Preoperative sentinel node identification with ultrasound using microbubbles in patients with breast cancer.
OBJECTIVE
Sentinel lymph node (SLN) biopsy is the standard procedure for axillary staging in early breast cancer. Lymphatic imaging after peritumoral microbubble injection has been described in animal models. The aim of this study was to identify and localize SLNs preoperatively by contrast-enhanced sonography after intradermal injection of microbubbles in patients with breast cancer.


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


RESULTS
In 71 (89%) of the 80 patients, SLNs were identified and guidewires were inserted. In these patients, operative findings using conventional radioisotope and blue dye techniques confirmed that the wired nodes were SLNs. Fourteen patients were found to have metastases in SLNs. In these patients, the SLNs were identified correctly and were localized with guidewires before surgery.


CONCLUSIONS
SLNs may be identified and localized before surgery using contrast-enhanced sonography after injection of microbubbles.
Department of Radiology, Maidstone Hospital, Hermitage Ln., ME16 9QQ, Maidstone, United Kingdom. ali.sever@nhs.net
Ali R
AR
Sever
Philippa
P
Mills
Susan E
SE
Jones
Karina
K
Cox
Jennifer
J
Weeks
David
D
Fish
Peter A
PA
Jones
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla / Q000000981:diagnostic imaging; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D018567:Breast Neoplasms, Male / Q000000981:diagnostic imaging; D002278:Carcinoma in Situ / Q000000981:diagnostic imaging*; D044584:Carcinoma, Ductal / Q000000981:diagnostic imaging / Q000556:secondary*; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000556:secondary*; D003287:Contrast Media; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D008297:Male; D008327:Mammography; D045423:Microbubbles; D008875:Middle Aged; D010743:Phospholipids; D057234:Preoperative Period; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013459:Sulfur Hexafluoride; D016217:Ultrasonography, Mammary / Q000379:methods
D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride