Sentinel node detection in melanomas using contrast-enhanced ultrasound.
BACKGROUND
Sentinel node (SN) biopsy has proven to be a useful clinical method based on the combination of radionuclide tracer principles and the dye technique. Contrast-enhanced ultrasound (CEUS) has been used successfully for detection of SN in animals, but the use of CEUS has not been reported in humans.


OBJECTIVE
To investigate the possible use of CEUS in detecting SN in patients with malignant melanomas (MM), and to improve the method by using different concentrations of contrast agent and various positions of the extremity.


METHODS
Ten patients with MM on an extremity and one healthy volunteer were included. One milliliter of a contrast agent (Sonovue; Bracco, Milan, Italy) was injected subcutaneously on both sides of the scar from the excised tumor. Contrast-enhanced lymph channels and lymph nodes (LNs) were searched for using low-mechanical-index CEUS and by stimulated acoustic emission. Afterward, lymphoscintigraphy was performed and the patient operated. During surgery, the SNs were located via scintigraphic findings, gamma-probe signals, and blue-dye visualization of lymph channels and LNs. Before the human study, a study of 10 mice was performed to exclude possible tissue damage, as the contrast agent was not registered for subcutaneous administration.


RESULTS
In one patient, two contrast-enhanced inguinal LNs were visualized by CEUS, corresponding to two inguinal SNs found by scintigraphic imaging. No contrast-enhanced lymph channels or LNs were visualized in any other patients or in the volunteer. No tissue damage was observed in the 10 mice.


CONCLUSIONS
This study does not support the use of CEUS for detection of SNs in humans. However, the application of CEUS for the investigation of SNs is still not fully explored in humans, and an alternative setup and/or contrast agent might provide better results.
Rue Nielsen
K
K
Department of Radiology, Section of Ultrasound X4123, Rigshospitalet, Copenhagen, Denmark. mariekristinanielsen@hotmail.com
Klyver
H
H
Hougaard Chakera
A
A
Nedergaard
L
L
Hesse
B
B
Bachmann Nielsen
M
M
D000818:Animals; D001365:Axilla; D003287:Contrast Media; D005121:Extremities; D006119:Groin; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis; D008545:Melanoma / Q000473:pathology*; D051379:Mice; D008819:Mice, Nude; D010743:Phospholipids; D012878:Skin Neoplasms / Q000556:secondary*; D013459:Sulfur Hexafluoride; D014463:Ultrasonography
D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride