title: Contrast Enhanced Ultrasound (CEU) Using Microbubbles for Sentinel Lymph Node Biopsy in Breast Cancer: a Systematic Review.
abstract: BACKGROUND
  The concept of sentinel lymph node (SLN) is not new to medical practice especially in breast cancer patients. CEU microbubble technique is an innovative technique which is applied with the same purpose. It utilizes ultrasound contrast agents based on the use of dispersion with sulfur hexafluoride gas. The aim of this review is to examine the clinical evidence on the role of intradermally injected microbubbles as a technique of preoperative identification of SLNs in patients with breast cancer.
  
  
  METHODS
  A systematic search was performed in PubMed (5 October 2014), Scopus (5 October 2014) and Cochrane libraries (5 October 2014).
  
  
  RESULTS
  Five prospective studies were included in the study. The total number of patients included was 727. The age of the included patients ranged from 19 to 93 years old. The median diameter of tumor ranged from 2 to 120 mm. Regarding the histological type, ductal carcinoma in situ was present in 31 patients, invasive ductal carcinoma in 438, invasive lobular carcinoma in 71 and not defined invasive breast tumors in 52 patients. The SLN identification rate ranged from 9.3% to 55.2% and the sensitivity from 61% to 89% while the false negative rate from 6.6% to 39% and the presence of micro/macrometastases from 1.9% to 64.3%.
  
  
  CONCLUSIONS
  CEU microbubble technique is an alternative technique of SLN detection in breast cancer patients. Further studies are necessary to standardize the method and clarify its specificity and sensitivity. Moreover, randomized control trials are suggested in order to compare this technique with the current techniques used for SLN detection.
authors.affiliation: First Department of Surgery, General Hospital of Attica "KAT", Athens, Greece.
authors.forename: I D
authors.initials: ID
authors.lastname: Gkegkes
authors.forename: C
authors.initials: C
authors.lastname: Iavazzo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla / Q000000981:diagnostic imaging; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D045423:Microbubbles; D008875:Middle Aged; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D018608:Ultrasonography, Doppler / Q000379:methods*; D055815:Young Adult