Trans-lymphatic Contrast-Enhanced Ultrasound in Combination with Blue Dye Injection is Feasible for Detection and Biopsy of Sentinel Lymph Nodes in Breast Cancer

doi:10.37015/AUDT.2018.180805

Abstract

Abstract:

Objective: The best method for sentinel lymph node biopsy (SLNB) in early-staged breast cancer (EBC) remains controversial. This study aimed to evaluate a novel method by combining trans-lymphatic contrast-enhanced ultrasound (TLCEUS) with blue dye injection as a guidance of SLNB.
Methods: TLCEUS was performed in 88 patients with newly diagnosed EBC. Methylene blue dye was percutaneously injected into enhanced sentinel lymph nodes (SLNs) under ultrasound guidance, followed by standard SLNB and axillary lymph node dissection. Enhancement patterns and the arriving time (AT) of contrast agent within SLNs were evaluated. Histopathological examination of dissected nodes was performed to confirm metastasis.
Results: A total of 95 enhanced SLNs were identified and biopsied in 86 of 88 patients with identification rate of 97.7%. The specificity was 75.0%, sensitivity was 83.3%, and false-negative rate was 16.7%. Contrast-enhanced SLNs with type I, type II, and type III patterns had a metastatic positive rate of 11.4% (5/44), 57.1% (12/21) and 80.0% (24/30), respectively. Metastatic positive SLNs showed a mean AT of 61.6 ± 58.7 s while metastatic negative SLNs showed a mean AT of 41.3 ± 19.9 s, which was statistically significantly different.
Conclusion: The TLCEUS/blue dye method can be used as an alternative to the radioisotope/blue dye method for its feasibility and accuracy.

Key words: Axillary lymph node dissection; Contrast-enhanced ultrasound; Early-staged breast cancer; Methylene blue dye; Sentinel lymph node biopsy

Xiangmei Chen, MD, Jieyu Zhong, MD, Zhengming Hu, MD, Wei Wei, MD, Weihua Yin, MD, Ligang Cui, MD, Ji-Bin Liu, MD, Desheng Sun, MD. Trans-lymphatic Contrast-Enhanced Ultrasound in Combination with Blue Dye Injection is Feasible for Detection and Biopsy of Sentinel Lymph Nodes in Breast Cancer. Advanced Ultrasound in Diagnosis and Therapy, 2018, 2(2): 94-100.

Figures/Tables 3

Table 1

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Clinical characteristics	Data (n = 88)
Menopause status
Postmenopause	25/88 (28.4%)
Premenopause	63/88 (71.6%)
Age
Mean	46.0 ± 10.9 years
Median	45 (27-74) years
Tumor orientation
Upper outer quadrant	32/88 (36.4%)
Upper inner quadrant	20/88 (22.7%)
Lower outer quadrant	17/88 (19.3%)
Lower inner quadrant	16/88 (18.2%)
Central area	3/88 (3.4%)
Maximum SLN diameter
Mean	21.6 ± 8.5 mm
Median	21.0 (7.0-48.0) mm
Tumor stage
Tis	50/88 (56.8%)
T1	16/88 (18.2%)
T2	22/88 (25.0%)
HER2 positive	15/88 (17.0%)
Triple negative	14/88 (15.9%)

Metastasis status	non-SLN+	non-SLN-	Total
SLN+	25 (83.3%)	14 (25.0%)	39 (45.3%)
SLN-	5 (16.7%)	42 (75.0%)	47 (54.7%)
Total	30 (100%)	56 (100%)	86 (100%)