hospital, 134 Dongjie, Fuzhou, China
| | - Song Zheng
- Department of Oral and Maxillofacial Surgery, Fujian Provincial Hospital, 134 Dongjie, Fuzhou, China
| | - Hong Gao
- Department of Oral and Maxillofacial Surgery, Fujian Provincial Hospital, 134 Dongjie, Fuzhou, China
| | - Zhi-yuan Wu
- Department of Oral and Maxillofacial Surgery, Fujian Provincial Hospital, 134 Dongjie, Fuzhou, China
| | - Jun-wu Xu
- Department of Oral and Maxillofacial Surgery, Fujian Provincial Hospital, 134 Dongjie, Fuzhou, China
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Xu YL, Liu XJ, Zhu Y, Lu H. Preoperative localization of sentinel lymph nodes using percutaneous contrast-enhanced ultrasonography in patients with breast cancer. Gland Surg 2022; 11:369-377. [PMID: 35284303 PMCID: PMC8899426 DOI: 10.21037/gs-22-10] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/18/2022] [Indexed: 09/03/2023]
Abstract
BACKGROUND This study aimed to investigate the feasibility of preoperative identification of sentinel lymph nodes (SLNs) by contrast-enhanced ultrasound (CEUS) for patients with breast cancer. METHODS The patients with T1-T2N0M0 breast cancer who were scheduled for primary surgical treatment were recruited. All the patients had received a periareolar intradermal injection of an ultrasonic contrast agent (SonoVue, Bracco, Milan, Italy) followed by an ultrasound to identify contrast-enhanced SLNs. A guidewire was deployed to localize the SLN. Methylene blue stain was used to help trace SLNs during the operation. The identification rate and accuracy rate were recorded. The number of SLNs labeled by two methods was counted and compared using Wilcoxon testing. RESULTS A total of 366 SLNs were detected in 72 patients by methylene blue intraoperatively, with a median of 5 lymph nodes [interquartile range (IQR), 4-6] per patient. A total of 95 SLNs were detected in 63 patients (87.5%) by CEUS, with a median of 1 lymph node (IQR, 1-2) per patient. The number of SLNs detected by CEUS was significantly less than that labeled by the methylene blue staining method (Z=-7.362, P=0000). Pathology confirmed 12 single metastases in all the lymph nodes examined, 10 of which were the only lymph node identified by CEUS. CONCLUSIONS Periareolar intradermal injection of an ultrasonic contrast agent was an effective and convenient supplementary to localize SLNs. The technique was expected to improve the accuracy of axillary staging with minor surgical trauma and postoperative complications.
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Affiliation(s)
- Yi-Lin Xu
- Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin (Ministry of Education), Key Laboratory of Breast Cancer Prevention and Therapy of Education Ministry, Tianjin, China
| | - Xue-Jing Liu
- Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin (Ministry of Education), Key Laboratory of Breast Cancer Prevention and Therapy of Education Ministry, Tianjin, China
| | - Ying Zhu
- Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin (Ministry of Education), Key Laboratory of Breast Cancer Prevention and Therapy of Education Ministry, Tianjin, China
| | - Hong Lu
- Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin (Ministry of Education), Key Laboratory of Breast Cancer Prevention and Therapy of Education Ministry, Tianjin, China
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Zhuang L, Ming X, Liu J, Jia C, Jin Y, Wang J, Shi Q, Wu R, Jin L, Du L. Comparison of lymphatic contrast-enhanced ultrasound and intravenous contrast-enhanced ultrasound in the preoperative diagnosis of axillary sentinel lymph node metastasis in patients with breast cancer. Br J Radiol 2022; 95:20210897. [PMID: 34797694 PMCID: PMC8822558 DOI: 10.1259/bjr.20210897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES This study aimed to compare diagnostic efficiency for axillary sentinel lymph node (SLN) metastasis between lymphatic contrast-enhanced ultrasound (LCEUS) and intravenous contrast-enhanced ultrasound (ICEUS) in patients with breast cancer. We also examined whether adding ICEUS to LCEUS could improve the diagnostic accuracy of LCEUS. METHODS Sixty-nine patients with breast cancer were recruited preoperatively. All patients underwent LCEUS followed by ICEUS, and the enhancement pattern of one SLN was analysed for each patient. The targeted SLN was marked with wire and excised during surgery. The imaging diagnosis was compared with the histopathological result. Diagnostic efficiency was compared among LCEUS, ICEUS, and the combination of LCEUS and ICEUS. RESULTS The sensitivity values for LCEUS, ICEUS, and the combination of LCEUS and ICEUS were 86.2%, 82.6% and 93.1%, respectively. Specificity values for the three methods were 95.0%, 92.5% and 87.5%, respectively. Accuracy values for the three methods were 91.3%, 88.4% and 89.9%, respectively. The area under the receiver operating characteristic (ROC) curve for LCEUS was 0.906, and there was no significant difference among LCEUS, ICEUS, and the combination of LCEUS and ICEUS (p = 0.752). CONCLUSIONS LCEUS may represent an accurate method for predicting SLN metastasis preoperatively. Our findings suggest that adding ICEUS to LCEUS for SLN evaluation in patients with breast cancer is unnecessary. ADVANCES IN KNOWLEDGE This is the first study in which both LCEUS and ICEUS were performed for the same lymph node and the first to compare the diagnostic efficiency of LCEUS, ICEUS, and the combination of LCEUS + ICEUS.
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Affiliation(s)
- Lingling Zhuang
- Department of Medical Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xu Ming
- Department of Breast-Thyroid-Vascular Surgery, Shanghai General Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, China
| | - Jun Liu
- Department of Breast-Thyroid-Vascular Surgery, Shanghai General Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, China
| | - Chao Jia
- Department of Medical Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yubiao Jin
- Department of Pathology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Jing Wang
- Department of Pathology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Qiusheng Shi
- Department of Medical Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Rong Wu
- Department of Medical Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Lifang Jin
- Department of Medical Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Lianfang Du
- Department of Medical Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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Effectiveness of Lymphatic Contrast Enhanced Ultrasound in the diagnosis of Cervical Lymph node metastasis from papillary thyroid carcinoma. Sci Rep 2022; 12:578. [PMID: 35022480 PMCID: PMC8755747 DOI: 10.1038/s41598-021-04503-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 12/20/2021] [Indexed: 12/17/2022] Open
Abstract
Cervical lymph node metastasis (CLNM) is common in patients with papillary thyroid carcinoma (PTC), which is responsible for tumor staging and surgical strategy. The accurate preoperative identification of CLNM is essential. In this study, twenty consecutive patients with PTC received a parenchyma injection of Sonazoid followed by contrast enhanced ultrasound (CEUS) to identify CLNM. The specific lymphatic CEUS (LCEUS) signs for diagnosing CLNM were summarized, which were further compared with the resected specimens to get the pathological basis. After the injection of contrast agent, lymphatic vessel and lymph node (LN) could be exclusively displayed as hyperperfusion on LCEUS. The dynamic perfusion process of contrast agent in CLNM over time can be clearly visualized. Perfusion defect and interruption of bright ring were the two characteristic LCEUS signs in diagnosing CLNM. After comparing with pathology, perfusion defect was correlated to the metastatic foci in medulla and interruption of bright ring was correlated to the tumor seeding in marginal sinus (all p values < 0.001). The diagnostic efficacies of these two signs were high (perfusion defect vs. interruption of bright ring: AUC, 0.899, 95% CI 0.752–1.000 vs. 0.904, 0.803–1.000). LCEUS has advantages in identifying CLNM from PTC. The typical LCEUS signs of CLNM correlated with pathology.
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Guo RQ, Xiang X, Wang LY, Zhu BH, Huang SY, Tang XY, Chen JJ, Qiu L. Percutaneous contrast-enhanced ultrasound for localization and qualitative diagnosis of sentinel lymph nodes in cutaneous malignant melanoma of lower extremities: a preliminary study. Quant Imaging Med Surg 2022; 12:366-375. [PMID: 34993085 DOI: 10.21037/qims-21-249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/21/2021] [Indexed: 02/05/2023]
Abstract
Background To explore the feasibility of sentinel lymph node (SLN) tracing by percutaneous contrast-enhanced ultrasound (pCEUS) in patients with cutaneous malignant melanoma (CMM) and the ability to enhance patterns of SLNs in diagnosing lymph nodes (LNs) metastases. Methods Fifty-three patients with CMM of the lower extremities treated at our hospital were included in the study. All the participants received pCEUS preoperatively. The enhanced lymphatic channels (LCs) and associated SLNs were observed and tracked in real-time. The number of enhanced LCs and enhancing patterns of SLNs were recorded. Subsequently, SLNs localized by pCEUS were pathologically examined. Results Of the 53 cases, SLNs were successfully localized by pCEUS in 48 cases. In total, there were 59 detected SLNs averaging 1.23±0.42 SLNs per case. The main lymphatic drainage patterns (LDPs) were the following: one enhanced LC pointed to one or more than one SLN, and multiple enhanced LCs pointed to one or multiple SLNs. There were four enhancing patterns of SLNs (uniform, annular, uneven, and no enhancement), among which the first two were considered benign nodes, while the latter two were considered metastatic nodes. With pathological results as the gold standard, the diagnostic sensitivity and specificity by pCEUS were 90.9% and 75.0%, respectively. Conclusions Contrast-enhanced ultrasound (US) is a feasible approach for SLN identification in patients with CMM of the lower extremities. Enhancing patterns of SLNs may help predict metastasizing SLNs. This novel method may be a promising technique for clinical application.
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Affiliation(s)
- Rui-Qian Guo
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Xi Xiang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Li-Yun Wang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Bi-Hui Zhu
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Song-Ya Huang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Xin-Yi Tang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Jun-Jie Chen
- Plastic and Burn Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Li Qiu
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, China
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Qi S, Wang X, Chang K, Shen W, Yu G, Du J. The bright future of nanotechnology in lymphatic system imaging and imaging-guided surgery. J Nanobiotechnology 2022; 20:24. [PMID: 34991595 PMCID: PMC8740484 DOI: 10.1186/s12951-021-01232-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/28/2021] [Indexed: 12/23/2022] Open
Abstract
Lymphatic system is identified the second vascular system after the blood circulation in mammalian species, however the research on lymphatic system has long been hampered by the lack of comprehensive imaging modality. Nanomaterials have shown the potential to enhance the quality of lymphatic imaging due to the unparalleled advantages such as the specific passive targeting and efficient co-delivery of cocktail to peripheral lymphatic system, ease molecular engineering for precise active targeting and prolonged retention in the lymphatic system of interest. Multimodal lymphatic imaging based on nanotechnology provides a complementary means to understand the kinetics of lymphoid tissues and quantify its function. In this review, we introduce the established approaches of lymphatic imaging used in clinic and summarize their strengths and weaknesses, and list the critical influence factors on lymphatic imaging. Meanwhile, the recent developments in the field of pre-clinical lymphatic imaging are discussed to shed new lights on the design of new imaging agents, the improvement of delivery methods and imaging-guided surgery strategies.
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Affiliation(s)
- Shaolong Qi
- Key Laboratory & Engineering Laboratory of Lymphatic Surgery Jilin Province, China-Japan Union Hospital of Jilin University, Changchun, 130031, People's Republic of China.,Key Laboratory of Bioorganic Phosphorus Chemistry & Chemical Biology, Department of Chemistry, Tsinghua University, Beijing, 100084, People's Republic of China
| | - Xinyu Wang
- Key Laboratory & Engineering Laboratory of Lymphatic Surgery Jilin Province, China-Japan Union Hospital of Jilin University, Changchun, 130031, People's Republic of China
| | - Kun Chang
- Department of Lymphology, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People's Republic of China
| | - Wenbin Shen
- Department of Lymphology, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People's Republic of China
| | - Guocan Yu
- Key Laboratory of Bioorganic Phosphorus Chemistry & Chemical Biology, Department of Chemistry, Tsinghua University, Beijing, 100084, People's Republic of China.
| | - Jianshi Du
- Key Laboratory & Engineering Laboratory of Lymphatic Surgery Jilin Province, China-Japan Union Hospital of Jilin University, Changchun, 130031, People's Republic of China.
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Shi XQ, Zhang H, Liu X, Dong Y, Yang P, Qian L. Feasibility and efficiency of contrast enhanced ultrasound real time guided fine needle aspiration for sentinel lymph node of breast cancer. Clin Hemorheol Microcirc 2022; 80:267-279. [PMID: 34719485 DOI: 10.3233/ch-211226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM To assess the feasibility and efficiency of contrast-enhanced ultrasound (CEUS) real-time guided fine needle aspiration (FNA) for sentinel lymph node (SLN) of breast cancer. MATERIALS AND METHODS This retrospective study reviewed 21 breast cancer patients who scheduled for surgical resection performed CEUS real-time guided SLN-FNA and intraoperative SLN biopsy (SLNB). The success rate of CEUS real-time guided SLN-FNA was analyzed. The FNA diagnostic efficiency of SLN metastasis was analyzed compared to SLNB. RESULTS Twenty-six SLNs were detected by intradermal CEUS whereas 130 SLNs were detected by SLNB. The median SLNs detected by intradermal CEUS (n = 1) and by SLNB (n = 5) was significantly difference (p < 0.001). All 26 CE-SLNs of 21 patients were successfully performed intradermal CEUS dual image real-time guided SLN-FNA including 5 SLNs of 4 patients which were difficult to distinguish in conventional ultrasound. Compared to SLNB, FNA found 2 of 5 cases of SLN metastasis, the diagnosis sensitivity, specificity, positive predictive value, negative predictive value, false negative rate, false positive rate and Yoden index were 40%, 100%, 100%, 84.2%, 60%, 0%and 40%, respectively. CONCLUSION SLN-FNA real-time guided by dual CEUS image mode was technically feasible. Patients with a positive SLN-FNA should be advised to ALND without intraoperative SLNB according to Chinese surgeon and patients' conservatism attitude. But a negative SLN-FNA did not obviate the need of conventional SLNB because of the high false negative rate.
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Affiliation(s)
- Xian-Quan Shi
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Huiming Zhang
- Department of Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xi Liu
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yunyun Dong
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Peipei Yang
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Linxue Qian
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Didier RA, Biko DM, Hwang M, Unnikrishnan S, Woźniak MM, Yusuf GT, Sridharan A. Emerging contrast-enhanced ultrasound applications in children. Pediatr Radiol 2021; 51:2418-2424. [PMID: 33791840 DOI: 10.1007/s00247-021-05045-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/27/2021] [Accepted: 03/01/2021] [Indexed: 11/25/2022]
Abstract
Ultrasound contrast agent (UCA) use in radiology is expanding beyond traditional applications such as evaluation of liver lesions, vesicoureteral reflux and echocardiography. Among emerging techniques, 3-D and 4-D contrast-enhanced ultrasound (CEUS) imaging have demonstrated potential in enhancing the accuracy of voiding urosonography and are ready for wider clinical adoption. US contrast-based lymphatic imaging has been implemented for guiding needle placement in MR lymphangiography in children. In adults, intraoperative CEUS imaging has improved diagnosis and assisted surgical management in tumor resection, and its translation to pediatric brain tumor surgery is imminent. Because of growing interest in precision medicine, targeted US molecular imaging is a topic of active preclinical research and early stage clinical translation. Finally, an exciting new development in the application of UCA is in the field of localized drug delivery and release, with a particular emphasis on treating aggressive brain tumors. Under the appropriate acoustic settings, UCA can reversibly open the blood-brain barrier, allowing drug delivery into the brain. The aim of this article is to review the emerging CEUS applications and provide evidence regarding the feasibility of these applications for clinical implementation.
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Affiliation(s)
- Ryne A Didier
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - David M Biko
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Misun Hwang
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Sunil Unnikrishnan
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Magdalena M Woźniak
- Department of Pediatric Radiology, Medical University of Lublin, Lublin, Poland
| | - Gibran T Yusuf
- Department of Radiology, King's College Hospital, Denmark Hill, London, UK
| | - Anush Sridharan
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
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Wang X, Tang L, Huang W, Cui Z, Hu D, Zhong Z, Wu X. The combination of contrast-enhanced ultrasonography with blue dye for sentinel lymph node detection in clinically negative node breast cancer. Arch Gynecol Obstet 2021; 304:1551-1559. [PMID: 34241688 DOI: 10.1007/s00404-021-06021-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/23/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this prospective study was to evaluate the value of the combination of contrast-enhanced ultrasonography (CEUS) and blue dye (BD) for SLN detection in patients with clinically negative node breast cancer. METHODS Patients with clinically negative node breast cancer were randomized into two cohorts for SLN biopsy (SLNB): the combination method cohort using CEUS and BD together, and the single BD method cohort. Standard axillary lymph node dissection was performed if any of the SLNs confirmed positive by pathology. The identification rate, the number of SLNs removed and recurrence-free survival (RFS) rates were evaluated between two cohorts. In addition, we assessed the sensitivity, specificity, accuracy, false-negative rate of CEUS for diagnosis of SLNs based on patterns of CEUS enhancement. RESULTS 144 consecutive patients with clinically negative node breast cancer were randomized into two cohorts. Each cohort consisted of 72 cases. In the combination method cohort, contrast-enhanced lymphatic vessels were clearly visualized and SLNs were accurately localized in 72 cases. The identification rate and the mean number of SLNs detected by the combination method were 100% (72/72) and 3.26 (1-9), respectively. In contrast, in the single BD method cohort, SLNs in 69 cases were successfully identified. The identification rate and the mean number of SLNs using BD alone were 95.8% (69/72) and 2.21 (1-4), respectively. According to patterns of CEUS enhancement, the sensitivity, specificity, accuracy, and the FNR of CEUS for SLN diagnosis were 69.2%, 96.6%, 91.7%, and 30.8%, respectively. After a median follow-up of 50 months for the combination method cohort and 51 months for the blue dye alone cohort, five patients in the combination method cohort and nine in the blue dye alone cohort had recurrence. RFS rates showed no significant difference (P = 0.26) between two cohorts. CONCLUSION The combination of CEUS and BD is more effective than BD alone for SLNB in clinically negative node patients with an identification rate as high as 100%. Use of BD and CEUS in combination may provide the possibility of a non-radioactive alternative method for SLNB in centers without access to radioisotope.
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Affiliation(s)
- Xiaojiang Wang
- Department of Molecular Pathology, Department of Breast Surgical Oncology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, No. 420 Fuma Road, Fuzhou, 350014, People's Republic of China
| | - Lina Tang
- Department of Ultrasound, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, 350014, Fujian, People's Republic of China
| | - Weiqin Huang
- Department of Ultrasound, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, 350014, Fujian, People's Republic of China
| | - Zhaolei Cui
- Laboratory of Biochemistry and Molecular Biology Research, Fujian Provincial Key Laboratory of Tumor Biotherapy, Department of Clinical Laboratory, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, 350014, Fujian, People's Republic of China
| | - Dan Hu
- Department of Pathology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, 350014, Fujian, People's Republic of China
| | - Zhaoming Zhong
- Department of Ultrasound, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, 350014, Fujian, People's Republic of China
| | - Xiufeng Wu
- Department of Breast Surgical Oncology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, 350014, Fujian, People's Republic of China.
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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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23
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Wei Y, Yu MA, Niu Y, Hao Y, Di JX, Zhao ZL, Cao XJ, Peng LL, Li Y. Combination of Lymphatic and Intravenous Contrast-Enhanced Ultrasound for Evaluation of Cervical Lymph Node Metastasis from Papillary Thyroid Carcinoma: A Preliminary Study. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:252-260. [PMID: 33158634 DOI: 10.1016/j.ultrasmedbio.2020.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/06/2020] [Accepted: 10/05/2020] [Indexed: 06/11/2023]
Abstract
The aim of this prospective study was to evaluate the value of the combination of lymphatic contrast-enhanced ultrasound (LCEUS) and intravenous contrast-enhanced ultrasound (IVCEUS) for the identification of cervical lymph node metastasis (CLNM) from papillary thyroid carcinoma (PTC). From November 2018 to March 2019, 24 consecutive patients with PTC were evaluated. All patients underwent routine US, LCEUS and IVCEUS. Pathology was used as the gold standard. After injection of a contrast agent into the thyroid parenchyma, lymphatic vessels and lymph nodes (LNs) could be exclusively displayed as hyper-enhancement on LCEUS. Benign LNs displayed a complete bright ring (100%) and homogeneous perfusion (88.9%) on LCEUS, while displaying centrifugal perfusion (66.7%) and homogenous enhancement (88.9%) on IVCEUS. Perfusion defects (94.9%) and interruption of the bright ring (71.8%) were the two characteristic LCEUS signs for diagnosing CLNM. On IVCEUS, CLNM appeared as centripetal perfusion (59.0%) and heterogeneous enhancement (59.0%). After comparison with pathology, perfusion defect was correlated to the metastatic foci in the medulla and interruption of the bright ring to the tumor seeding in the marginal sinus (all p values <0.05). LCEUS had more value (area under the receiver operating characteristic curve [AUC] = 0.850, 95% confidence interval [CI]: 0.682-1.000) in diagnosing CLNM than IVCEUS (AUC = 0.692, 95% CI: 0.494-0.890) and routine US (AUC = 0.581, 95% CI: 0.367-0.796). The combination of LCEUS and IVCEUS has the highest diagnostic value (AUC = 0.863, 95% CI: 0.696-1.000). LCEUS had higher diagnostic value than IVCEUS and US for CLNM from PTC. The combination of LCEUS and IVCEUS has the highest diagnostic value for CLNM.
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Affiliation(s)
- Ying Wei
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ming-An Yu
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China.
| | - Yun Niu
- Department of Pathology, China-Japan Friendship Hospital, Beijing, China
| | - Ying Hao
- Department of Ultrasound, Tumor Hospital of Mu Dan Jiang City, Mudanjiang, China
| | - Jin-Xi Di
- Department of Pathology, China-Japan Friendship Hospital, Beijing, China
| | - Zhen-Long Zhao
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Xiao-Jing Cao
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Li-Li Peng
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yan Li
- Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China
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Hao Y, Sun Y, Lei Y, Zhao H, Cui L. Percutaneous Sonazoid-enhanced ultrasonography combined with in vitro verification for detection and characterization of sentinel lymph nodes in early breast cancer. Eur Radiol 2021; 31:5894-5901. [PMID: 33502555 PMCID: PMC8270836 DOI: 10.1007/s00330-020-07639-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 11/25/2020] [Accepted: 12/17/2020] [Indexed: 12/04/2022]
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.
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Affiliation(s)
- Yunxia Hao
- Department of Ultrasound, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Yan Sun
- Department of Ultrasound, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Yutao Lei
- Department of General Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Hongmei Zhao
- Department of General Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Ligang Cui
- Department of Ultrasound, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
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25
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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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26
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Fournier Q, Thierry F, Longo M, Malbon A, Cazzini P, Bisson J, Woods S, Liuti T, Bavcar S. Contrast-enhanced ultrasound for sentinel lymph node mapping in the routine staging of canine mast cell tumours: A feasibility study. Vet Comp Oncol 2020; 19:451-462. [PMID: 32840038 DOI: 10.1111/vco.12647] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/10/2020] [Accepted: 08/22/2020] [Indexed: 12/15/2022]
Abstract
Canine mast cell tumours (MCTs) typically spread to lymph nodes (LNs) before reaching distant sites, and LN assessment is an important part of MCT staging. Sentinel LN (SLN) mapping techniques to identify draining LNs are being developed and could improve the accuracy of MCT staging. The primary objective of this feasibility study was to determine the safety and effectiveness of contrast-enhanced ultrasound (CEUS) to identify SLNs. Secondary objectives were to determine if the SLNs identified by CEUS coincided with the regional LN predicted by the anatomical lymphosomes, if previous MCT excision altered CEUS SLN findings, and if CEUS could identify MCT nodal metastases. Between June 2017 and March 2019, 59 dogs with 62 MCTs were enrolled. No adverse events related to CEUS were reported. CEUS detected at least 1 SLN in 59/62 MCTs (95.2%, 95% CI: 86.5-99.0%). In only 32/59 (54.2%) MCTs, clinicians would have correctly predicted the SLN(s) identified by CEUS. Among the 35 MCTs that had histological examination of the SLN(s), the prevalence of metastasis was 60% (95% CI: 42.1-76.1%). Additional staging procedures did not reveal any metastases in dogs with histologically non-metastatic SLNs. Integration of CEUS SLN mapping into the routine staging of MCTs is promising, but future studies are required to refine this procedure and to investigate if it would translate into a clinical benefit.
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Affiliation(s)
- Quentin Fournier
- Department of Small Animal Teaching Hospital, The Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Florence Thierry
- Department of Small Animal Teaching Hospital, The Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Edinburgh, UK.,Occitanie Veterinary Hospital, Toulouse, France
| | - Maurizio Longo
- Department of Small Animal Teaching Hospital, The Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Edinburgh, UK.,Department of Veterinary Medicine, Veterinary Teaching Hospital, University of Milan, Lodi, Italy
| | - Alexandra Malbon
- Easter Bush Pathology, The Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Paola Cazzini
- Easter Bush Pathology, The Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Jocelyn Bisson
- Department of Small Animal Teaching Hospital, The Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Samantha Woods
- Department of Small Animal Teaching Hospital, The Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Edinburgh, UK.,Veterinary Specialists, Scotland, Livingston, Scotland
| | - Tiziana Liuti
- Department of Small Animal Teaching Hospital, The Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Spela Bavcar
- Department of Small Animal Teaching Hospital, The Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Edinburgh, UK
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27
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Zheng F, Li P, Bachawal SV, Wang H, Li C, Yuan W, Huang B, Paulmurugan R. Assessment of Metastatic and Reactive Sentinel Lymph Nodes with B7-H3-Targeted Ultrasound Molecular Imaging: A Longitudinal Study in Mouse Models. Mol Imaging Biol 2020; 22:1003-1011. [PMID: 32034623 PMCID: PMC11162558 DOI: 10.1007/s11307-020-01478-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE To explore the potential of B7-H3-targeted ultrasound molecular imaging (USMI) for longitudinal assessment and differentiation of metastatic and reactive sentinel lymph nodes (SLNs) in mouse models. PROCEDURES Metastatic and reactive SLN models were established by injection of 4T1 breast cancer cells and complete Freund's adjuvant (CFA) respectively to the 4th mammary fat pad of female BALB/c mice. At day 21, 28, and 35 after inoculation, USMI was performed following intravenous injection of B7-H3-targeted microbubbles (MBB7-H3) or IgG-control microbubbles (MBcontrol). All SLNs were histopathologically examined after the last imaging session. RESULTS A total of 20 SLNs from tumor-bearing mice (T-SLNs) and five SLNs from CFA-injected mice (C-SLNs) were examined by USMI. Nine T-SLNs were histopathologically positive for metastasis (MT-SLNs). From day 21 to 35, T-SLNs showed a rising trend in MBB7-H3 signal with a steep increase in MT-SLNs at day 35 (213.5 ± 80.8 a.u.) as compared to day 28 (87.6 ± 77.2 a.u., P = 0.002) and day 21 (55.7 ± 35.5 a.u., P < 0.001). At day 35, MT-SLNs had significantly higher MBB7-H3 signal than non-metastatic T-SLNs (NMT-SLNs) (101.9 ± 48.0 a.u., P = 0.001) and C-SLNs (38.5 ± 34.0 a.u., P = 0.001); MBB7-H3 signal was significantly higher than MBcontrol in MT-SLNs (P = 0.001), but not in NMT-SLNs or C-SLNs (both P > 0.05). A significant correlation was detected between MBB7-H3 signal and volume fraction of metastasis in MT-SLNs (r = 0.76, P = 0.017). CONCLUSIONS B7-H3-targeted USMI allows differentiation of MT-SLNs from NMT-SLNs and C-SLNs in mouse models and has great potential to evaluate tumor burden in SLNs of breast cancer.
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Affiliation(s)
- Fengyang Zheng
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Stanford University School of Medicine, 3155 Porter Drive, Palo Alto, CA, 94305, USA
- Department of Ultrasound, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, People's Republic of China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, People's Republic of China
| | - Pan Li
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Stanford University School of Medicine, 3155 Porter Drive, Palo Alto, CA, 94305, USA
- Institute of Ultrasound Imaging of Chongqing Medical University, Chongqing, 400010, People's Republic of China
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People's Republic of China
| | - Sunitha V Bachawal
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Stanford University School of Medicine, 3155 Porter Drive, Palo Alto, CA, 94305, USA
| | - Huaijun Wang
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Stanford University School of Medicine, 3155 Porter Drive, Palo Alto, CA, 94305, USA
| | - Chaolun Li
- Department of Ultrasound, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, People's Republic of China
- Shanghai Institute of Medical Imaging, Shanghai, 200032, People's Republic of China
| | - Wei Yuan
- Department of pathology, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, People's Republic of China
| | - Beijian Huang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, People's Republic of China.
- Shanghai Institute of Medical Imaging, Shanghai, 200032, People's Republic of China.
| | - Ramasamy Paulmurugan
- Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Stanford University School of Medicine, 3155 Porter Drive, Palo Alto, CA, 94305, USA.
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Cui Q, Dai L, Li J, Xue J. Accuracy of CEUS-guided sentinel lymph node biopsy in early-stage breast cancer: a study review and meta-analysis. World J Surg Oncol 2020; 18:112. [PMID: 32471428 PMCID: PMC7260746 DOI: 10.1186/s12957-020-01890-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 05/19/2020] [Indexed: 12/24/2022] Open
Abstract
Objective To investigate whether preoperative localization of sentinel lymph node (SLN) by contrast-enhanced ultrasound (CEUS) can further improve the accuracy of sentinel lymph node biopsy (SLNB). Method Collect published literatures or conference reports by searching electronic databases. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) evaluation method is used to evaluate the quality of the screened literatures. The pooled risk ratio of cancer metastasis of SLN identified by CEUS (CE-SLN) compared with SLN not identified by CEUS (nonCE-SLN) is calculated, and the pooled diagnostic accuracy of CE-SLN for pathological status of all SLNs is also evaluated. Result Through search and screening, a total of 16 studies were included, of which five and seven studies, respectively, entered the meta-analysis of metastatic risk ratio and diagnostic accuracy. The localization rate of preoperative CEUS for sentinel lymph nodes was 70 to 100%. The meta-analysis shows that the risk of metastasis of SLN identified by CEUS is significantly higher than that not identified by CEUS, 26.0% vs 4.6%, and risk ratio (RR) is 6.08 (95% CI 4.17–8.85). In early-stage breast cancer, the pathological status of CE-SLN is a good representative of all SLNs, with a pooled sensitivity of 98% (95% CI 0.94–1.00), pooled specificity of 100% (95% CI 0.99–1.00), diagnostic odds ratio (DOR) of 2153.18 (95% CI 476.53–9729.06), and area under the subject receiver operating characteristic (SROC) curve of 0.9968. Conclusion In early-stage breast cancer, preoperative localization of SLN by CEUS is expected to further improve the accuracy of sentinel lymph node biopsy (SLNB).
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Affiliation(s)
- Qiuxia Cui
- Department of Thyroid and Breast Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Li Dai
- Department of Thyroid and Breast Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Jialu Li
- Department of Thyroid and Breast Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Jialei Xue
- Department of Thyroid and Breast Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China.
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29
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Choi M, Yoon J, Choi M. Contrast-enhanced ultrasound sonography combined with strain elastography to evaluate mandibular lymph nodes in clinically healthy dogs and those with head and neck tumors. Vet J 2020; 257:105447. [PMID: 32546353 DOI: 10.1016/j.tvjl.2020.105447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 02/25/2020] [Accepted: 02/25/2020] [Indexed: 12/18/2022]
Abstract
Determining lymph node metastases in dogs with neoplasia is important in staging and developing a therapeutic plan. In this study, the clinical efficacy of combined lymphosonography and strain elastography was evaluated for its ability to identify metastatic mandibular lymph nodes. Data from clinically healthy dogs (n = 16) and those with head/neck tumors (n = 11) were enrolled. Strain elastographic patterns were classified according to the percentage of the stiffness lymph node area (grade 1-4/4). Lymphosonographic images were evaluated quantitatively (visualization of lymphatic vessels/lymph nodes; contrast transit time) and qualitatively (enhancement pattern). There was a significant difference in the strain elastographic pattern (P = 0.011) and lymphosonographic contrast enhancement (P = 0.001) in the metastatic nodes compared to clinical healthy or non-metastatic nodes. Mandibular lymph nodes with filling defects after lymphosonography and high-grade strain elastographic patterns suggested metastasis, and the combination of lymphosonography and strain elastography was useful for identifying malignancy.
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Affiliation(s)
- Mihyun Choi
- Haemaru Referral Animal Hospital, Seongnam, 13590, Republic of Korea; The Department of Veterinary Medical Imaging, College of Veterinary Medicine, Seoul National University, Seoul, 08826, Republic of Korea
| | - Junghee Yoon
- The Department of Veterinary Medical Imaging, College of Veterinary Medicine, Seoul National University, Seoul, 08826, Republic of Korea
| | - Mincheol Choi
- The Department of Veterinary Medical Imaging, College of Veterinary Medicine, Seoul National University, Seoul, 08826, Republic of Korea.
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30
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Zhou Y, Li Y, Mao F, Zhang J, Zhu Q, Shen S, Lin Y, Zhang X, Liu H, Xiao M, Jiang Y, Sun Q. Preliminary study of contrast-enhanced ultrasound in combination with blue dye vs. indocyanine green fluorescence, in combination with blue dye for sentinel lymph node biopsy in breast cancer. BMC Cancer 2019; 19:939. [PMID: 31604469 PMCID: PMC6787996 DOI: 10.1186/s12885-019-6165-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/16/2019] [Indexed: 02/06/2023] Open
Abstract
Background This preliminary study aimed to examine the feasibility of sentinel lymph node biopsy (SLNB) using contrast-enhanced ultrasound (CEUS) vs. indocyanine green fluorescence (ICG), combined with blue dye in patients with breast cancer. Methods This was a retrospective study of consecutive female patients with invasive stage I-III (based on pre-operative physical examination and imaging) primary breast cancer at the Peking Union Medical College Hospital between 01/2013 and 01/2015 who underwent preoperative SLNB by ICG + blue dye or CEUS + blue dye. The numbers of detected SLNs, detection rates, and recurrence-free survival (RFS) rates were compared between the two groups. Results A total of 443 patients were included. The detection rates of SLNs in the CEUS + blue dye and ICG + blue dye groups were 98.4 and 98.1%, respectively (P = 0.814). The average numbers of SLNs detected per patient showed no significant difference between the two groups (3.06 ± 1.33 and 3.12 ± 1.31 in the CEUS + blue dye and ICG + blue dye groups, respectively; P = 0.659). After a median follow-up of 46 months, five patients in the CEUS + blue dye group and 15 in the ICG + blue dye group had recurrence. RFS rates showed no significant difference (P = 0.55). Conclusion This preliminary study suggests that CEUS + blue dye and ICG + blue dye are both feasible for SLN detection in breast cancer.
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Affiliation(s)
- Yidong Zhou
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China.
| | - Yan Li
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Feng Mao
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Jing Zhang
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Qingli Zhu
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Songjie Shen
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Yan Lin
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Xiaohui Zhang
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - He Liu
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Mengsu Xiao
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Yuxin Jiang
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China.
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Liu J, Liu X, He J, Gou B, Luo Y, Deng S, Wen H, Zhou L. Percutaneous contrast-enhanced ultrasound for localization and diagnosis of sentinel lymph node in early breast cancer. Sci Rep 2019; 9:13545. [PMID: 31537856 PMCID: PMC6753066 DOI: 10.1038/s41598-019-49736-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 08/30/2019] [Indexed: 01/07/2023] Open
Abstract
This study assessed the efficacy of percutaneous contrast-enhanced ultrasound (CEUS) in localization sentinel lymph node (SLNs) for biopsy and diagnosis of metastatic SLNs in patients with early breast cancer. From January to November 2017, seventy-five patients with early breast cancer confirmed by pathology were enrolled in this study. CEUS was performed after subdermal injection of ultrasound contrast agent (SonoVue, 2.0 ml in total dose) around the areola on the ipsilateral side of the breast. The contrast-enhanced lymphatic vessels and associated SLNs were observed and traced in real time. The lymphatic vessels and SLN were mapped and labeled on the skin surface. Sentinel lymph node biopsy (SLNB) was performed after injection of 2.0 ml methylene blue at same injection site of SonoVue. The accuracy of percutaneous CEUS localization of SLNs was determined compared to blue dye injection technique. The pathological results under blue dye guided biopsy were used as the reference standard to calculate the sensitivity and specificity of CEUS for the diagnosis of SLNs. A total of 163 SLNs obtained through SLNB following methylene blue tracing in 75 patients. There were 116 SLNs identified by percutaneous CEUS. The difference of detection rates between blue dye and CEUS was statistically significant (Z = -2.651, P = 0.008). The identification rate of SLNs by CEUS was 71.17% (116/163). The accuracy of percutaneous CEUS localization of axillary SLNs was 94.67% (71/75) compared to blue dye-guided biopsy. Among the 116 SLNs detected by percutaneous CEUS, pathologic results showed 51 positive SLNs and 65 negative SLNs whiles CEUS findings indicated 83 positive SLNs and 33 negative SLNs. Only 50 of 83 SLNs had metastasis on pathology, while 33 were detected as false positive. The sensitivity and specificity of CEUS for the diagnosis of metastatic SLN was 98.04%(50/51) and 49.23%(32/65), respectively. Percutaneous CEUS can be used as an effective method to localize the SLNs for guiding SLNB. This method has excellent sensitivity for identifying the SLNs but lower specificity for detecting metastatic SLNs in patients with early stage breast cancer.
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Affiliation(s)
- Jian Liu
- Department of Ultrasound, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, 610500, China.
| | - Xiaoling Liu
- Department of Ultrasound, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, 610500, China
| | - Jiao He
- Department of Ultrasound, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, 637000, China
| | - Bo Gou
- Department of Ultrasound, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, 610500, China
| | - Yujie Luo
- Department of Ultrasound, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, 637000, China
| | - Sihui Deng
- Department of Ultrasound, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, 637000, China
| | - Hong Wen
- Department of Ultrasound, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, 637000, China
| | - Lin Zhou
- Department of Ultrasound, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, 637000, China
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Zhu J, Lin S, Leow CH, Rowland EM, Riemer K, Harput S, Weinberg PD, Tang MX. High Frame Rate Contrast-Enhanced Ultrasound Imaging for Slow Lymphatic Flow: Influence of Ultrasound Pressure and Flow Rate on Bubble Disruption and Image Persistence. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2456-2470. [PMID: 31279503 DOI: 10.1016/j.ultrasmedbio.2019.05.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 04/09/2019] [Accepted: 05/13/2019] [Indexed: 06/09/2023]
Abstract
Contrast-enhanced ultrasound (CEUS) utilising microbubbles shows great potential for visualising lymphatic vessels and identifying sentinel lymph nodes (SLNs) which are valuable for axillary staging in breast cancer patients. However, current CEUS imaging techniques have limitations that affect the accurate visualisation and tracking of lymphatic vessels and SLN. (i) Tissue artefacts and bubble disruption can reduce the image contrast. (ii) Limited spatial and temporal resolution diminishes the amount of information that can be captured by CEUS. (iii) The slow lymph flow makes Doppler-based approaches less effective. This work evaluates on a lymphatic vessel phantom the use of high frame rate (HFR) CEUS for the detection of lymphatic vessels where flow is slow. Specifically, the work particularly investigates the impact of key factors in lymphatic imaging, including ultrasound pressure and flow velocity as well as probe motion during vessel tracking, on bubble disruption and image contrast. Experiments were also conducted to apply HFR CEUS imaging on vasculature in a rabbit popliteal lymph node (LN). Our results show that (i) HFR imaging and singular value decomposition (SVD) filtering can significantly reduce tissue artefacts in the phantom at high clinical frequencies; (ii) the slow flow rate within the phantom makes image contrast and signal persistence more susceptible to changes in ultrasound amplitude or mechanical index (MI), and an MI value can be chosen to reach a compromise between images contrast and bubble disruption under slow flow condition; (iii) probe motion significantly decreases image contrast of the vessel, which can be improved by applying motion correction before SVD filtering; (iv) the optical observation of the impact of ultrasound pressure on HFR CEUS further confirms the importance of optimising ultrasound amplitude and (v) vessels inside rabbit LN with blood flow less than 3 mm/s are clearly visualised.
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Affiliation(s)
- Jiaqi Zhu
- Department of Bioengineering, Imperial College London, UK
| | - Shengtao Lin
- Department of Bioengineering, Imperial College London, UK
| | - Chee Hau Leow
- Department of Bioengineering, Imperial College London, UK
| | | | - Kai Riemer
- Department of Bioengineering, Imperial College London, UK
| | - Sevan Harput
- Department of Bioengineering, Imperial College London, UK
| | | | - Meng-Xing Tang
- Department of Bioengineering, Imperial College London, UK.
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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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Ha SW, Lee HJ, Cho AS, Hwang SI, Lee HJ. Evaluation of lymph node metastasis in a rabbit tumor model: correlations between contrast-enhanced ultrasound and pathologic findings. Ultrasonography 2019; 39:60-69. [PMID: 31786903 PMCID: PMC6920616 DOI: 10.14366/usg.19010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/10/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the ability of contrast-enhanced ultrasonography (CEUS) with microbubbles to detect metastatic lymph nodes (LNs) for treatment planning and prognosis. Methods For the metastatic LN model, ground VX2 tumor tissues were injected subcutaneously in 12 rabbits, just below the right hind limb. The rabbits were classified into three groups based on the LN area: group A (n=4, >1.9 cm2 ), group B (n=4, 1-1.9 cm2 ), and group C (n=4, <1 cm2 ). The LNs were monitored on CEUS for 10 seconds after injecting 2.5 mL of microbubbles. The percent area of metastatic LNs was calculated on pathologic images and compared with CEUS images. Results In group A, the mean percent area of metastasis was 40.7%±19.4%. In all cases of metastasis, round-shaped perfusion defects were clearly observed in CEUS images. The metastatic areas were strongly correlated with pathologic findings. The mean percent area in group B was 21.5%±14.4%. The CEUS findings showed multiple nodular perfusion defects, clearly revealing the metastatic areas. In group B, the CEUS and pathologic findings were concordant for three of the four cases. The mean percent area in group C was 9.1%±6.4%. However, in this group, CEUS only detected a small perfusion defect in one case. Conclusion CEUS has the potential to depict characteristic imaging features of metastatic LNs but still has limitations in early detection.
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Affiliation(s)
- Shin-Woo Ha
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.,Research Institute, IMGT Co., Ltd., Seongnam, Korea
| | - Hyun-Je Lee
- Department of Nanoconvergence, Seoul National University Graduate School of Convergence Science and Technology, Suwon, Korea
| | - Ae-Sin Cho
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sung Il Hwang
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hak Jong Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.,Research Institute, IMGT Co., Ltd., Seongnam, Korea.,Department of Nanoconvergence, Seoul National University Graduate School of Convergence Science and Technology, Suwon, Korea
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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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Nam K, Stanczak M, Forsberg F, Liu JB, Eisenbrey JR, Solomides CC, Lyshchik A. Sentinel Lymph Node Characterization with a Dual-Targeted Molecular Ultrasound Contrast Agent. Mol Imaging Biol 2019; 20:221-229. [PMID: 28762204 DOI: 10.1007/s11307-017-1109-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study was to assess the performance of molecular ultrasound with dual-targeted microbubbles to detect metastatic disease in the sentinel lymph nodes (SLNs) in swine model of naturally occurring melanoma. The SLN is the first lymph node in the lymphatic chain draining primary tumor, and early detection of metastatic SLN involvement is critical in the appropriate management of melanoma. PROCEDURE Nine Sinclair swine (weight 3-7 kg; Sinclair BioResources, Columbia, MO, USA) with naturally occurring melanoma were examined. Siemens S3000 scanner with a 9L4 probe was used for imaging (Siemens Healthineers, Mountain View, CA). Dual-targeted contrast agent was created using Targestar SA microbubbles (Targeson, San Diego, CA, USA) labeled with ανβ3-integrin and P-selectin antibodies. Targestar SA microbubbles labeled with IgG-labeled were used as control. First, peritumoral injection of Sonazoid contrast agent (GE Healthcare, Oslo, Norway) was performed to detect SLNs. After that, dual-targeted and IGG control Targestar SA microbubbles were injected intravenously with a 30-min interval between injections. Labeled Targestar SA microbubbles were allowed to circulate for 4 min to enable binding. After that, two sets of image clips were acquired several seconds before and after a high-power destruction sequence. The mean intensity difference pre- to post-bubble destruction within the region of interest placed over SLN was calculated as a relative measure of targeted microbubble contrast agent retention. This process was repeated for non-SLNs as controls. All lymph nodes evaluated on imaging were surgically removed and histologically examined for presence of metastatic involvement. RESULTS A total of 43 lymph nodes (25 SLNs and 18 non-SLNs) were included in the analysis with 18 SLNs demonstrating metastatic involvement greater than 5 % on histology. All non-SLNs were benign. The mean intensity (± SD) of the dual-targeted microbubbles for metastatic SLNs was significantly higher than that of benign LNs (18.05 ± 19.11 vs. 3.30 ± 6.65 AU; p = 0.0008), while IgG-labeled control microbubbles demonstrated no difference in retained contrast intensity between metastatic and benign lymph nodes (0.39 ± 1.14 vs. 0.03 ± 0.24 AU; p = 0.14). CONCLUSIONS The results indicate that dual-targeted microbubbles labeled with P-selectin and ανβ3-integrin antibodies may aid in detecting metastatic involvement in SLNs of melanoma.
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Affiliation(s)
- Kibo Nam
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street, Philadelphia, PA, 19107, USA
| | - Maria Stanczak
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street, Philadelphia, PA, 19107, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street, Philadelphia, PA, 19107, USA
| | - Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street, Philadelphia, PA, 19107, USA
| | - John R Eisenbrey
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street, Philadelphia, PA, 19107, USA
| | | | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street, Philadelphia, PA, 19107, USA.
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Zhong J, Sun DS, Wei W, Liu X, Liu J, Wu X, Zhang Y, Luo H, Li Y. Contrast-Enhanced Ultrasound-Guided Fine-Needle Aspiration for Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1371-1378. [PMID: 29631800 DOI: 10.1016/j.ultrasmedbio.2018.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 02/17/2018] [Accepted: 03/05/2018] [Indexed: 05/25/2023]
Abstract
The purpose of this study was to assess whether translymphatic contrast-enhanced ultrasound (CEUS) combined with fine-needle aspiration (FNA) can be used pre-operatively to assess the status of axillary lymph nodes in early-stage breast cancer patients. Furthermore, we wanted to determine whether this less invasive method could potentially be a pre-operative surgical strategy. One hundred sixty-four sentinel lymph nodes (SLNs) were detected by CEUS after intradermal injection of microbubbles in 126 cases. One hundred twenty of 126 cases (95.24%) were accurately diagnosed with the SLN-FNA method. All 6 false-negative cases were due to micrometastasis or macrometastasis. There were no false-positive results after CEUS-guided FNA biopsy based on post-operative histopathological results. In conclusion, translymphatic CEUS combined with SLN-FNA is a less traumatic approach that has high accuracy in the pre-operative evaluation of axillary lymph node status. It might have the potential to be as reliable an indicator for axillary lymph node dissection as SLN biopsy.
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Affiliation(s)
- Jieyu Zhong
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - De-Sheng Sun
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China.
| | - Wei Wei
- Department of Breast Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Xiaoling Liu
- Department of Breast Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Jun Liu
- Department of Pathology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Xiaoqin Wu
- Department of Breast Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Yusen Zhang
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Haiyu Luo
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Yongbin Li
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
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Machado P, Stanczak M, Liu JB, Moore JN, Eisenbrey JR, Needleman L, Kraft WK, Forsberg F. Subdermal Ultrasound Contrast Agent Injection for Sentinel Lymph Node Identification: An Analysis of Safety and Contrast Agent Dose in Healthy Volunteers. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1611-1620. [PMID: 29205451 PMCID: PMC5988650 DOI: 10.1002/jum.14502] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/21/2017] [Accepted: 09/14/2017] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Mapping of the lymphatic chain for identification of the sentinel lymph node (SLN) is an important aspect of predicting outcomes for patients with breast cancer, and it is usually performed as an intraoperative procedure using blue dye and/or radiopharmaceutical agents. Recently, the use of contrast-enhanced ultrasound (CEUS) has been proposed as an alternative imaging technique for this mapping. The objective of this study was to evaluate the use of subdermal administration of the ultrasound (US) contrast agent Sonazoid (GE Healthcare, Oslo, Norway) in terms of patient safety and to select the dose to be used for lymphatic applications in humans. METHODS This study was performed in 12 female volunteers who received bilateral subdermal injections of Sonazoid (1 or 2 mL dose) in the mid-upper outer quadrant of their breasts at 2 different time points. Contrast-enhanced US examinations were performed 0, 0.25, 0.5, 1, 2, 4, 6, and 24 hours after injection to identify SLNs. RESULTS Sentinel lymph nodes were identified within the first hour after injection as enhanced structures, and there was no significant difference by dose in the number of SLNs identified (P = .74). The volunteers only had minor adverse experiences (AEs) that resolved completely without intervention by study completion. CONCLUSIONS The subdermal use of Sonazoid in this study showed only minor local and nonsignificant AEs that were completely resolved without any intervention. Two different doses were compared with no significant differences observed between them. Hence, the lower dose studied (1 mL) was selected for use in future clinical studies.
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Affiliation(s)
- Priscilla Machado
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Maria Stanczak
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jason N. Moore
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - John R. Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Laurence Needleman
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Walter K. Kraft
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
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Lowes S, Leaver A, Cox K, Satchithananda K, Cosgrove D, Lim A. Evolving imaging techniques for staging axillary lymph nodes in breast cancer. Clin Radiol 2018; 73:396-409. [DOI: 10.1016/j.crad.2018.01.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 01/02/2018] [Indexed: 12/18/2022]
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Cox K, Taylor-Phillips S, Sharma N, Weeks J, Mills P, Sever A, Lim A, Haigh I, Hashem M, de Silva T, Satchithananda K, Tang M, Wallis M. Enhanced pre-operative axillary staging using intradermal microbubbles and contrast-enhanced ultrasound to detect and biopsy sentinel lymph nodes in breast cancer: a potential replacement for axillary surgery. Br J Radiol 2017; 91:20170626. [PMID: 29125333 DOI: 10.1259/bjr.20170626] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To compare the experience of four UK Centres in the use of intradermal microbubbles and contrast enhanced ultrasound (CEUS) to pre-operatively identify and biopsy sentinel lymph nodes (SLN) in patients with breast cancer. METHODS In all centres, breast cancer patients had a microbubble/CEUS SLN core biopsy prior to axillary surgery and patients in Centres 1 and 2 had a normal greyscale axillary ultrasound. Data were collected between 2010 and 2016; 1361 from Centre 1 (prospective, sequential), 376 from Centre 2 (retrospective, sequential), 121 from Centre 3 (retrospective, selected) and 48 from Centre 4 (prospective, selected). RESULTS SLN were successfully core biopsied in 80% (Centre 1), 79.6% (Centre 2), 77.5% (Centre 3) and 88% (Centre 4). The sensitivities to identify all SLN metastases were 46.9% [95% confidence intervals (CI) (39.4-55.1)], 52.5% [95% CI (39.1-65.7)], 46.4% [95% CI (27.5-66.1)] and 45.5% [95% CI (16.7-76.6)], respectively. The specificities were 99.7% [95% CI (I98.9-100)], 98.1% [95% CI (94.5-99.6)], 100% [95% CI (93.2-100%)] and 96.3% [95% CI (81-99.9)], respectively.The negative predictive values were 87.0% [95% CI (84.3-89.3)], 84.5% [95% CI (78.4-89.5)], 86.9% [95% CI (82.4-90.3)] and 86.2% [95% CI (78.4-91.5)], respectively. At Centres 1 and 2, 12/730 (1.6%) and 7/181 (4%), respectively, of patients with a benign microbubble/CEUS SLN core biopsy had two or more lymph node (LN) macrometastases found at the end of primary surgical treatment. CONCLUSION The identification and biopsy of SLN using CEUS is a reproducible technique. Advances in knowledge: In the era of axillary conservation, microbubble/CEUS SLN core biopsy has the potential to succeed surgical staging of the axilla.
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Affiliation(s)
- Karina Cox
- 1 Breast Surgery, Peggy Wood Breast Unit, Maidstone Hospital, Hermitage Lane , Peggy Wood Breast Unit, Maidstone Hospital, Hermitage Lane , Kent, Maidstone , UK
| | - Sian Taylor-Phillips
- 2 WMS - Population Evidence and Technologies, University of Warwick , University of Warwick , Coventry , UK
| | - Nisha Sharma
- 3 Breast Radiology, Leeds Breast Unit, St James's University Hospital, Beckett Street , Leeds Breast Unit, St James's University Hospital, Beckett Street , Leeds , UK
| | - Jennifer Weeks
- 1 Breast Surgery, Peggy Wood Breast Unit, Maidstone Hospital, Hermitage Lane , Peggy Wood Breast Unit, Maidstone Hospital, Hermitage Lane , Kent, Maidstone , UK
| | - Philippa Mills
- 1 Breast Surgery, Peggy Wood Breast Unit, Maidstone Hospital, Hermitage Lane , Peggy Wood Breast Unit, Maidstone Hospital, Hermitage Lane , Kent, Maidstone , UK
| | - Ali Sever
- 4 Breast Radiology, Breast Care Unit, Kings College Hospital, Ground floor, Cheyne Wing, Denmark Hill , Breast Care Unit, Kings College Hospital, Ground floor, Cheyne Wing, Denmark Hill , Brixton, London , UK
| | - Adrian Lim
- 5 Breast Radiology, Breast Unit, Charing Cross Hospital, Fulham Palace Road , Breast Unit, Charing Cross Hospital, Fulham Palace Road , London , UK
| | - Isobel Haigh
- 3 Breast Radiology, Leeds Breast Unit, St James's University Hospital, Beckett Street , Leeds Breast Unit, St James's University Hospital, Beckett Street , Leeds , UK
| | - Mohamed Hashem
- 1 Breast Surgery, Peggy Wood Breast Unit, Maidstone Hospital, Hermitage Lane , Peggy Wood Breast Unit, Maidstone Hospital, Hermitage Lane , Kent, Maidstone , UK
| | - Tania de Silva
- 6 School of Surgery, Health Education Kent Surrey and Sussex , Health Education Kent Surrey and Sussex , London , UK
| | - Keshthra Satchithananda
- 4 Breast Radiology, Breast Care Unit, Kings College Hospital, Ground floor, Cheyne Wing, Denmark Hill , Breast Care Unit, Kings College Hospital, Ground floor, Cheyne Wing, Denmark Hill , Brixton, London , UK
| | - Mengxing Tang
- 7 Department of Bioengineering, Imperial College London , Imperial College London , London , UK
| | - Matthew Wallis
- 8 Breast Radiology, Breast Unit, Addenbrooke's Treatment Centre , Breast Unit, Addenbrooke's Treatment Centre , Cambridge , UK
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Lahtinen O, Eloranta M, Anttila M, Kärkkäinen H, Sironen R, Vanninen R, Rautiainen S. Preoperative sentinel lymph node localization in vulvar cancer: preliminary experience with inguinal intradermal contrast-enhanced ultrasound. Eur Radiol 2017; 28:2089-2095. [DOI: 10.1007/s00330-017-5155-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 09/26/2017] [Accepted: 10/23/2017] [Indexed: 10/18/2022]
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42
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Beer P, Pozzi A, Rohrer Bley C, Bacon N, Pfammatter NS, Venzin C. The role of sentinel lymph node mapping in small animal veterinary medicine: A comparison with current approaches in human medicine. Vet Comp Oncol 2017; 16:178-187. [DOI: 10.1111/vco.12372] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 10/17/2017] [Indexed: 12/20/2022]
Affiliation(s)
- P. Beer
- Clinic for Small Animal Surgery, Vetsuisse Faculty; University of Zurich; Zurich Switzerland
| | - A. Pozzi
- Clinic for Small Animal Surgery, Vetsuisse Faculty; University of Zurich; Zurich Switzerland
| | - C. Rohrer Bley
- Division of Radiation Oncology, Vetsuisse Faculty; University of Zurich; Zurich Switzerland
| | - N. Bacon
- Fitzpatrick Referrals Oncology and Soft Tissue; Guildford Hospital; Guildford UK
| | - N. S. Pfammatter
- Clinic for Diagnostic Imaging, Vetsuisse Faculty; University of Zurich; Zurich Switzerland
| | - C. Venzin
- Clinic for Small Animal Surgery, Vetsuisse Faculty; University of Zurich; Zurich Switzerland
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Abstract
Purpose of Review Axillary staging in the context of breast cancer is a contentious topic due to the varied practices across UK, Europe, and America. The ACOSOG Z0011 trial has questioned the role of axillary ultrasound in women with breast cancer. Published data has shown that women with ultrasound-positive lymph nodes have a worse prognosis than those with ultrasound-negative lymph nodes. Axillary ultrasound is limited as the sentinel lymph node (SLN) cannot be identified using B-mode ultrasound; however, with the advent of contrast-enhanced ultrasound (CEUS), this has now changed. Recent Findings The published literature has shown that the sentinel lymph node can be identified using CEUS. The rates are equivalent to blue dye alone but currently inferior to the dual technique of sentinel lymph node biopsy. There are several different contrast agents that can be used and the agents that remain in the sentinel lymph node for longer can identify areas of poor enhancement, allowing for targeted biopsy. Summary CEUS has the potential to revolutionize the way we manage the axilla in the future and may even replace surgical staging.
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Affiliation(s)
- Nisha Sharma
- Breast Unit, Level 1 Chancellor Wing, St James Hospital, Beckett Street, Leeds, LS9 7TF UK.,University of Leeds, Leeds, LS2 9JT UK
| | - Karina Cox
- Department of Breast Surgery, Maidstone Hospital, Hermitage Lane, Maidstone, Kent ME16 9QQ UK
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Gvetadze SR, Xiong P, Li J, Lv M, Li J, Yang X, Ilkaev KD, Sun J. Contrast-enhanced ultrasound for diagnosis of an enlarged cervical lymph node in a patient with oropharyngeal cancer: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:495-499. [DOI: 10.1016/j.oooo.2017.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 08/06/2017] [Accepted: 08/10/2017] [Indexed: 12/27/2022]
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45
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Nielsen Moody A, Bull J, Culpan AM, Munyombwe T, Sharma N, Whitaker M, Wolstenhulme S. Preoperative sentinel lymph node identification, biopsy and localisation using contrast enhanced ultrasound (CEUS) in patients with breast cancer: a systematic review and meta-analysis. Clin Radiol 2017; 72:959-971. [DOI: 10.1016/j.crad.2017.06.121] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/11/2017] [Accepted: 06/26/2017] [Indexed: 01/08/2023]
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46
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Zhao J, Zhang J, Zhu QL, Jiang YX, Sun Q, Zhou YD, Wang MQ, Meng ZL, Mao XX. The value of contrast-enhanced ultrasound for sentinel lymph node identification and characterisation in pre-operative breast cancer patients: A prospective study. Eur Radiol 2017; 28:1654-1661. [DOI: 10.1007/s00330-017-5089-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/28/2017] [Accepted: 09/22/2017] [Indexed: 12/11/2022]
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47
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Britton P, Willsher P, Taylor K, Kilburn-Toppin F, Provenzano E, Forouhi P, Benson J, Agrawal A, Forman J, Wallis M. Microbubble detection and ultrasound-guided vacuum-assisted biopsy of axillary lymph nodes in patients with breast cancer. Clin Radiol 2017; 72:772-779. [DOI: 10.1016/j.crad.2017.03.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 01/18/2017] [Accepted: 03/15/2017] [Indexed: 10/19/2022]
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48
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Shimazu K, Ito T, Uji K, Miyake T, Aono T, Motomura K, Naoi Y, Shimomura A, Shimoda M, Kagara N, Kim SJ, Noguchi S. Identification of sentinel lymph nodes by contrast-enhanced ultrasonography with Sonazoid in patients with breast cancer: a feasibility study in three hospitals. Cancer Med 2017; 6:1915-1922. [PMID: 28766883 PMCID: PMC5548878 DOI: 10.1002/cam4.1142] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 05/18/2017] [Accepted: 06/12/2017] [Indexed: 11/08/2022] Open
Abstract
The aim of this prospective study was to evaluate the feasibility of periareolar injection of the contrast agent Sonazoid (SNZ) followed by ultrasonography (US) for the identification of sentinel lymph node (SLN) in breast cancer patients with clinically negative node. Patients (n = 100) with T1-2N0M0 breast cancer received a periareolar injection of SNZ followed by US to identify contrast-enhanced SLN. Each contrast-enhanced SLN underwent fine needle aspiration cytology (FNAC) followed by SLN biopsy with a conventional method using blue dye and/or radiocolloid (B/R). In almost all cases, contrast-enhanced lymphatic vessels were clearly visualized by US soon after the periareolar injection of SNZ and the SLNs were easily identified with an identification rate of 98% (98/100) for SNZ and 100% (100/100) for B/R. The number of SLNs identified by SNZ (SNZ-SLN) (mean per patient, 1.52) was significantly lower than that identified by B/R (B/R-SLN) (2.19) (P < 0.0001). Twenty-five patients with positive SLNs had at least one positive SNZ-SLN. On a node-by-node basis, sensitivity, specificity, and accuracy of FNAC for SNZ-SLNs (n = 149) were 33.3%, 99.2%, and 85.9%, respectively. Identification of SLN by periareolar injection of SNZ is a technically simple method with an identification rate as high as 98%. SNZ-SLN thus seems to be a good target for FNAC, but sensitivity of FNAC for SNZ-SLNs needs to be improved.
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Affiliation(s)
- Kenzo Shimazu
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan
| | - Toshikazu Ito
- Department of Surgery, Rinku General Medical Center, Osaka, Japan
| | - Kumiko Uji
- Department of Surgery, Rinku General Medical Center, Osaka, Japan
| | - Tomohiro Miyake
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan
| | - Toyokazu Aono
- Department of Breast Surgery, Osaka General Medical Center, Osaka, Japan
| | - Kazuyoshi Motomura
- Department of Breast Surgery, Osaka General Medical Center, Osaka, Japan
| | - Yasuto Naoi
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan
| | - Atsushi Shimomura
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan
| | - Masafumi Shimoda
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan
| | - Naofumi Kagara
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan
| | - Seung Jin Kim
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan
| | - Shinzaburo Noguchi
- Department of Breast and Endocrine Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan
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Saidha NK, Aggarwal R, Sen A. Identification of Sentinel Lymph Nodes Using Contrast-Enhanced Ultrasound in Breast Cancer. Indian J Surg Oncol 2017; 9:355-361. [PMID: 30287998 DOI: 10.1007/s13193-017-0646-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 03/20/2017] [Indexed: 12/12/2022] Open
Abstract
Sentinel lymph node (SLN) biopsy has become the standard of care in axillary staging of breast cancer patients who are clinically node negative as it reduces the morbidity of axillary nodal dissection. SLN biopsy using blue dye and radioisotopes have high identification rates but its limitations include anaphylaxis, disposal of radioactive waste, and potential second surgery in up to 35% of patients who show nodal metastases on SLN biopsy. Contrast-enhanced ultrasound (CEUS) has the potential for SLNs to be identified without the aforementioned risks. CEUS involves the administration of intravenous contrast agents containing microbubbles of perfluorocarbon or nitrogen gas. The bubbles greatly affect ultrasound backscatter and increase vascular contrast in a similar manner to intravenous contrast agents used in CT and MRI. It is safe and easily performed with no requirement for ionizing radiation and no risk of nephrotoxicity. Microbubbles are taken up by lymph nodes when injected directly into tissues, including sub-areolar injection in the breast cancer patient. This method may prove valuable in patients with ductal carcinoma in situ, where operative SLN biopsy remains controversial, and in women undergoing prophylactic mastectomies for high risk. This technique may also have a role after neoadjuvant chemotherapy where frequently there is fibrosis in the treated SLNs.
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50
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Gvetadze SR, Xiong P, Lv M, Li J, Hu J, Ilkaev KD, Yang X, Sun J. Contrast-enhanced ultrasound mapping of sentinel lymph nodes in oral tongue cancer-a pilot study. Dentomaxillofac Radiol 2017; 46:20160345. [PMID: 28045344 DOI: 10.1259/dmfr.20160345] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To assess the usefulness of contrast-enhanced ultrasound (CEUS) with peritumoral injection of microbubble contrast agent for detecting the sentinel lymph nodes for oral tongue carcinoma. METHODS The study was carried out on 12 patients with T1-2cN0 oral tongue cancer. A radical resection of the primary disease was planned; a modified radical supraomohyoid neck dissection was reserved for patients with larger lesions (T2, n = 8). The treatment plan and execution were not influenced by sentinel node mapping outcome. The Sonovue™ contrast agent (Bracco Imaging, Milan, Italy) was utilized. After detection, the position and radiologic features of the sentinel nodes were recorded. RESULTS The identification rate of the sentinel nodes was 91.7%; one patient failed to demonstrate any enhanced areas. A total of 15 sentinel nodes were found in the rest of the 11 cases, with a mean of 1.4 nodes for each patient. The sentinel nodes were localized in: Level IA-1 (6.7%) node; Level IB-11 (73.3%) nodes; Level IIA-3 (20.0%) nodes. No contrast-related adverse effects were observed. CONCLUSIONS For oral tongue tumours, CEUS is a feasible and potentially widely available approach of sentinel node mapping. Further clinical research is required to establish the position of CEUS detection of the sentinel nodes in oral cavity cancers.
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Affiliation(s)
- Shalva R Gvetadze
- 1 Department of Oral Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai, China.,2 Department of Reconstructive Maxillofacial Surgery with Microsurgery and External Prosthetics, Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia.,3 Department of Consulting and Diagnostics, Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - Ping Xiong
- 4 Department of Ultrasound, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mingming Lv
- 1 Department of Oral Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Jun Li
- 1 Department of Oral Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Jingzhou Hu
- 1 Department of Oral Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Konstantin D Ilkaev
- 5 Department of Head and Neck Surgery, NN Blokhin Russian Cancer Research Center, Moscow, Russia
| | - Xin Yang
- 1 Department of Oral Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Jian Sun
- 1 Department of Oral Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai, China
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