title: Dynamic visualization of lymphatic channels and sentinel lymph nodes using intradermal microbubbles and contrast-enhanced ultrasound in a swine model and patients with breast cancer.
abstract: OBJECTIVE
  Sentinel lymph node (SLN) identification using intradermal micro-bubbles and contrast-enhanced ultrasound (CEUS) has been recently reported in swine models and patients with breast cancer. The objective of this study was to investigate the dynamics of intradermally administered microbubbles as they travel to draining SLNs in pigs. We also performed a detailed study of the passage of microbubbles through breast lymphatic channels in a small group of patients with breast cancer.
  
  
  METHODS
  Nine anesthetized healthy pigs were used for the study, and 5 female patients with primary breast cancer were recruited. Pigs received intradermal injections of a microbubble contrast agent in several territories to access lymphatic drainage to regional lymph nodes. Patients had periareolar intradermal injection of the microbubble contrast agent. Ultrasound examination was performed in the real-time contrast pulse sequencing mode with a commercial scanner.
  
  
  RESULTS
  Sentinel lymph nodes were identified rapidly (<1 minute) and consistently in pigs. Intradermal microbubble injection and CEUS were found to have perfect concordance with the Evans blue dye method in locating swine SLNs. In all 5 patients with breast cancer, the microbubble contrast agent entered breast lymphatic channels and traveled to draining ipsilateral axillary SLNs within 3 minutes.
  
  
  CONCLUSIONS
  Intradermally injected microbubbles traverse readily though lymphatic channels in pigs and human breast tissue. The ability to rapidly identify SLNs in the diagnostic period would enable targeted biopsy and may facilitate preoperative axillary staging in patients with early breast cancer.
authors.affiliation: Department of Radiology, Maidstone Hospital Breast Clinic, Maidstone and Tunbridge Wells National Health Service Trust, Maidstone, Kent, England.
authors.forename: Ali
authors.initials: A
authors.lastname: Sever
authors.forename: Anne
authors.initials: A
authors.lastname: Broillet
authors.forename: Michel
authors.initials: M
authors.lastname: Schneider
authors.forename: Karina
authors.initials: K
authors.lastname: Cox
authors.forename: Sue
authors.initials: S
authors.lastname: Jones
authors.forename: Jenny
authors.initials: J
authors.lastname: Weeks
authors.forename: Pippa
authors.initials: P
authors.lastname: Mills
authors.forename: David
authors.initials: D
authors.lastname: Fish
authors.forename: Peter
authors.initials: P
authors.lastname: Jones
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging* / Q000473:pathology*; D004195:Disease Models, Animal; D005260:Female; D006801:Humans; D007089:Image Enhancement; D007271:Injections, Intradermal; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D042601:Lymphatic Vessels / Q000000981:diagnostic imaging*; D045423:Microbubbles; D008875:Middle Aged; D010743:Phospholipids; D013459:Sulfur Hexafluoride; D013552:Swine; D016217:Ultrasonography, Mammary
chemical_list: D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride