Advanced Ultrasound in Diagnosis and Therapy ›› 2023, Vol. 7 ›› Issue (1): 1-7.doi: 10.37015/AUDT.2023.230001

• Review Articles • Previous Articles     Next Articles

Sentinel Lymph Node Identification Using Contrast Lymphosonography: A Systematic Review

Priscilla Machado, MD, Ji-Bin Liu, MD, Flemming Forsberg, PhD()   

  1. Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
  • Received:2023-01-09 Accepted:2023-03-09 Online:2023-03-30 Published:2023-03-30
  • Contact: Flemming Forsberg, PhD,


The sentinel lymph node (SLN) concept hypothesizes that metastatic cancer cells will spread through the lymphatic system to the SLN being the first one in the lymphatic chain to receive the metastatic cells, indicating that if the SLN is free of cancer cells the rest of the lymphatic chain is also without metastatic disease. Diagnostic ultrasound imaging (US) has been used to evaluate lymph nodes (LN) to determine level of suspicion and to guide LN biopsies. However, conventional US cannot be used for lymphatic mapping, which requires administration of a tracer. This has been changed with the use of contrast-enhanced US (CEUS) to detect lymphatic channels and SLNs after subcutaneous injections of microbubble-based US contrast agents (UCAs). The aim of this review is to examine the clinical evidence on the role of subcutaneous injection of UCA, known as lymphosonography, to be used as preoperative identification of SLNs in patients with breast and other cancers.

Key words: Contrast-enhanced ultrasound; Sentinel lymph node; Breast cancer; Lymphatic tracer; Ultrasound contrast agent; Lymphosonography; Lymphatic mapping