Preoperative localization of sentinel lymph nodes using intradermal microbubbles and contrast-enhanced ultrasonography in patients with breast cancer.
BACKGROUND
Sentinel lymph node (SLN) biopsy is the standard procedure for axillary staging in early breast cancer. Lymphatic imaging after intraparenchymal microbubble injection has been reported in animal models. The aim of this study was to identify and localize SLNs before surgery by contrast-enhanced ultrasonography after intradermal injection of microbubbles in patients with breast cancer.


METHODS
Fifty-four consecutive, consenting patients with primary breast cancer were recruited. Patients received a periareolar intradermal injection of microbubble contrast agent. Breast lymphatics were visualized by ultrasonography and followed to identify putative axillary SLNs. A guidewire was deployed to localize the SLN. The next day, patients underwent standard tumour excision and SLN biopsy.


RESULTS
SLNs were identified and guidewires inserted in 48 patients. In these patients operative findings confirmed that the wired lymph nodes were SLNs. The sensitivity of SLN detection, compared with radioisotope and blue dye, was 89 per cent. Five patients were found to have metastases in SLNs. In these patients the SLNs were identified correctly and localized before surgery with guidewires.


CONCLUSIONS
SLNs may be identified and localized before surgery using contrast-enhanced ultrasonography after injection of microbubbles.
Department of Radiology, Maidstone Hospital Breast Clinic, The Maidstone Hospital, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK. ali.sever@nhs.net
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A
Sever
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S
Jones
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Cox
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Weeks
P
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Mills
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P
Jones
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D003287:Contrast Media; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D045423:Microbubbles; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D012680:Sensitivity and Specificity; D014463:Ultrasonography
D003287:Contrast Media