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Annoni M, Borgonovo S, Aralla M. Sentinel lymph node mapping in canine mast cell tumours using a preoperative radiographic indirect lymphography: Technique description and results in 138 cases. Vet Comp Oncol 2023; 21:469-481. [PMID: 37191042 DOI: 10.1111/vco.12906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 05/17/2023]
Abstract
Several sentinel lymph node (SLN) mapping techniques, to detect nodal metastasis in canine tumours have been investigated in the last 10 years in veterinary oncology. The purpose of this prospective study was to describe a reliable, quick, and inexpensive technique for SLN mapping in canine patients affected by cutaneous and subcutaneous mast cell tumours (MCT). Eighty dogs were enrolled in this study for a total of 138 cytologically diagnosed MCTs. Sentinel lymph node mapping was performed by injecting iomeprole peritumorally followed by serial radiographs at 1, 3, 6 and 9-min post injection. A total of 168 SLNs were detected, 90% at first radiograph, 1 min after the peritumoral iomeprole injection, while in the rest of the cases SLN was identified at 3 min. Sentinel lymph nodes detected by the preoperative radiographic indirect lymphography with iomeprole (PRILI) differed from regional lymph nodes in 57% of cases. The PRILI technique detected simultaneously multiple SLNs in the 26% of cases and multiple lymph centers in the 31% of MCTs. To allow the surgical identification of the SLNs, a peritumoral injection of methylene blue was performed at the time of surgery. This study reports a widely available technique for SLN mapping using digital radiographs in combination with a water-soluble medium, representing a cost-effective alternative to other SLN mapping procedures. Based on our results, this technique can be effective for SLNs mapping in dogs with MCTs but further comparative studies are needed to assess its reliability and efficacy in different tumours.
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Affiliation(s)
- Maurizio Annoni
- Department of Soft Tissue and Oncologic Surgery, AniCura Clinica Veterinaria Tibaldi, Milan, Italy
| | - Simone Borgonovo
- Department of Diagnostic Imaging, AniCura Clinica Veterinaria Tibaldi, Milan, Italy
| | - Marina Aralla
- Department of Oncology, Pronto Soccorso Veterinario Laudense, Lodi, Milan, Italy
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Omoto K, Futsuhara K, Watanabe T. Sentinel lymph node identification using contrast-enhanced ultrasound in breast cancer: review of the literature. J Med Ultrason (2001) 2023:10.1007/s10396-023-01313-y. [PMID: 37423960 DOI: 10.1007/s10396-023-01313-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/10/2023] [Indexed: 07/11/2023]
Abstract
Before breast cancer surgery, sentinel lymph node (SLN) identification and biopsy using blue dye, radioisotope (RI) with a gamma probe, or a combination of the two are mainly performed. The dye-guided method requires skilled technique to make an incision in the skin and identify SLNs without damaging the lymphatic vessels. In addition, dye-induced anaphylactic shock has been reported. To use the γ-probe-guided method, the facility must be able to handle RI. However, to overcome the drawbacks of these methods, Omoto et al. developed a new identification modality using contrast-enhanced ultrasound with an ultrasound contrast agent (UCA) in 2002. Since then, many basic experiments and clinical studies using various UCA have been reported. In particular, a number of studies in SLN detection using Sonazoid have been reported and are herein reviewed.
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Affiliation(s)
- Kiyoka Omoto
- Department of Laboratory Medicine, Jichi Medical University, Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan.
| | - Kazushige Futsuhara
- Department of Surgery, Jichi Medical University, Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
| | - Tamami Watanabe
- Department of Laboratory Medicine, Jichi Medical University, Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
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3
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Cui Q, Dai L, Li J, Shen Y, Tao H, Zhou X, Xue J. Contrast-enhanced ultrasound-guided sentinel lymph node biopsy in early-stage breast cancer: a prospective cohort study. World J Surg Oncol 2023; 21:143. [PMID: 37158920 PMCID: PMC10165809 DOI: 10.1186/s12957-023-03024-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/27/2023] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVE This study evaluated the identification efficiency of contrast-enhanced ultrasound (CEUS) for sentinel lymph nodes (SLN) to accurately represent the axillary node status in early-stage breast cancer. METHOD In total, 109 consecutive consenting patients with clinically node-negative and T1-2 breast cancer were included in this study. All patients received CEUS to identify SLN before surgery, and a guidewire was deployed to locate SLN in those who were successfully explored by CEUS. The patients underwent sentinel lymph node biopsy (SLNB), and the blue dye was used to trace SLN during the surgery. The decision to perform axillary lymph node dissection (ALND) depended on the intraoperative pathological identification of SLN by CEUS (CE-SLN). The concordance rate of pathological status between CE-SLN and dyed SLN was calculated. RESULT The CEUS detection rate was 96.3%; CE-SLN failed in 4 patients. Among the remaining 105 successful identifications, 18 were CE-SLN positive by intraoperative frozen section, and one with CE-SLN micrometastasis was diagnosed by paraffin section. No additional lymph node metastases were found in CE-SLN-negative patients. The concordance rate of pathological status between CE-SLN and dyed SLN was 100%. CONCLUSION CEUS can accurately represent the status of axillary lymph nodes in patients with clinically node-negative and small tumor burden breast cancer.
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Affiliation(s)
- Qiuxia Cui
- Department of Thyroid and Breast Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, No. 6, Huanghe Road, Changshu, 215500, Jiangsu, China
| | - Li Dai
- Department of Thyroid and Breast Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, No. 6, Huanghe Road, Changshu, 215500, Jiangsu, China
| | - Jialu Li
- Department of Thyroid and Breast Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, No. 6, Huanghe Road, Changshu, 215500, Jiangsu, China
| | - Yang Shen
- Department of Ultrasonic Medicine, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, China
| | - Huijiang Tao
- Department of Ultrasonic Medicine, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, China
| | - Xiaofeng Zhou
- Department of Ultrasonic Medicine, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, China
| | - Jialei Xue
- Department of Thyroid and Breast Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, No. 6, Huanghe Road, Changshu, 215500, Jiangsu, China.
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Niu Z, Gao Y, Xiao M, Mao F, Zhou Y, Zhu Q, Jiang Y. Contrast-enhanced lymphatic US can improve the preoperative diagnostic performance for sentinel lymph nodes in early breast cancer. Eur Radiol 2023; 33:1593-1602. [PMID: 36152038 PMCID: PMC9510155 DOI: 10.1007/s00330-022-09139-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/20/2022] [Accepted: 09/05/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the preoperative diagnostic value of contrast-enhanced lymphatic ultrasound (CEUS) for the sentinel lymph node (SLN) status in early breast cancer. MATERIALS AND METHODS We prospectively recruited 102 consecutive patients with clinically node-negative early breast cancer from July 2021 to October 2021. All patients underwent conventional US and percutaneous CEUS examinations. The CEUS of SLNs were classified into four enhancement patterns: homogeneous (I), featured inhomogeneous (II), focal defect (III), and no enhancement (IV). The diagnostic performance of conventional US and CEUS for SLN metastasis was assessed by receiver operating characteristic (ROC) curves and decision curves. RESULTS A total of 78 women were enrolled in this study, including 55, 18, and 5 patients with negative axilla, 1-2, and ≥ 3 metastastic SLNs pathologically, respectively. The identification rate of SLNs by CEUS was 100%. Patterns I and II can select 91.7% (44/48) of patients with disease-free axilla, while patterns III and IV had higher percentages of metastasis (65.2%, p < 0.001 and 57.1%, p < 0.002, respectively). For the SLN metastatic burden, 100% (48/48) of patients with pattern I/II had ≤ 2 metastatic SLNs. Compared with conventional US, the CEUS enhancement patterns showed significant improvement in diagnosing metastatic SLNs (0.813 vs 0.601, p < 0.001). CEUS had greater clinical benefits and correctly reclassified 48% of metastatic SLNs (p < 0.001) without sacrificing the classification accuracy of negative SLNs (p = 0.25), and could improve prediction accuracy by 0.42 (p < 0.001). CONCLUSIONS CEUS demonstrated better diagnostic performance and greater clinical benefits than conventional US for the preoperative diagnosis of SLNs, showing its potential to select candidates for precluding axillary surgery in early breast cancer. KEY POINTS • The homogeneous and featured inhomogeneous enhancement of SLNs are highly suggestive of negative LNs, while focal defect (p < 0.001) and no enhancement (p < 0.002) patterns had higher percentages of metastasis. • The proportion of SLNs with highly suspicious signs on conventional US increases as the type of enhancement pattern increases (no suspicious signs in pattern I/II, 34.8% in pattern III, and 85.7% in pattern IV). • Compared with conventional US, CEUS improved the area under the receiver operating characteristic curve (0.813 vs. 0.601, p < 0.001) and had greater clinical benefits (IDI = 0.42, p < 0.001) for the diagnosis of axillary metastasis.
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Affiliation(s)
- Zihan Niu
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Yuanjing Gao
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Mengsu Xiao
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Feng Mao
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Yidong Zhou
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Qingli Zhu
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China.
| | - Yuxin Jiang
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People's Republic of China.
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Zhu J, Zhang C, Christensen-Jeffries K, Zhang G, Harput S, Dunsby C, Huang P, Tang MX. Super-Resolution Ultrasound Localization Microscopy of Microvascular Structure and Flow for Distinguishing Metastatic Lymph Nodes - An Initial Human Study. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:592-598. [PMID: 36206774 DOI: 10.1055/a-1917-0016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE Detecting and distinguishing metastatic lymph nodes (LNs) from those with benign lymphadenopathy are crucial for cancer diagnosis and prognosis but remain a clinical challenge. A recent advance in super-resolution ultrasound (SRUS) through localizing individual microbubbles has broken the diffraction limit and tracking enabled in vivo noninvasive imaging of vascular morphology and flow dynamics at a microscopic level. In this study we hypothesize that SRUS enables quantitative markers to distinguish metastatic LNs from benign ones in patients with lymphadenopathy. MATERIALS AND METHODS Clinical contrast-enhanced ultrasound image sequences of LNs from 6 patients with lymph node metastasis and 4 with benign lymphadenopathy were acquired and motion-corrected. These were then used to generate super-resolution microvascular images and super-resolved velocity maps. From these SRUS images, morphological and functional measures were obtained including micro-vessel density, fractal dimension, mean flow speed, and Local Flow Direction Irregularity (LFDI) measuring the variance in local flow direction. These measures were compared between pathologically proven reactive and metastasis LNs. RESULTS Our initial results indicate that the difference in the indicator of flow irregularity (LFDI) derived from the SRUS images is statistically significant between the two groups. The LFDI is 60% higher in metastatic LNs compared with reactive nodes. CONCLUSION This pilot study demonstrates the feasibility of super-resolution ultrasound for clinical imaging of lymph nodes and the potential of using the irregularity of local blood flow directions afforded by SRUS for the characterization of LNs.
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Affiliation(s)
- Jiaqi Zhu
- Bioengineering, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Chao Zhang
- Department of Ultrasound, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, People's Republic of China
| | - Kirsten Christensen-Jeffries
- Imaging Sciences and Biomedical Engineering, King's College London School of Medical Education, London, United Kingdom of Great Britain and Northern Ireland
| | - Ge Zhang
- Bioengineering, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Sevan Harput
- Division of Electrical and Electronic Engineering, London South Bank University, London, United Kingdom of Great Britain and Northern Ireland
| | - Christopher Dunsby
- Physics, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Pintong Huang
- Department of Ultrasound, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, People's Republic of China
| | - Meng-Xing Tang
- Bioengineering, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
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Lian Y, Li T, Wu N, Wu J, Tang Z. Lymphography method based on time-autocorrelated optical coherence tomography. BIOMEDICAL OPTICS EXPRESS 2022; 13:5390-5399. [PMID: 36425642 PMCID: PMC9664883 DOI: 10.1364/boe.470390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/27/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
Lymphatic vessels are structurally similar to blood vessels, and the lymphatic fluid flowing within the lymphatic vessels is distributed throughout the body and plays a vital role in the human immune system. Visualization of the lymphatic vessels is clinically important in the diagnosis of tumor cell metastasis and related immune system diseases, but lymph is difficult to image due to its near-transparent nature and low flow rate. In this paper, we present a lymphography method based on time-autocorrelated optical coherence tomography. By using the minimum value difference of the autocorrelation function of the time-varying interference intensity between the lymph and the surrounding tissues, the non-invasive and high-sensitivity imaging of lymph vessels can be achieved. The method proposed in this paper has potential significance for the research and treatment of immune system diseases.
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Affiliation(s)
- Yi Lian
- School of Physics and Telecommunication Engineering, South China Normal University, Guangzhou 510006, China
- Contributed equally to this work
| | - Tingfeng Li
- School of Physics and Telecommunication Engineering, South China Normal University, Guangzhou 510006, China
- Contributed equally to this work
| | - Nanshou Wu
- School of Physics and Telecommunication Engineering, South China Normal University, Guangzhou 510006, China
| | - Jiayi Wu
- School of Physics and Telecommunication Engineering, South China Normal University, Guangzhou 510006, China
| | - Zhilie Tang
- School of Physics and Telecommunication Engineering, South China Normal University, Guangzhou 510006, China
- Laboratory of Quantum Engineering and Quantum Material,
South China Normal University, IMOT , Guangzhou 510006, China
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Niu Z, Xiao M, Ma L, Qin J, Li W, Zhang J, Zhu Q, Jiang Y. The value of contrast-enhanced ultrasound enhancement patterns for the diagnosis of sentinel lymph node status in breast cancer: systematic review and meta-analysis. Quant Imaging Med Surg 2022; 12:936-948. [PMID: 35111595 DOI: 10.21037/qims-21-416] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/20/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The sentinel lymph node (SLN) can represent the metastasis status of axillary lymph nodes and is a prognostic factor of breast cancer. Preoperative imaging provides information for axillary surgery decision-making, and this meta-analysis evaluated the diagnostic value of contrast-enhanced ultrasound (CEUS) for SLN status in breast cancer patients. METHODS The PubMed, Embase, Medline, Google Scholar, Clinical Trails gov. and Cochrane Library databases were searched from inception until 31 March 2020. Two review authors independently screened and selected the relevant studies and extracted data, and the assessment of the methodological quality of studies was according to the QUADAS-2 tool. The diagnostic value of CEUS was assessed by calculating the pooled sensitivity, specificity, area under the curve, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio, and a summary receiver operating characteristic curve and hierarchical modeling method was used to conduct the meta-analysis. RESULTS Five studies with 771 breast cancer patients were included, and the results showed CEUS could provide additional information for SLN preoperative diagnosis. A homogeneous or uniform enhancement pattern suggested a benign lymph node, and a heterogeneous, no pattern, or weak enhancement pattern suggested a node was malignant, demonstrating high sensitivity of 0.960 (95% CI: 0.856, 0.989) and moderate specificity of 0.807 (0.581, 0.926). The pooled positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 4.987 (2.104, 11.822) and 0.049 (0.014, 0.168), and 101.294 (31.202, 328.837), respectively. CONCLUSIONS A homogeneous enhancement pattern was highly suggestive of benign lymph nodes with high sensitivity. CEUS could effectively identify the SLN, and facilitate the diagnosis of its metastatic status. REGISTRATION NUMBER PROSPERO protocol CRD42020176828.
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Affiliation(s)
- Zihan Niu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mengsu Xiao
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Ma
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Qin
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenbo Li
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Zhang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qingli Zhu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuxin Jiang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Dumitru D, Ghanakumar S, Provenzano E, Benson JR. A Prospective Study Evaluating the Accuracy of Indocyanine Green (ICG) Fluorescence Compared with Radioisotope for Sentinel Lymph Node (SLN) Detection in Early Breast Cancer. Ann Surg Oncol 2022; 29:3014-3020. [DOI: 10.1245/s10434-021-11255-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/08/2021] [Indexed: 02/05/2023]
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9
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Deng H, Lei J, Jin L, Shi H. Diagnostic efficacy of sentinel lymph node in breast cancer under percutaneous contrast-enhanced ultrasound: An updated meta-analysis. Thorac Cancer 2021; 12:2849-2856. [PMID: 34605207 PMCID: PMC8563157 DOI: 10.1111/1759-7714.14139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/19/2021] [Indexed: 11/28/2022] Open
Abstract
Background To investigate the diagnostic efficacy of sentinel lymph nodes (SLN) in breast cancer by percutaneous contrast‐enhanced ultrasound (CEUS) through pooled analysis of relevant studies published before June 2021. Methods We conducted a systematic review and meta‐analysis of relevant studies by searching the electronic databases of PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang and VIP and the studies were screened according to their inclusion and exclusion criteria. Sensitivity (SEN), specificity (SPE), positive likelihood ratio (+LR), negative likelihood ratio (−LR) and diagnostic odds ratio (DOR) were calculated by Meta‐disc 1.4 software and the summary receiver operating characteristic (SROC) curve and area under the curve of ROC (AUC) were constructed. Results Twenty‐two publications evaluating the diagnostic efficacy of SLN in breast cancer under percutaneous CEUS were included in the meta‐analysis. The diagnostic sensitivity, specificity were 0.86 (95% CI: 0.83–0.88) and 0.89 (95% CI: 0.87–0.91) for SLN in breast cancer detected by percutaneous CEUS respectively using a random effect model. The +LR and –LR were combined in a random effect model due to significant statistical heterogeneity (p < 0.05). The pooled +LR, −LR were 7.06 (95% CI: 4.34–11.50), and 0.17 (95% CI: 0.12–0.24), respectively. The combined DOR was 53.32 (95% CI: 29.74–95.61) for SLN diagnosis in breast cancer by percutaneous CEUS under a random effect model. The AUC was 0.94 which indicated that CEUS had high diagnostic efficacy of SLN in patients with breast cancer. Conclusions CEUS is a noninvasive method for the detection SLN in patients of breast cancer with relative high prediction efficacy.
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Affiliation(s)
- Huadong Deng
- Department of Ultrasonography, Lishui People's Hospital, Lishui, China
| | - Jianming Lei
- Department of Ultrasonography, Lishui People's Hospital, Lishui, China
| | - Lixian Jin
- Department of Ultrasonography, Lishui People's Hospital, Lishui, China
| | - Hongwei Shi
- Department of Ultrasonography, Lishui People's Hospital, Lishui, China
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Bove S, Fragomeni SM, Romito A, DI Giorgio D, Rinaldi P, Pagliara D, Verri D, Romito I, Paris I, Tagliaferri L, Marazzi F, Visconti G, Franceschini G, Masetti R, Garganese G. Techniques for sentinel node biopsy in breast cancer. Minerva Surg 2021; 76:550-563. [PMID: 34338468 DOI: 10.23736/s2724-5691.21.09002-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Sentinel node biopsy (SNB) is the standard of care in women with breast cancer (BC) and clinically non suspicious axillary lymph nodes (LNs), due to its high negative predictive value (NPV) in the assessment of nodal status. SNB has significantly reduced complications related to the axillary lymph node dissection, such as lymphedema and upper limb dysfunction. EVIDENCE ACQUISITION The gold standard technique for SNB is the blue dye (BD) and technetium labelled nanocolloid (Tc-99m) double technique. However, nuclear medicine is not available in all Institutions and several new tracers and devices have been proposed, such as indocyanine green (ICG) and superparamagnetic iron oxides (SPIO). All these techniques show an accuracy and detection rate not inferior to that of the standard technique, with different specific pros and cons. The choice of how to perform a SNB primarily depends on the surgeon's confidence with the procedure, the availability of nuclear medicine and the economic resources of the Institutions. In this setting, new tracers, hybrid tracers and imaging techniques are being evaluated in order to improve the detection rate of sentinel lymph nodes (SNs) and minimize the number of unnecessary axillary surgeries through an accurate preoperative assessment of nodal status and to guide new minimally invasive diagnostic procedures of SNs. In particular, the contrast-enhanced ultrasound (CEUS) is an active field of research but cannot be recommended for clinical use at this time. EVIDENCE SYNTHESIS The ICG fluorescence technique was superior in terms of DR, as well as having the lowest FNR. The DR descending order was SPIO, Tc, dual modality (Tc/BD), CEUS and BD. CONCLUSIONS This paper is a narrative review of the most common SNB techniques in BC with a focus on recent innovations.
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Affiliation(s)
- Sonia Bove
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - Simona M Fragomeni
- Unità di Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessia Romito
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy -
| | | | - Pierluigi Rinaldi
- Radiology and Interventional Radiology Unit, Mater Olbia Hospital, Olbia, Italy.,Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Domenico Pagliara
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - Debora Verri
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - Ilaria Romito
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - Ida Paris
- Unità di Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Tagliaferri
- Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia - Gemelli ART (Advanced Radiation Therapy), Interventional Oncology Center (IOC), Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Fabio Marazzi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe Visconti
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, UOC Chirurgia Plastica, Università Cattolica del Sacro Cuore - Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - Gianluca Franceschini
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Multidisciplinary Breast Center, Università Cattolica del Sacro Cuore - Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - Riccardo Masetti
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Multidisciplinary Breast Center, Università Cattolica del Sacro Cuore - Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - Giorgia Garganese
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy.,Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
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Liu YB, Xia M, Li YJ, Li S, Li H, Li YL. Contrast-Enhanced Ultrasound in Locating Axillary Sentinel Lymph Nodes in Patients with Breast Cancer: A Prospective Study. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1475-1483. [PMID: 33714619 DOI: 10.1016/j.ultrasmedbio.2021.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/30/2021] [Accepted: 02/03/2021] [Indexed: 06/12/2023]
Abstract
The objective was to explore the clinical value of contrast-enhanced ultrasound (CEUS) in locating the sentinel lymph node (SLN) in patients with early breast cancer. We screened 143 consecutive patients with breast cancer between July 2017 and August 2019. The number of SLNs identified by CEUS and dual labeling (blue dye and radiolabeled colloid) were recorded. The accuracy of CEUS plus fine-needle aspiration cytology (FNAC) was assessed. The rate of identification of SLNs with CEUS was 84.0% (121/144), and that of dual labeling was 97.92% (141/144). There was no significant association between non-enhancement (p = 0.060) or inhomogeneous enhancement (p = 0.468) and lymph node metastasis. The sensitivity and specificity of CEUS-SLNs plus FNAC was 78.38% and 100%, respectively. The technique of CEUS is a promising method for locating the axillary SLN. But it is hard to identify lymph node metastasis with CEUS alone. CEUS-SLNs plus FNAC is a sound technique for diagnosis of the metastasis of SLN.
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Affiliation(s)
- Yan-Bing Liu
- Department of Breast Surgery (First Breast Cancer Center), Shandong Cancer Hospital and Institute Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Mei Xia
- Shandong First Medical University (Shandong Academy of Medical Sciences), Jinan, Shandong, China
| | - Yun-Jie Li
- Logistics Support Department, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Sheng Li
- Department of Hepatobiliary Surgery, Shandong Cancer Hospital and Institute Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Hao Li
- Shandong Pharmaceutical Research Institute, Jinan, Shandong, China
| | - Yun-Ling Li
- Department of Special Diagnosis, Shandong Cancer Hospital and Institute Affiliated to Shandong First Medical University, Jinan, Shandong Province, China.
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Hao Y, Sun Y, Lei Y, Zhao H, Cui L. Percutaneous Sonazoid-enhanced ultrasonography combined with in vitro verification for detection and characterization of sentinel lymph nodes in early breast cancer. Eur Radiol 2021; 31:5894-5901. [PMID: 33502555 PMCID: PMC8270836 DOI: 10.1007/s00330-020-07639-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 11/25/2020] [Accepted: 12/17/2020] [Indexed: 12/04/2022]
Abstract
Objectives To assess the efficacy of percutaneous Sonazoid-enhanced ultrasound and in vitro verification for identification sentinel lymph nodes (SLNs) and diagnosis of metastatic SLNs in patients with early breast cancer (BC). Methods Sixty-eight patients with early BC were enrolled finally. After the induction of general anesthesia, 0.4 ml of Sonazoid (SNZ), a new second-generation tissue-specific ultrasound contrast agent (UCA), mixed with 0.6 ml of methylene blue, was injected intradermally. The lymphatic vessels and connected SLNs were immediately observed and marked. After being resected, these SLNs were soaked in saline water and examined still in the mode of contrast-enhanced ultrasound (CEUS) in vitro. This procedure could ensure that all the enhanced nodes had been removed as much as possible. The numbers of SLNs detected by UCA and blue dye were recorded. The enhancement patterns of SLNs were compared with the final pathological results. Results SLNs detection rate by SNZ-CEUS was 100%, which was higher than that by blue dye (95.59%). CEUS identified a median of 1.5 nodes, while blue dye identified a median of 1.9 nodes per case (p = 0.0012). When homogeneous high perfusion and complete annular high perfusion were regarded as negative nodes, the sensitivity and negative predictive value were 92.31% and 96.79% respectively, while the specificity was 84.21%. Conclusions Percutaneous SNZ-enhanced ultrasonography combined with in vitro verification is a feasible and reliable method for SLNs identification intraoperatively. Enhancement patterns can be helpful in determining the status of SLNs. Key Points • CEUS with percutaneous injection of Sonazoid can successfully identify SLNs with the rate of 100% in early breast cancer patients, higher than 95.59% of blue dye. • Sonazoid, with high affinity with reticuloendothelial cells, increases the imaging time of SLNs and facilitates biopsy intraoperatively better than Sonovue as a lymphatic tracer. • Homogenous high and complete annular high perfusions have a sensitivity of 92.31% and a negative predictive value of 96.79% in the prediction of uninvolved SLNs.
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Affiliation(s)
- Yunxia Hao
- Department of Ultrasound, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Yan Sun
- Department of Ultrasound, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Yutao Lei
- Department of General Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Hongmei Zhao
- Department of General Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Ligang Cui
- Department of Ultrasound, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
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Wu X, Tang L, Huang W, Huang S, Peng W, Hu D. Contrast-enhanced ultrasonography and blue dye methods in detection of sentinel lymph nodes following neoadjuvant chemotherapy in initially node positive breast cancer. Arch Gynecol Obstet 2020; 302:685-692. [PMID: 32602000 DOI: 10.1007/s00404-020-05646-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/10/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Recent studies show that contrast-enhanced ultrasonography (CEUS) using SonoVue has the potential to improve the performance of sentinel lymph node biopsy (SLNB) in patients with early breast cancer. However, the evidence of SLNB using CEUS in patients converting from cN1 to cN0 after neoadjuvant chemotherapy (NAC) is lacking. The aim of this prospective study is to evaluate the feasibility of CEUS using SonoVue for the identification of sentinel lymph node (SLN) and the value of the combination of CEUS and blue dye (BD) for SLNB in patients converting from cN1 to cN0 following NAC. METHODS Patients with cytology-proven node positive breast cancer at the initial diagnosis (stage T1-T3N1M0) from January 2018 to January 2019, underwent NAC. Patients converting from cN1 to cN0 following NAC were enrolled and randomized into two groups for SLNB: the combination method group using CEUS and BD together, and the single BD method group. Then all patients underwent complete axillary lymph node dissection (ALND) and primary breast surgery. Compared with the final pathological results, the identification rate, sensitivity, specificity, accuracy, false negative rate, negative predictive value, positive predictive value were recorded and compared between two methods. RESULTS A total of 400 patients with stage T1-T3N1M0 disease underwent NAC between January 2018 to January 2019, among which 134 (33.5%) patients had clinically negative node confirmed by imaging after NAC and randomized into two groups. Each group included 67 cases. In the combination method group, contrast-enhanced lymphatic vessels in 66 cases of 67 were clearly visualized by US soon after the periareolar injection of SonoVue and the SLNs were accurately localized. The identification rate of the combination method was 98.5%%, which was significantly higher than 83.6% (56/67) using the single BD method. The mean numbers of SLNs identified by the combination method was higher than that by the single BD method. Compared with pathological diagnosis, sensitivity, specificity, accuracy, the positive predictive value, the negative predictive value, and the FNR of the combingation method were 84.4%, 100%, 89.4%, 100%, 75%, and 15.6%, respectively. In contrast, sensitivity, specificity, accuracy, the positive predictive value, the negative predictive value, and the FNR using single blue dye were 73.9%, 100%, 89.3%, 100%, 84.6%, and 26.1%, respectively. The FNR using the combination method was significantly lower than that using single BD. CONCLUSION Identification of SLNs in patients converting from cN1 to cN0 following NAC by CEUS is a technically feasible. The combination of CEUS and BD is more effective than BD alone for SLNB in patients converting from cN1 to cN0 following NAC.
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Affiliation(s)
- Xiufeng Wu
- Department of Breast Surgical Oncology, Fujian Medical University Cancer Hospital and Fujian Cancer Hospital, No. 420 Fuma Road, Fuzhou, 350014, Fujian, People's Republic of China.
| | - Lina Tang
- Department of Ultrasound, Fujian Medical University Cancer Hospital and Fujian Cancer Hospital, Fuzhou, 350014, Fujian, People's Republic of China
| | - Weiqin Huang
- Department of Ultrasound, Fujian Medical University Cancer Hospital and Fujian Cancer Hospital, Fuzhou, 350014, Fujian, People's Republic of China
| | - Shixin Huang
- Department of Ultrasound, Fujian Medical University Cancer Hospital and Fujian Cancer Hospital, Fuzhou, 350014, Fujian, People's Republic of China
| | - Wei Peng
- Department of Clinical Laboratory, Fujian Medical University Cancer Hospital and Fujian Cancer Hospital, Fuzhou, 350014, Fujian, People's Republic of China
| | - Dan Hu
- Department of Pathology, Fujian Medical University Cancer Hospital and Fujian Cancer Hospital, Fuzhou, 350014, Fujian, People's Republic of China
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Cui Q, Dai L, Li J, Xue J. Accuracy of CEUS-guided sentinel lymph node biopsy in early-stage breast cancer: a study review and meta-analysis. World J Surg Oncol 2020; 18:112. [PMID: 32471428 PMCID: PMC7260746 DOI: 10.1186/s12957-020-01890-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 05/19/2020] [Indexed: 12/24/2022] Open
Abstract
Objective To investigate whether preoperative localization of sentinel lymph node (SLN) by contrast-enhanced ultrasound (CEUS) can further improve the accuracy of sentinel lymph node biopsy (SLNB). Method Collect published literatures or conference reports by searching electronic databases. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) evaluation method is used to evaluate the quality of the screened literatures. The pooled risk ratio of cancer metastasis of SLN identified by CEUS (CE-SLN) compared with SLN not identified by CEUS (nonCE-SLN) is calculated, and the pooled diagnostic accuracy of CE-SLN for pathological status of all SLNs is also evaluated. Result Through search and screening, a total of 16 studies were included, of which five and seven studies, respectively, entered the meta-analysis of metastatic risk ratio and diagnostic accuracy. The localization rate of preoperative CEUS for sentinel lymph nodes was 70 to 100%. The meta-analysis shows that the risk of metastasis of SLN identified by CEUS is significantly higher than that not identified by CEUS, 26.0% vs 4.6%, and risk ratio (RR) is 6.08 (95% CI 4.17–8.85). In early-stage breast cancer, the pathological status of CE-SLN is a good representative of all SLNs, with a pooled sensitivity of 98% (95% CI 0.94–1.00), pooled specificity of 100% (95% CI 0.99–1.00), diagnostic odds ratio (DOR) of 2153.18 (95% CI 476.53–9729.06), and area under the subject receiver operating characteristic (SROC) curve of 0.9968. Conclusion In early-stage breast cancer, preoperative localization of SLN by CEUS is expected to further improve the accuracy of sentinel lymph node biopsy (SLNB).
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Affiliation(s)
- Qiuxia Cui
- Department of Thyroid and Breast Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Li Dai
- Department of Thyroid and Breast Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Jialu Li
- Department of Thyroid and Breast Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Jialei Xue
- Department of Thyroid and Breast Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China.
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Serquiz N, Moro L, Menossi CA, Almeida NR, Baccarin G, de Paiva Silva GR, Shinzato JY, Derchain S, Jales RM. Perinodal fibrosis developed after ultrasonography-guided core-needle biopsy of a contrast-enhanced ultrasound-detected sentinel axillary node interferes with subsequent surgical sentinel node dissection. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:445-452. [PMID: 31359458 DOI: 10.1002/jcu.22765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 06/13/2019] [Accepted: 07/15/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate perinodal fibrosis after 14-gauge staging core-needle biopsy (CNB) of the axillary sentinel lymph node (SLN) identified using contrast-enhanced ultrasonography (CEUS) and its interference with subsequent surgical SLN dissection in breast cancer patients. METHODS Frequencies or means of main clinical, sonographic, pathological, and surgical characteristics were calculated. We also compared patient groups with and without perinodal pathological fibrosis. RESULTS Forty-eight patients who underwent CEUS + CNB and axillary surgery were eligible for this cross-sectional study. Axillary surgical specimens showed perinodal fibrosis in 9/48 (18.7%) patients. Interference with SLN dissection was reported in 4/48 (8.3%) patients (two hematomas, three abnormal palpation findings, and four difficult dissections). The overall surgical detection rate of SLN was 43/48 (89.6%). In the majority of cases, perinodal fibrosis was described as moderate (4/9 [44.4%]) or severe (4/9 [44.4%]). The mean time elapsed between CEUS + CNB and axillary dissection was shorter in patients with perinodal fibrosis (P = .04). Interference with SLN dissection was only reported in patients with perinodal fibrosis (P < .001). Surgical SLN detection was successful in all nine cases in which perinodal pathological fibrosis or interference with SLN dissection was reported. CONCLUSION Perinodal fibrosis may impair the surgical SLN dissection in early stage breast cancer patients who were staged using CEUS + CNB using a14-gauge needle.
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Affiliation(s)
- Nicoli Serquiz
- Faculty of Medical Sciences, Imaging Section, Department of Obstetrics and Gynecology, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Luciano Moro
- Department of Radiology, Faculty of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Carlos A Menossi
- Faculty of Medical Sciences, Imaging Section, Department of Obstetrics and Gynecology, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Natalie R Almeida
- Faculty of Medical Sciences, Imaging Section, Department of Obstetrics and Gynecology, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Gabrielle Baccarin
- Faculty of Medical Sciences, Imaging Section, Department of Obstetrics and Gynecology, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Geisilene R de Paiva Silva
- Faculty of Medical Sciences, Imaging Section, Department of Obstetrics and Gynecology, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Julia Y Shinzato
- Faculty of Medical Sciences, Imaging Section, Department of Obstetrics and Gynecology, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Sophie Derchain
- Faculty of Medical Sciences, Imaging Section, Department of Obstetrics and Gynecology, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Rodrigo M Jales
- Faculty of Medical Sciences, Imaging Section, Department of Obstetrics and Gynecology, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil
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Mok CW, Tan SM, Zheng Q, Shi L. Network meta-analysis of novel and conventional sentinel lymph node biopsy techniques in breast cancer. BJS Open 2019; 3:445-452. [PMID: 31388636 PMCID: PMC6677105 DOI: 10.1002/bjs5.50157] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 01/31/2019] [Indexed: 02/06/2023] Open
Abstract
Background The aim of this network meta‐analysis was to compare the performance of blue dye alone or in combination with radioisotope (technetium‐99m, Tc) with three novel techniques for sentinel lymph node detection in breast cancer: indocyanine green fluorescence (ICG), superparamagnetic iron oxide (SPIO) nanoparticles and contrast‐enhanced ultrasound imaging (CEUS). Methods PubMed, Embase, the Cochrane Library, China Knowledge Research Integrated Database,
ClinicalTrials.gov and OpenGrey databases were searched up to 31 November 2017, without language restriction. Studies that compared the detection performance of at least one of the novel methods (ICG, SPIO and CEUS) with that of traditional methods (blue dye and/or radioisotope) were included in network meta‐analysis. Results Thirty‐five studies were included. Pooled risk ratios (RRs) for Tc (1·09, 95 per cent c.i. 1·04 to 1·15), ICG (1·12, 1·07 to 1·16) and SPIO (1·09, 1·01 to 1·18) showed statistically better performance in detecting sentinel lymph nodes than blue dye alone. ICG had the lowest false‐negative rate, with a RR of 0·29 (0·16 to 0·54), followed by Tc (RR 0·44, 0·20 to 0·96) and SPIO (RR 0·45, 0·14 to 1·45), with blue dye alone as the reference group. Conclusion SPIO or ICG alone are superior to blue dye alone and comparable to the standard dual‐modality technique of blue dye with Tc.
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Affiliation(s)
- C W Mok
- Division of Breast Surgery, Department of Surgery Changi General Hospital Singapore
| | - S-M Tan
- Division of Breast Surgery, Department of Surgery Changi General Hospital Singapore
| | - Q Zheng
- Singapore Clinical Research Institute Singapore
| | - L Shi
- Singapore Clinical Research Institute Singapore
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17
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Diagnosing and Managing the Malignant Axilla in Breast Cancer. CURRENT BREAST CANCER REPORTS 2019. [DOI: 10.1007/s12609-019-0299-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Liu M, Yang Y, Xie F, Guo J, Wang S, Yang H, Wang S. Could axillary clearance be avoided in clinically node-negative breast cancer patients with positive nodes diagnosed by ultrasound guided biopsy in the post-ACOSOG Z0011 era? PLoS One 2019; 14:e0210437. [PMID: 30629686 PMCID: PMC6328118 DOI: 10.1371/journal.pone.0210437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 12/22/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The role of ultrasound (US) guided biopsy in selecting patients for an upfront lymph node dissection (ALND) has been controversial following the publication of the American College of Surgeons (ACOSOG) Z0011 data. The purpose of this study was to investigate if patients with positive axillary lymph nodes (LNs) proven by US guided biopsy should be recommended for ALND and to analyze the utility of preoperative US and US guided biopsy in planning axillary surgery to avoid both unnecessary ALND and unnecessary SLNB. METHODS Patients with a positive preoperative LN biopsy were identified and evaluated to determine their suitability for inclusion according to the criteria proposed in the Z0011 data. The correlation of the number of suspicious nodes found using US with the number of positive nodes on ALND was studied. RESULTS A total of 261 breast cancer patients who had a positive preoperative LN needle biopsy were identified, among them, 79 patients with cT1-2N0 breast cancer and ALND were enrolled in the study. Thirty-one patients (39.2%) had ≤2 positive nodes identified in pathology and 10 patients (12.7%) met all of the Z0011 criteria and might have been spared ALND. A significantly greater proportion of women with ≥3 positive nodes during ALND had >1 abnormal LN identified using US compared to women with ≤2 positive LNs found using ALND (66.7% vs. 6.5%, p<0.0001). CONCLUSION US with needle biopsy is valuable to patients with multiple suspicious nodes found using US while SLND without US guided needle biopsy is suggested if only one abnormal LN is detected on US in the post-Z0011 era.
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Affiliation(s)
- Miao Liu
- Breast Center, Peking University People's Hospital, Beijing, China
| | - Yang Yang
- Breast Center, Peking University People's Hospital, Beijing, China
| | - Fei Xie
- Breast Center, Peking University People's Hospital, Beijing, China
| | - Jiagia Guo
- Breast Center, Peking University People's Hospital, Beijing, China
| | - Siyuan Wang
- Breast Center, Peking University People's Hospital, Beijing, China
| | - Houpu Yang
- Breast Center, Peking University People's Hospital, Beijing, China
| | - Shu Wang
- Breast Center, Peking University People's Hospital, Beijing, China
- * E-mail:
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19
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Favril S, Stock E, Hernot S, Hesta M, Polis I, Vanderperren K, de Rooster H. Sentinel lymph node mapping by near-infrared fluorescence imaging and contrast-enhanced ultrasound in healthy dogs. Vet Comp Oncol 2018; 17:89-98. [PMID: 30311430 DOI: 10.1111/vco.12449] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 09/04/2018] [Accepted: 09/24/2018] [Indexed: 02/06/2023]
Abstract
Sentinel lymph node (SLN) mapping is a valuable and crucial diagnostic procedure in staging malignancies. We compared two non-invasive techniques, near-infrared (NIR) fluorescence imaging and contrast-enhanced ultrasound (CEUS), to identify the SLNs in three superficial anatomical regions in an animal model. Six healthy laboratory dogs were included in a proof-of-concept trial. A NIR fluorescent dye (Indocyanine Green) and microbubbles (Sonovue) were consecutively injected subdermally in the Inguinal, axillary and popliteal region to map the SLNs. Transcutaneous NIR fluorescence imaging identified SLNs in 17 out of a total of 18 occasions. CEUS identified SLNs in all regions (18/18). Whereas NIR fluorescence imaging performed better in the visualization of the afferent lymphatic tract, CEUS demonstrated different filling patterns of the SLNs, a feature potentially critical for the concept of SLN mapping in cancer patients. Both NIR fluorescence imaging and CEUS are safe, non-invasive, practical and accurate methods to perform real-time transcutaneous SLN mapping with potential in a clinical setting.
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Affiliation(s)
- Sophie Favril
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.,Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Emmelie Stock
- Department of Medical Imaging of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Sophie Hernot
- Laboratory in vivo Cellular and Molecular Imaging (ICMI-BEFY/MIMA), Vrije Universiteit Brussel, Brussels, Belgium
| | - Myriam Hesta
- Laboratory of Animal Nutrition, Department of Nutrition, Genetics and Ethology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Ingeborgh Polis
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Katrien Vanderperren
- Department of Medical Imaging of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Hilde de Rooster
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.,Cancer Research Institute Ghent (CRIG), Ghent, Belgium
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Abstract
Contrast-enhanced ultrasound (CEUS) has evolved from the use of agitated saline to second generation bioengineered microbubbles designed to withstand insonation with limited destruction. While only one of these newer agents is approved by the Food and Drug Administration for use outside echocardiography, interventional radiologists are increasingly finding off-label uses for ultrasound contrast agents. Notably, these agents have an extremely benign safety profile with no hepatic or renal toxicities and no radiation exposure. Alongside diagnostic applications, CEUS has begun to develop its own niche within the realm of interventional oncology. Certainly, the characterization of focal solid organ lesions (such as hepatic and renal lesions) by CEUS has been an important development. However, interventional oncologists are finding that the dynamic and real-time information afforded by CEUS can improve biopsy guidance, ablation therapy, and provide early evidence of tumor viability after locoregional therapy. Even more novel uses of CEUS include lymph node mapping and sentinel lymph node localization. Critical areas of research still exist. The purpose of this article is to provide a narrative review of the emerging roles of CEUS in interventional oncology.
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Bloom JB, Stern M, Patel NH, Zhang M, Phillips JL. Detection of lymph node metastases in penile cancer. Transl Androl Urol 2018; 7:879-886. [PMID: 30456191 PMCID: PMC6212620 DOI: 10.21037/tau.2018.08.01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Penile cancer (PC) is a relatively rare malignancy in the United States (US) but a greater concern in developing nations. Lymph node imaging remains critical to the staging and treatment of this disease as metastases develop in a predictable, anatomic fashion. Early surgical intervention remains a mainstay in treatment and imaging often aids in decision making. This review highlights the indications for imaging in both low-stage and advanced disease. Furthermore, we discuss the benefits and limitations of currently available imaging for staging of inguinal and pelvic lymph nodes in PC and novel modalities in development.
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Affiliation(s)
- Jonathan B Bloom
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael Stern
- Department of Urology, New York Medical College, Valhalla, NY, USA
| | - Neel H Patel
- Department of Urology, New York Medical College, Valhalla, NY, USA
| | - Michael Zhang
- Department of Urology, New York Medical College, Valhalla, NY, USA
| | - John L Phillips
- Department of Urology, New York Medical College, Valhalla, NY, USA
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22
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Li C, Torres VC, Tichauer KM. Noninvasive detection of cancer spread to lymph nodes: A review of molecular imaging principles and protocols. J Surg Oncol 2018; 118:301-314. [PMID: 30196532 DOI: 10.1002/jso.25124] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 05/06/2018] [Indexed: 12/20/2022]
Abstract
Identification of cancer spread to tumor-draining lymph nodes offers critical information for guiding treatment in many cancer types. Current clinical methods of nodal staging are invasive and can have substantial negative side effects. Molecular imaging protocols have long been proposed as a less invasive means of nodal staging, having the potential to enable highly sensitive and specific evaluations. This review article summarizes the current status and future perspectives for molecular targeted nodal staging.
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Affiliation(s)
- Chengyue Li
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Illinois
| | - Veronica C Torres
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Illinois
| | - Kenneth M Tichauer
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Illinois
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Zhong J, Sun DS, Wei W, Liu X, Liu J, Wu X, Zhang Y, Luo H, Li Y. Contrast-Enhanced Ultrasound-Guided Fine-Needle Aspiration for Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1371-1378. [PMID: 29631800 DOI: 10.1016/j.ultrasmedbio.2018.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 02/17/2018] [Accepted: 03/05/2018] [Indexed: 05/25/2023]
Abstract
The purpose of this study was to assess whether translymphatic contrast-enhanced ultrasound (CEUS) combined with fine-needle aspiration (FNA) can be used pre-operatively to assess the status of axillary lymph nodes in early-stage breast cancer patients. Furthermore, we wanted to determine whether this less invasive method could potentially be a pre-operative surgical strategy. One hundred sixty-four sentinel lymph nodes (SLNs) were detected by CEUS after intradermal injection of microbubbles in 126 cases. One hundred twenty of 126 cases (95.24%) were accurately diagnosed with the SLN-FNA method. All 6 false-negative cases were due to micrometastasis or macrometastasis. There were no false-positive results after CEUS-guided FNA biopsy based on post-operative histopathological results. In conclusion, translymphatic CEUS combined with SLN-FNA is a less traumatic approach that has high accuracy in the pre-operative evaluation of axillary lymph node status. It might have the potential to be as reliable an indicator for axillary lymph node dissection as SLN biopsy.
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Affiliation(s)
- Jieyu Zhong
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - De-Sheng Sun
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China.
| | - Wei Wei
- Department of Breast Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Xiaoling Liu
- Department of Breast Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Jun Liu
- Department of Pathology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Xiaoqin Wu
- Department of Breast Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Yusen Zhang
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Haiyu Luo
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Yongbin Li
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
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Machado P, Stanczak M, Liu JB, Moore JN, Eisenbrey JR, Needleman L, Kraft WK, Forsberg F. Subdermal Ultrasound Contrast Agent Injection for Sentinel Lymph Node Identification: An Analysis of Safety and Contrast Agent Dose in Healthy Volunteers. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1611-1620. [PMID: 29205451 PMCID: PMC5988650 DOI: 10.1002/jum.14502] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/21/2017] [Accepted: 09/14/2017] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Mapping of the lymphatic chain for identification of the sentinel lymph node (SLN) is an important aspect of predicting outcomes for patients with breast cancer, and it is usually performed as an intraoperative procedure using blue dye and/or radiopharmaceutical agents. Recently, the use of contrast-enhanced ultrasound (CEUS) has been proposed as an alternative imaging technique for this mapping. The objective of this study was to evaluate the use of subdermal administration of the ultrasound (US) contrast agent Sonazoid (GE Healthcare, Oslo, Norway) in terms of patient safety and to select the dose to be used for lymphatic applications in humans. METHODS This study was performed in 12 female volunteers who received bilateral subdermal injections of Sonazoid (1 or 2 mL dose) in the mid-upper outer quadrant of their breasts at 2 different time points. Contrast-enhanced US examinations were performed 0, 0.25, 0.5, 1, 2, 4, 6, and 24 hours after injection to identify SLNs. RESULTS Sentinel lymph nodes were identified within the first hour after injection as enhanced structures, and there was no significant difference by dose in the number of SLNs identified (P = .74). The volunteers only had minor adverse experiences (AEs) that resolved completely without intervention by study completion. CONCLUSIONS The subdermal use of Sonazoid in this study showed only minor local and nonsignificant AEs that were completely resolved without any intervention. Two different doses were compared with no significant differences observed between them. Hence, the lower dose studied (1 mL) was selected for use in future clinical studies.
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Affiliation(s)
- Priscilla Machado
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Maria Stanczak
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jason N. Moore
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - John R. Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Laurence Needleman
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Walter K. Kraft
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
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Lowes S, Leaver A, Cox K, Satchithananda K, Cosgrove D, Lim A. Evolving imaging techniques for staging axillary lymph nodes in breast cancer. Clin Radiol 2018; 73:396-409. [DOI: 10.1016/j.crad.2018.01.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 01/02/2018] [Indexed: 12/18/2022]
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Cox K, Taylor-Phillips S, Sharma N, Weeks J, Mills P, Sever A, Lim A, Haigh I, Hashem M, de Silva T, Satchithananda K, Tang M, Wallis M. Enhanced pre-operative axillary staging using intradermal microbubbles and contrast-enhanced ultrasound to detect and biopsy sentinel lymph nodes in breast cancer: a potential replacement for axillary surgery. Br J Radiol 2017; 91:20170626. [PMID: 29125333 DOI: 10.1259/bjr.20170626] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To compare the experience of four UK Centres in the use of intradermal microbubbles and contrast enhanced ultrasound (CEUS) to pre-operatively identify and biopsy sentinel lymph nodes (SLN) in patients with breast cancer. METHODS In all centres, breast cancer patients had a microbubble/CEUS SLN core biopsy prior to axillary surgery and patients in Centres 1 and 2 had a normal greyscale axillary ultrasound. Data were collected between 2010 and 2016; 1361 from Centre 1 (prospective, sequential), 376 from Centre 2 (retrospective, sequential), 121 from Centre 3 (retrospective, selected) and 48 from Centre 4 (prospective, selected). RESULTS SLN were successfully core biopsied in 80% (Centre 1), 79.6% (Centre 2), 77.5% (Centre 3) and 88% (Centre 4). The sensitivities to identify all SLN metastases were 46.9% [95% confidence intervals (CI) (39.4-55.1)], 52.5% [95% CI (39.1-65.7)], 46.4% [95% CI (27.5-66.1)] and 45.5% [95% CI (16.7-76.6)], respectively. The specificities were 99.7% [95% CI (I98.9-100)], 98.1% [95% CI (94.5-99.6)], 100% [95% CI (93.2-100%)] and 96.3% [95% CI (81-99.9)], respectively.The negative predictive values were 87.0% [95% CI (84.3-89.3)], 84.5% [95% CI (78.4-89.5)], 86.9% [95% CI (82.4-90.3)] and 86.2% [95% CI (78.4-91.5)], respectively. At Centres 1 and 2, 12/730 (1.6%) and 7/181 (4%), respectively, of patients with a benign microbubble/CEUS SLN core biopsy had two or more lymph node (LN) macrometastases found at the end of primary surgical treatment. CONCLUSION The identification and biopsy of SLN using CEUS is a reproducible technique. Advances in knowledge: In the era of axillary conservation, microbubble/CEUS SLN core biopsy has the potential to succeed surgical staging of the axilla.
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Affiliation(s)
- Karina Cox
- 1 Breast Surgery, Peggy Wood Breast Unit, Maidstone Hospital, Hermitage Lane , Peggy Wood Breast Unit, Maidstone Hospital, Hermitage Lane , Kent, Maidstone , UK
| | - Sian Taylor-Phillips
- 2 WMS - Population Evidence and Technologies, University of Warwick , University of Warwick , Coventry , UK
| | - Nisha Sharma
- 3 Breast Radiology, Leeds Breast Unit, St James's University Hospital, Beckett Street , Leeds Breast Unit, St James's University Hospital, Beckett Street , Leeds , UK
| | - Jennifer Weeks
- 1 Breast Surgery, Peggy Wood Breast Unit, Maidstone Hospital, Hermitage Lane , Peggy Wood Breast Unit, Maidstone Hospital, Hermitage Lane , Kent, Maidstone , UK
| | - Philippa Mills
- 1 Breast Surgery, Peggy Wood Breast Unit, Maidstone Hospital, Hermitage Lane , Peggy Wood Breast Unit, Maidstone Hospital, Hermitage Lane , Kent, Maidstone , UK
| | - Ali Sever
- 4 Breast Radiology, Breast Care Unit, Kings College Hospital, Ground floor, Cheyne Wing, Denmark Hill , Breast Care Unit, Kings College Hospital, Ground floor, Cheyne Wing, Denmark Hill , Brixton, London , UK
| | - Adrian Lim
- 5 Breast Radiology, Breast Unit, Charing Cross Hospital, Fulham Palace Road , Breast Unit, Charing Cross Hospital, Fulham Palace Road , London , UK
| | - Isobel Haigh
- 3 Breast Radiology, Leeds Breast Unit, St James's University Hospital, Beckett Street , Leeds Breast Unit, St James's University Hospital, Beckett Street , Leeds , UK
| | - Mohamed Hashem
- 1 Breast Surgery, Peggy Wood Breast Unit, Maidstone Hospital, Hermitage Lane , Peggy Wood Breast Unit, Maidstone Hospital, Hermitage Lane , Kent, Maidstone , UK
| | - Tania de Silva
- 6 School of Surgery, Health Education Kent Surrey and Sussex , Health Education Kent Surrey and Sussex , London , UK
| | - Keshthra Satchithananda
- 4 Breast Radiology, Breast Care Unit, Kings College Hospital, Ground floor, Cheyne Wing, Denmark Hill , Breast Care Unit, Kings College Hospital, Ground floor, Cheyne Wing, Denmark Hill , Brixton, London , UK
| | - Mengxing Tang
- 7 Department of Bioengineering, Imperial College London , Imperial College London , London , UK
| | - Matthew Wallis
- 8 Breast Radiology, Breast Unit, Addenbrooke's Treatment Centre , Breast Unit, Addenbrooke's Treatment Centre , Cambridge , UK
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Lahtinen O, Eloranta M, Anttila M, Kärkkäinen H, Sironen R, Vanninen R, Rautiainen S. Preoperative sentinel lymph node localization in vulvar cancer: preliminary experience with inguinal intradermal contrast-enhanced ultrasound. Eur Radiol 2017; 28:2089-2095. [DOI: 10.1007/s00330-017-5155-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 09/26/2017] [Accepted: 10/23/2017] [Indexed: 10/18/2022]
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Beer P, Pozzi A, Rohrer Bley C, Bacon N, Pfammatter NS, Venzin C. The role of sentinel lymph node mapping in small animal veterinary medicine: A comparison with current approaches in human medicine. Vet Comp Oncol 2017; 16:178-187. [DOI: 10.1111/vco.12372] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 10/17/2017] [Indexed: 12/20/2022]
Affiliation(s)
- P. Beer
- Clinic for Small Animal Surgery, Vetsuisse Faculty; University of Zurich; Zurich Switzerland
| | - A. Pozzi
- Clinic for Small Animal Surgery, Vetsuisse Faculty; University of Zurich; Zurich Switzerland
| | - C. Rohrer Bley
- Division of Radiation Oncology, Vetsuisse Faculty; University of Zurich; Zurich Switzerland
| | - N. Bacon
- Fitzpatrick Referrals Oncology and Soft Tissue; Guildford Hospital; Guildford UK
| | - N. S. Pfammatter
- Clinic for Diagnostic Imaging, Vetsuisse Faculty; University of Zurich; Zurich Switzerland
| | - C. Venzin
- Clinic for Small Animal Surgery, Vetsuisse Faculty; University of Zurich; Zurich Switzerland
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Abstract
Purpose of Review Axillary staging in the context of breast cancer is a contentious topic due to the varied practices across UK, Europe, and America. The ACOSOG Z0011 trial has questioned the role of axillary ultrasound in women with breast cancer. Published data has shown that women with ultrasound-positive lymph nodes have a worse prognosis than those with ultrasound-negative lymph nodes. Axillary ultrasound is limited as the sentinel lymph node (SLN) cannot be identified using B-mode ultrasound; however, with the advent of contrast-enhanced ultrasound (CEUS), this has now changed. Recent Findings The published literature has shown that the sentinel lymph node can be identified using CEUS. The rates are equivalent to blue dye alone but currently inferior to the dual technique of sentinel lymph node biopsy. There are several different contrast agents that can be used and the agents that remain in the sentinel lymph node for longer can identify areas of poor enhancement, allowing for targeted biopsy. Summary CEUS has the potential to revolutionize the way we manage the axilla in the future and may even replace surgical staging.
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Affiliation(s)
- Nisha Sharma
- Breast Unit, Level 1 Chancellor Wing, St James Hospital, Beckett Street, Leeds, LS9 7TF UK.,University of Leeds, Leeds, LS2 9JT UK
| | - Karina Cox
- Department of Breast Surgery, Maidstone Hospital, Hermitage Lane, Maidstone, Kent ME16 9QQ UK
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Nielsen Moody A, Bull J, Culpan AM, Munyombwe T, Sharma N, Whitaker M, Wolstenhulme S. Preoperative sentinel lymph node identification, biopsy and localisation using contrast enhanced ultrasound (CEUS) in patients with breast cancer: a systematic review and meta-analysis. Clin Radiol 2017; 72:959-971. [DOI: 10.1016/j.crad.2017.06.121] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/11/2017] [Accepted: 06/26/2017] [Indexed: 01/08/2023]
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Zhao J, Zhang J, Zhu QL, Jiang YX, Sun Q, Zhou YD, Wang MQ, Meng ZL, Mao XX. The value of contrast-enhanced ultrasound for sentinel lymph node identification and characterisation in pre-operative breast cancer patients: A prospective study. Eur Radiol 2017; 28:1654-1661. [DOI: 10.1007/s00330-017-5089-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/28/2017] [Accepted: 09/22/2017] [Indexed: 12/11/2022]
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Britton P, Willsher P, Taylor K, Kilburn-Toppin F, Provenzano E, Forouhi P, Benson J, Agrawal A, Forman J, Wallis M. Microbubble detection and ultrasound-guided vacuum-assisted biopsy of axillary lymph nodes in patients with breast cancer. Clin Radiol 2017; 72:772-779. [DOI: 10.1016/j.crad.2017.03.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 01/18/2017] [Accepted: 03/15/2017] [Indexed: 10/19/2022]
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Wang Y, Zhou W, Li C, Gong H, Li C, Yang N, Zha X, Chen L, Xia T, Liu X, Wang M, Ding Q. Variation of sentinel lymphatic channels (SLCs) and sentinel lymph nodes (SLNs) assessed by contrast-enhanced ultrasound (CEUS) in breast cancer patients. World J Surg Oncol 2017; 15:127. [PMID: 28693494 PMCID: PMC5504859 DOI: 10.1186/s12957-017-1195-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 06/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of this study was to assess the feasibility of detecting the variation of sentinel lymphatic channels (SLCs) and sentinel lymph nodes (SLNs) in breast cancer patients using contrast-enhanced ultrasound (CEUS). METHODS A total of 46 breast cancer patients were prospectively recruited in the study. All the participants received intradermal and peritumoral injection of microbubbles as contrast agent, and SLCs and SLNs were assessed preoperatively. Blue dye was injected subareolarly and peritumorally during the surgery. The SLNs detected by CEUS and blue dye were sent to the pathology laboratory for histopathological analysis. RESULTS At least one SLC and SLN were detected by CEUS in all 46 cases. Three types of SLCs were detected, including superficial sentinel lymphatic channels (SSLCs), penetrating sentinel lymphatic channels (PSLCs), and deep sentinel lymphatic channels (DSLCs). Five lymphatic drainage patterns (LDPs) were found, including SSLC, PSLC, SSLC + PSLC, SSLC + DSLC, and SSLC + PSLC + DSLC. Only SSLC was detected on CEUS in 24 cases; only PSLC was detected in 3 cases; both SSLC and PSLC were detected in 8 cases; both SSLC and DSLC were detected in 7 cases; SSLC, PSLC, and DSLC were all detected in the remaining 4 cases. An actual LDP was defined on the combination of CEUS and dissection of the specimen. The accuracy rate of CEUS was 43/46. Interestingly, a bifurcated SLC was found in 8 patients. In 3 patients, a discontinuous SLC and non-enhanced SLN were found by CEUS. Also, no dyed SLNs were detected during the surgery. The axillary lymph nodes turned out tumor involved histologically. CONCLUSION CEUS is feasible to assess the variation of SLCs and SLNs preoperatively in breast cancer patients. SLNB is not suggested when a discontinuous SLC and non-enhanced SLN were detected by CEUS.
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Affiliation(s)
- Ying Wang
- Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China
| | - Wenbin Zhou
- Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China
| | - Cuiying Li
- Department of Ultrasound, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China
| | - Haiyan Gong
- Department of Ultrasound, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China
| | - Chunlian Li
- Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China
| | - Nianzhao Yang
- Department of General Surgery, The First Affiliated Yijishan Hospital with Wannan Medical College, Wuhu, Anhui, China
| | - Xiaoming Zha
- Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China
| | - Lin Chen
- Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China
| | - Tiansong Xia
- Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China
| | - Xiaoan Liu
- Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China.
| | - Minghai Wang
- Department of General Surgery, The First Affiliated Yijishan Hospital with Wannan Medical College, Wuhu, Anhui, China.
| | - Qiang Ding
- Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, China.
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Saidha NK, Aggarwal R, Sen A. Identification of Sentinel Lymph Nodes Using Contrast-Enhanced Ultrasound in Breast Cancer. Indian J Surg Oncol 2017; 9:355-361. [PMID: 30287998 DOI: 10.1007/s13193-017-0646-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 03/20/2017] [Indexed: 12/12/2022] Open
Abstract
Sentinel lymph node (SLN) biopsy has become the standard of care in axillary staging of breast cancer patients who are clinically node negative as it reduces the morbidity of axillary nodal dissection. SLN biopsy using blue dye and radioisotopes have high identification rates but its limitations include anaphylaxis, disposal of radioactive waste, and potential second surgery in up to 35% of patients who show nodal metastases on SLN biopsy. Contrast-enhanced ultrasound (CEUS) has the potential for SLNs to be identified without the aforementioned risks. CEUS involves the administration of intravenous contrast agents containing microbubbles of perfluorocarbon or nitrogen gas. The bubbles greatly affect ultrasound backscatter and increase vascular contrast in a similar manner to intravenous contrast agents used in CT and MRI. It is safe and easily performed with no requirement for ionizing radiation and no risk of nephrotoxicity. Microbubbles are taken up by lymph nodes when injected directly into tissues, including sub-areolar injection in the breast cancer patient. This method may prove valuable in patients with ductal carcinoma in situ, where operative SLN biopsy remains controversial, and in women undergoing prophylactic mastectomies for high risk. This technique may also have a role after neoadjuvant chemotherapy where frequently there is fibrosis in the treated SLNs.
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De-escalation of axillary surgery in early breast cancer. Lancet Oncol 2017; 17:e430-e441. [PMID: 27733269 DOI: 10.1016/s1470-2045(16)30311-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 07/05/2016] [Accepted: 07/08/2016] [Indexed: 12/15/2022]
Abstract
With the advent of sentinel lymph node biopsy, surgical methods for accurately staging the axilla in patients with early-stage breast cancer have become progressively less extensive, with formal axillary lymph node dissection confined to a dwindling group of patients. Although details of methods for sentinel lymph node biopsy have yet to be standardised, this technique is now widely practised and accepted as standard of care worldwide. In the past 5 years, attention has focused on minimisation of surgical morbidity by restricting further axillary surgery or considering radiotherapy in patients with a small tumour burden in their sentinel nodes. This change in approach to patients with positive sentinel lymph node biopsies has increased the complexity of axillary management, and any policy of de-escalation and avoidance of morbidity must not compromise patient outcomes. This trend for de-escalation has accompanied a shift in understanding of how any residual tumour burden can be adequately managed without surgical extirpation and reliance on effective adjuvant therapies. Indications for omission of completion axillary lymph node dissection in patients with two or fewer nodes containing macrometastases demand further clarification, together with the roles of preoperative imaging in defining axillary nodal burden, deselection of patients for sentinel lymph node biopsy, and provision of radiotherapy. Downstaging of biopsy-proven node-positive patients with neoadjuvant chemotherapy could safely permit sentinel lymph node biopsy alone when the index node has been successfully retrieved at surgery, while nodal deposits of any size continue to mandate completion axillary lymph node dissection. Developments in molecular imaging technologies and percutaneous biopsy techniques could potentially render sentinel lymph node biopsy redundant in the future.
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Gvetadze SR, Xiong P, Lv M, Li J, Hu J, Ilkaev KD, Yang X, Sun J. Contrast-enhanced ultrasound mapping of sentinel lymph nodes in oral tongue cancer-a pilot study. Dentomaxillofac Radiol 2017; 46:20160345. [PMID: 28045344 DOI: 10.1259/dmfr.20160345] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To assess the usefulness of contrast-enhanced ultrasound (CEUS) with peritumoral injection of microbubble contrast agent for detecting the sentinel lymph nodes for oral tongue carcinoma. METHODS The study was carried out on 12 patients with T1-2cN0 oral tongue cancer. A radical resection of the primary disease was planned; a modified radical supraomohyoid neck dissection was reserved for patients with larger lesions (T2, n = 8). The treatment plan and execution were not influenced by sentinel node mapping outcome. The Sonovue™ contrast agent (Bracco Imaging, Milan, Italy) was utilized. After detection, the position and radiologic features of the sentinel nodes were recorded. RESULTS The identification rate of the sentinel nodes was 91.7%; one patient failed to demonstrate any enhanced areas. A total of 15 sentinel nodes were found in the rest of the 11 cases, with a mean of 1.4 nodes for each patient. The sentinel nodes were localized in: Level IA-1 (6.7%) node; Level IB-11 (73.3%) nodes; Level IIA-3 (20.0%) nodes. No contrast-related adverse effects were observed. CONCLUSIONS For oral tongue tumours, CEUS is a feasible and potentially widely available approach of sentinel node mapping. Further clinical research is required to establish the position of CEUS detection of the sentinel nodes in oral cavity cancers.
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Affiliation(s)
- Shalva R Gvetadze
- 1 Department of Oral Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai, China.,2 Department of Reconstructive Maxillofacial Surgery with Microsurgery and External Prosthetics, Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia.,3 Department of Consulting and Diagnostics, Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - Ping Xiong
- 4 Department of Ultrasound, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mingming Lv
- 1 Department of Oral Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Jun Li
- 1 Department of Oral Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Jingzhou Hu
- 1 Department of Oral Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Konstantin D Ilkaev
- 5 Department of Head and Neck Surgery, NN Blokhin Russian Cancer Research Center, Moscow, Russia
| | - Xin Yang
- 1 Department of Oral Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Jian Sun
- 1 Department of Oral Maxillofacial-Head Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory of Stomatology, Shanghai, China
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Wendler T, Paepke S. Axillary sentinel node aspiration biopsy: towards minimally invasive lymphatic staging in breast cancer. Clin Transl Imaging 2016. [DOI: 10.1007/s40336-016-0205-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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38
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Qin J, Wang TY, Willmann JK. Sonoporation: Applications for Cancer Therapy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 880:263-91. [PMID: 26486343 DOI: 10.1007/978-3-319-22536-4_15] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Therapeutic efficacy of both traditional chemotherapy and gene therapy in cancer is highly dependent on the ability to deliver drugs across natural barriers, such as the vessel wall or tumor cell membranes. In this regard, sonoporation induced by ultrasound-guided microbubble (USMB) destruction has been widely investigated in the enhancement of therapeutic drug delivery given it can help overcome these natural barriers, thereby increasing drug delivery into cancer. In this chapter we discuss challenges in current cancer therapy and how some of these challenges could be overcome using USMB-mediated drug delivery. We particularly focus on recent advances in delivery approaches that have been developed to further improve therapeutic efficiency and specificity of various cancer treatments. An example of clinical translation of USMB-mediated drug delivery is also shown.
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Affiliation(s)
- Jiale Qin
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, School of Medicine, Stanford, CA, USA
| | - Tzu-Yin Wang
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, School of Medicine, Stanford, CA, USA
| | - Jürgen K Willmann
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, School of Medicine, Stanford, CA, USA.
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39
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Wang L, Hu Y, Peng Q, Zhou J, Zhou Q, An S, Niu C. Indocyanine-green-loaded microbubbles for localization of sentinel lymph node using near-infrared fluorescence/ultrasound imaging: a feasibility study. RSC Adv 2016. [DOI: 10.1039/c5ra26814a] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Current strategies for sentinel lymph node (SLN) biopsy to detect cancer metastasis have some limitations such as the associated radiation exposure and high false-negative rates due to dye particles through the true SLNs to contiguous LNs.
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Affiliation(s)
- Long Wang
- Department of Orthopedics
- Xiangya Hospital
- Central South University
- Changsha
- P. R. China
| | - Yihe Hu
- Department of Orthopedics
- Xiangya Hospital
- Central South University
- Changsha
- P. R. China
| | - Qinghai Peng
- Department of Ultrasound
- The Second Xiangya Hospital
- Central South University
- Changsha
- P. R. China
| | - Jiawei Zhou
- Department of Ultrasound
- The Second Xiangya Hospital
- Central South University
- Changsha
- P. R. China
| | - Qichang Zhou
- Department of Ultrasound
- The Second Xiangya Hospital
- Central South University
- Changsha
- P. R. China
| | - Senbo An
- Department of Orthopedics
- Xiangya Hospital
- Central South University
- Changsha
- P. R. China
| | - Chengcheng Niu
- Department of Ultrasound
- The Second Xiangya Hospital
- Central South University
- Changsha
- P. R. China
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40
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[Focus on methods for detection of sentinel nodes in breast cancer]. ACTA ACUST UNITED AC 2015; 44:35-42. [PMID: 26698220 DOI: 10.1016/j.gyobfe.2015.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 11/24/2015] [Indexed: 10/22/2022]
Abstract
The sentinel node procedure (GS) is the recommended technique for axillary surgical exploration in localized breast cancer with no clinical or radiological lymph node involvement. This surgical technique is based on a dual isotope and colorimetric detection. Although it allows a significant reduction in morbidity compared to axillary dissection (CA), this procedure induces a number of organizational constraints, in particular for the radioisotope injection. Specially for this reason, other GS methods have emerged in recent years, some of which appear promising (detection by fluorescence and magnetic iron). The objective of this paper was to carry out a synthesis of the reference method of detection (radioisotope) GS and analyze the recent literature on new detection methods.
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Xie F, Zhang D, Cheng L, Yu L, Yang L, Tong F, Liu H, Wang S, Wang S. Intradermal microbubbles and contrast-enhanced ultrasound (CEUS) is a feasible approach for sentinel lymph node identification in early-stage breast cancer. World J Surg Oncol 2015; 13:319. [PMID: 26585236 PMCID: PMC4653941 DOI: 10.1186/s12957-015-0736-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 11/12/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Microbubbles and contrast-enhanced ultrasound (CEUS) is a new technique for locating sentinel lymph node (SLN). The aim of this study is to explore the feasibility of SLNs tracing by CEUS using microbubbles in breast cancer patients and the value of enhancing patterns in diagnosing lymph nodes metastases. METHODS A clinical trial was registered (trial registration: ChiCTR-DDT-13003778). One hundred and one consecutive consenting patients with breast cancer undergoing SLN biopsy were enrolled. Before the surgery, microbubble was injected periareolarly. Lymphatic drainage pathway was detected by CEUS, and guidewire was deployed to locate the SLN before the operation. Blue dye was also used to help in tracing sentinel lymph node during the operation. The identification rate and the accuracy rate were recorded. Enhancing patterns of lymph nodes were recorded and compared with the pathological diagnosis. RESULTS Of the 101 cases, SLNs in 99 cases were successfully identified by at least one tracer, including 98 cases identified by CEUS and 97 cases by blue dye. There was no significant difference between the two methods (P = 0.705). Guidewires were deployed successfully in all 98 cases, and the localized SLNs were all isolated successfully in the following operations. The status of SLNs isolated by CEUS was completely identical to that of the whole axillary lymph node while 7.1 % cases were misdiagnosed as negative by blue dye method. The sensitivity of predicting SLNs metastases by CEUS enhancing pattern was 81.8 %, the specificity was 86.2 %, and the positive and negative predictive values were 75.0 and 90.3 %, respectively. CONCLUSIONS Microbubbles and CEUS are feasible approaches for SLN identification. The enhancing patterns on CEUS may be helpful to recognize the metastasizing SLNs. This novel method may be a promising technique for the clinical application.
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Affiliation(s)
- Fei Xie
- Department of Breast Disease, Peking University People's Hospital, Beijing, China.
| | - Dongjie Zhang
- Department of Breast Disease, Peking University People's Hospital, Beijing, China.
| | - Lin Cheng
- Department of Breast Disease, Peking University People's Hospital, Beijing, China.
| | - Lei Yu
- Department of Ultrasound Diagnosis, Peking University People's Hospital, Beijing, China.
| | - Li Yang
- Department of Ultrasound Diagnosis, Peking University People's Hospital, Beijing, China.
| | - Fuzhong Tong
- Department of Breast Disease, Peking University People's Hospital, Beijing, China.
| | - Hongjun Liu
- Department of Breast Disease, Peking University People's Hospital, Beijing, China.
| | - Shu Wang
- Department of Ultrasound Diagnosis, Peking University People's Hospital, Beijing, China.
| | - Shan Wang
- Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing, China.
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42
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Rautiainen S, Sudah M, Joukainen S, Sironen R, Vanninen R, Sutela A. Contrast-enhanced ultrasound -guided axillary lymph node core biopsy: Diagnostic accuracy in preoperative staging of invasive breast cancer. Eur J Radiol 2015; 84:2130-6. [DOI: 10.1016/j.ejrad.2015.08.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/09/2015] [Accepted: 08/12/2015] [Indexed: 10/23/2022]
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43
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Esfehani MH, Yazdankhah-Kenari A, Omranipour R, Mahmoudzadeh HA, Shahriaran S, Zafarghandi MR, Amoli HA. Validation of Contrast Enhanced Ultrasound Technique to Wire Localization of Sentinel Lymph Node in Patients with Early Breast Cancer. Indian J Surg Oncol 2015; 6:370-3. [PMID: 27065663 DOI: 10.1007/s13193-015-0446-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/07/2015] [Indexed: 02/06/2023] Open
Abstract
Axillary staging is one of the primary steps in management of Breast cancer patients. Current standard methods including blue dye and radicolloid have limitations and disadvantages. In this study, the feasibility of visualization of lymph node pathways and localization of SLN with the help of CEUS was assessed. 50 patients with early breast cancer diagnosis underwent CEUS and wire localization, methylenblue dye, and isotope scan methods for SLN detection. The pathology findings of the wired SLN were compared with those obtained from, methylenblue dye, and isotope scan methods. Lymph node wiring was successfully performed in 48 patients.Radio-isotope technique detected SLN in all 50 patients while blue-dye succeeded in 48. Sensitivity of CEUS to detect SLN compared with radio-isotope and blue dye methods was 96 % and 100 %, respectively. Considering costs and facilities required to perform radio-isotope technique and complications of blue dye we may accept CEUS with the help of micro-bubble contrasts as a viable alternative. However, more studies with larger sample volumes, using various drugs, and including non-selective population are warranted to better clarify feasibility and accuracy of this technique in comparison with current methods.
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Affiliation(s)
- Maryam H Esfehani
- Department of Surgery, Iranian National Cancer Institute, Imam Khomeini Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Adel Yazdankhah-Kenari
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramesh Omranipour
- Department of Surgery, Iranian National Cancer Institute, Imam Khomeini Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Habib Allah Mahmoudzadeh
- Department of Surgery, Iranian National Cancer Institute, Imam Khomeini Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahriar Shahriaran
- Department of Radiology, Iranian National Cancer Institute, Imam Khomeini Complex, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Hadi Ahmadi Amoli
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Teixeira SC, Peeters MJTFDV, Stokkel MPM, Rutgers EJTH, Olmos RAV, Koolen BB. The role of PET/CT for nodal staging in primary stage II/III breast cancer patients. BREAST CANCER MANAGEMENT 2015. [DOI: 10.2217/bmt.15.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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45
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Cox K, Weeks J, Mills P, Chalmers R, Devalia H, Fish D, Sever A. Contrast-Enhanced Ultrasound Biopsy of Sentinel Lymph Nodes in Patients with Breast Cancer: Implications for Axillary Metastases and Conservation. Ann Surg Oncol 2015; 23:58-64. [DOI: 10.1245/s10434-015-4606-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Indexed: 11/18/2022]
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Growing indications for CEUS: The kidney, testis, lymph nodes, thyroid, prostate, and small bowel. Eur J Radiol 2015; 84:1675-84. [PMID: 26014102 DOI: 10.1016/j.ejrad.2015.05.008] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 05/05/2015] [Indexed: 12/11/2022]
Abstract
Contrast enhanced ultrasonography (CEUS) is increasingly used for non-hepatic applications as well, so that nearly all organs have been investigated. Among them, there is a growing clinical use for a variety of pathologies of the kidney, testis, and small bowel. The possibility to differentiate benign from malignant nodes in cancer patients has been investigated. A new application is in the detection of sentinel nodes after intradermal microbubble injection. The need to distinguish thyroid nodules eligible for fine needle aspiration cytology has led to the use of CEUS in thyroid examinations as well. The potential of CEUS for prostate cancer detection has been extensively investigated, with encouraging initial results. Early promise, however, has not been fulfilled. New perspective regards evaluation of the extent of prostate tissue devascularization following ablative treatments.
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Preoperative diagnosis of sentinel lymph node (SLN) metastasis using 3D CT lymphography (CTLG). Breast Cancer 2015; 23:519-24. [PMID: 25814093 DOI: 10.1007/s12282-015-0597-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 02/16/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) became a standard procedure for patients with early breast cancer, however, an indication of SLN navigation to metastatic disease may lead to misdiagnosis for staging. Preoperative CTLG with a water-soluble iodinated contrast medium visualizes the correct primary SLNs and its afferent lymphatic channels surrounding detailed anatomy, therefore it can predict LN metastasis by visualizing the lymph vessel obstruction or stain defect of the SLN by tumor. The current study presents the value of CTLG for preoperative prediction for SLN status. METHODS A total of 228 patients with Tis-T2 breast cancer who did not receive primary chemotherapy were studied. SLN metastasis was diagnosed according to the following staining patterns of SLNs and afferent lymphatic vessels: stain defect of SLN, obstruction, stagnation, dilation, and detour of the lymphatic vessels by tumor occupation. The diagnosis was compared with the pathological results to evaluate the accuracy of prediction for SLN metastasis using CTLG. RESULTS Twenty-seven of 228 patients had metastatic SLN pathologically. Twenty-five of these were diagnosed as metastatic preoperatively. The accuracy for metastatic diagnosis using CTLG was 89.0%, sensitivity was 92.6%, and specificity was 88.6%. The positive predictive value was 52.1% and negative predictive value was 98.8%. CONCLUSION CTLG can select the candidate with truly node negative cases in early breast cancer patients, because it predicts lymph node metastasis preoperatively from natural status of the lymphographic image. It also might omit the SLN biopsy itself.
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48
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Niu G, Chen X. Lymphatic imaging: focus on imaging probes. Am J Cancer Res 2015; 5:686-97. [PMID: 25897334 PMCID: PMC4402493 DOI: 10.7150/thno.11862] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 03/10/2015] [Indexed: 01/10/2023] Open
Abstract
In view of the importance of sentinel lymph nodes (SLNs) in tumor staging and patient management, sensitive and accurate imaging of SLNs has been intensively explored. Along with the advance of the imaging technology, various contrast agents have been developed for lymphatic imaging. In this review, the lymph node imaging agents were summarized into three groups: tumor targeting agents, lymphatic targeting agents and lymphatic mapping agents. Tumor targeting agents are used to detect metastatic tumor tissue within LNs, lymphatic targeting agents aim to visualize lymphatic vessels and lymphangionesis, while lymphatic mapping agents are mainly for SLN detection during surgery after local administration. Coupled with various signal emitters, these imaging agents work with single or multiple imaging modalities to provide a valuable way to evaluate the location and metastatic status of SLNs.
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Sentinel lymph node localization with contrast-enhanced ultrasound and an I-125 seed: An ideal prospective development study. Int J Surg 2015; 14:1-6. [DOI: 10.1016/j.ijsu.2014.12.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 12/17/2014] [Indexed: 11/21/2022]
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50
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Ahmed M, Purushotham AD, Douek M. Novel techniques for sentinel lymph node biopsy in breast cancer: a systematic review. Lancet Oncol 2014; 15:e351-62. [PMID: 24988938 DOI: 10.1016/s1470-2045(13)70590-4] [Citation(s) in RCA: 164] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The existing standard for axillary lymph node staging in breast cancer patients with a clinically and radiologically normal axilla is sentinel lymph node biopsy with a radioisotope and blue dye (dual technique). The dependence on radioisotopes means that uptake of the procedure is limited to only about 60% of eligible patients in developed countries and is negligible elsewhere. We did a systematic review to assess three techniques for sentinel lymph node biopsy that are not radioisotope dependent or that refine the existing method: indocyanine green fluorescence, contrast-enhanced ultrasound using microbubbles, and superparamagnetic iron oxide nanoparticles. Our systematic review suggested that these new methods for sentinel lymph node biopsy have clinical potential but give high levels of false-negative results. We could not identify any technique that challenged the existing standard procedure. Further assessment of these techniques against the standard dual technique in randomised trials is needed.
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Affiliation(s)
- Muneer Ahmed
- Department of Research Oncology, King's College London, London, UK; Oncology and Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Arnie D Purushotham
- Department of Research Oncology, King's College London, London, UK; Oncology and Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Michael Douek
- Department of Research Oncology, King's College London, London, UK; Oncology and Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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