title: Contrast-enhanced ultrasound-guided Sentinel lymph node biopsy of the ocular conjunctiva.
abstract: OBJECTIVE
  Sentinel lymph node biopsy (SLNB) has been utilized for cutaneous melanoma and other malignancies arising from the eye and ocular adnexa. Currently, SLNB requires blue dyes and/or radiopharmaceuticals; both of which have significant shortcomings. This study sought to evaluate the feasibility of SLNB with the use of real-time, contrast-enhanced ultrasound (CEUS) as an alternative technique for tumors arising in the conjunctiva.
  
  
  METHODS
  Prospective feasibility study in a porcine model.
  
  
  METHODS
  Twelve experiments were performed on six non-tumor-bearing Yorkshire swine. An ultrasound contrast agent, Sonazoid (GE Healthcare, Oslo, Norway), (99m) technetium ((99m) Tc), and methylene blue (MB) (Covidien, Mansfield, MA) were injected in the ocular conjunctiva. Sentinel lymph nodes (SLNs) were localized with CEUS and findings were compared to that of MB and (99m) Tc. Fisher exact test was used.
  
  
  RESULTS
  Contrast-enhanced SLNs were identified within an average of 6.2 minutes from time of injection of Sonazoid. A total of 17 SLNs were identified by at least one of the three techniques. Correlation between Sonazoid and (99m) Tc was 94.1% (16/17 SLNs). Correlation between (99m) Tc and MB was 88.2% (15/17). One SLN that was positive for (99m) Tc but negative for Sonazoid and was considered to be a false positive (1/17); findings were similar for MB (1/17). Differences between the three techniques were not significant (P = .886).
  
  
  CONCLUSIONS
  CEUS-guided injection of conjunctiva for SLNB is technically feasible and correlates well with standard detection techniques. This technique shows promise for rapid, real-time, intraoperative imaging for SLNB, using a widely available imaging modality and avoiding the need for radiopharmaceuticals.
  
  
  METHODS
  NA
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Mindy R
authors.initials: MR
authors.lastname: Rabinowitz
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Merton
authors.forename: Ji-Bin
authors.initials: JB
authors.lastname: Liu
authors.forename: Shivam
authors.initials: S
authors.lastname: Saxena
authors.forename: John
authors.initials: J
authors.lastname: Pluta
authors.forename: John R
authors.initials: JR
authors.lastname: Eisenbrey
authors.forename: Adam L
authors.initials: AL
authors.lastname: Baker
authors.forename: Michael P
authors.initials: MP
authors.lastname: Rabinowitz
authors.forename: Sara
authors.initials: S
authors.lastname: Lally
authors.forename: David
authors.initials: D
authors.lastname: Cognetti
authors.forename: Barry B
authors.initials: BB
authors.lastname: Goldberg
authors.forename: Edmund A
authors.initials: EA
authors.lastname: Pribitkin
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Curry
mesh_terms: D000818:Animals; D003228:Conjunctiva / Q000601:surgery*; D003230:Conjunctival Neoplasms / Q000473:pathology / Q000601:surgery*; D003287:Contrast Media; D004195:Disease Models, Animal; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D005240:Feasibility Studies; D005290:Ferric Compounds; D056965:Injections, Intraocular; D007501:Iron; D008545:Melanoma / Q000473:pathology / Q000601:surgery*; D010087:Oxides; D011897:Random Allocation; D012394:Rosaniline Dyes; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013552:Swine; D013671:Technetium Tc 99m Sulfur Colloid
chemical_list: D003287:Contrast Media; D005290:Ferric Compounds; D010087:Oxides; D012394:Rosaniline Dyes; C069727:Sonazoid; D013671:Technetium Tc 99m Sulfur Colloid; D007501:Iron
keywords: Sentinel lymph node biopsy; Sonazoid; conjunctival melanoma; ultrasound contrast