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. 2023 Feb;49(2):616-625.
doi: 10.1016/j.ultrasmedbio.2022.10.020. Epub 2022 Nov 26.

Sentinel Lymph Node Identification in Patients With Breast Cancer Using Lymphosonography

Priscilla Machado  1 , Ji-Bin Liu  1 , Laurence Needleman  1 , Melissa Lazar  2 , Alliric I Willis  2 , Kristin Brill  2 , Susanna Nazarian  2 , Adam Berger  2 , Flemming Forsberg  3
Affiliations

Sentinel Lymph Node Identification in Patients With Breast Cancer Using Lymphosonography

Priscilla Machado et al. Ultrasound Med Biol. 2023 Feb.

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.

Keywords: Breast cancer; Contrast-enhanced ultrasound; Lymphatic mapping; Lymphatic tracer; Lymphosonography; Sentinel lymph node; Ultrasound; Ultrasound contrast agent.

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Conflict of interest statement

Conflict of interest disclosure P.M., J.B.L., L.N., M.L., A.I.W., K.B., S.N. and A.B. have nothing to disclose. F.F. received grant and equipment support from GE.

Figures

Figure 1:
Figure 1:
Enrollment diagram
Figure 2:
Figure 2:
Example of a benign study case. The subject is a 76 years-old female patient diagnosed with an invasive ductal carcinoma breast cancer located on the left breast at 2 o’clock position measuring 1.0 cm. After the surgical excision, the SLN was sent to pathology, which determine to be negative for metastatic disease. The SLN was positive for the presence of blue dye, radioactive tracer and UCA at the time of the excision. A, B-mode image of the tumor (arrow). FB, Color Doppler image of the tumor (arrow). C, Dual-image CEUS and B-mode of the SLN (arrow). D, Dual-image CEUS and B-mode of the SLN with measurement (arrow). E, B-mode image of the ex-vivo specimen of the SLN seen in C and D (arrow). F, Color Doppler image of the ex vivo specimen of the SLN seen in C and D showing the uptake of UCA (arrow).
Figure 3:
Figure 3:
Example of a malignant study case. The subject is a 67 years-old female patient diagnosed with an invasive ductal carcinoma breast cancer located on the left breast at 2 o’clock position measuring 2.1 cm. After the surgical excision, the SLN was sent to pathology, which determine to be positive for metastatic disease. The SLN was positive for the presence of blue dye, radioactive tracer and UCA at the time of the excision. A B-mode image of the tumor (arrow). B, Color Doppler image of the tumor (arrow). C, Dual-image CEUS and B-mode of the SLN (arrow). D, Dual-image CEUS and B-mode of the SLN with measurement (arrow). E, B-mode image of the ex-vivo specimen of the SLN seen in C and D (arrow). F, Color Doppler image of the ex-vivo specimen of the SLN seen in C and D showing the uptake of UCA (arrow).
See this image and copyright information in PMC

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