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. 2023 Jul;42(7):1509-1517.
doi: 10.1002/jum.16164. Epub 2023 Jan 2.

Sentinel Lymph Node Identification in Post Neoadjuvant Chemotherapy Breast Cancer Patients Undergoing Surgical Excision 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  1
Affiliations

Sentinel Lymph Node Identification in Post Neoadjuvant Chemotherapy Breast Cancer Patients Undergoing Surgical Excision Using Lymphosonography

Priscilla Machado et al. J Ultrasound Med. 2023 Jul.

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.

Keywords: breast cancer; contrast-enhanced ultrasound; lymph node; lymphatic tracer; neoadjuvant chemotherapy.

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Figures

Figure 1:
Figure 1:
Example of a benign SLN study case. The subject is a 47 years-old female patient diagnosed with an invasive ductal carcinoma breast cancer located on the right breast at 8 o’clock position measuring 0.9 cm (2.2 cm before NAC). 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). B, Dual-image CEUS and B-mode of the SLN (arrow). C, B-mode image of the ex-vivo specimen of the SLN seen in B (arrow). D, Color Doppler image of the ex vivo specimen of the SLN seen in B showing the uptake of UCA (arrow).
Figure 2:
Figure 2:
Example of a malignant SLN study case. The subject is a 49 years-old female patient diagnosed with an invasive ductal carcinoma breast cancer located on the right breast at 7 o’clock position measuring 1.2 cm (4.7 cm before NAC). 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, Dual-image CEUS and B-mode of the SLN (arrow). C, B-mode image of the ex-vivo specimen of the SLN seen in B (arrow). D, Color Doppler image of the ex-vivo specimen of the SLN seen in B showing the uptake of UCA (arrow).
See this image and copyright information in PMC

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