The Value of Percutaneous Contrast-Enhanced Ultrasound in the Evaluation of Sentinel Lymph Node of Breast Cancer

doi:10.37015/AUDT.2018.180808

Abstract

Abstract:

Objective: To analysis breast cancer sentinel lymph channels (SLCs) and the shape of the sentinel lymph nodes (SLNs) perfusion by contrast-enhanced ultrasound (CEUS) and to explore its value in the diagnosis of sentinel metastasis lymph nodes.
Methods: A retrospective analysis, 66 breast cancer patients with 101 ipsilateral axillary SLNs checking by CEUS, was confirmed by pathology. SLCs and SLNs positions were marked and then the rough needle biopsy pathology was used to confirm the benign or malignant SLNs. According to the different perfusion, SLNs were divided into five groups and evaluated by scores. MecNemar test and receiver operating characteristic (ROC) curve were used to analyze the statistical analysis. The difference of p < 0.05 was statistically significant. The cut-off value was finally determined, and the results of ultrasound screening test were evaluated.
Results: A total of 66 patients with 101 SLNs were successfully evaluated, including 42 cases of metastatic lymph nodes, and 59 cases of benign lymph nodes. The area under the ROC curve was 0.752 (p < 0.05). To ROC curve, the cut off value was 3.5. The scores 4 and 5 of lymph nodes were negative, and scores 1, 2, 3 of lymph nodes were positive. The sensitivity, specificity, false negative rate, false positive rate, and the coincidence rate of the screening test were 44.19%, 93.10%, 55.81%, 6.9%, 72.28% respectively. The value of positive predictive and the negative predictive were 82.61%, 69.23% respectively.
Conclusion: To evaluate SLCs shape and judge benign and malignant SLNs, percutaneous CEUS has a high practical value.

Key words: Breast cancer; Contrast ultrasound; SLNs; Needle biopsy

Ping Wang, MM, Jian Liu, MD, Wensheng Yue, MM, Wenyan Li, MM, Yuqun Luo, MM, Jiao He, MM. The Value of Percutaneous Contrast-Enhanced Ultrasound in the Evaluation of Sentinel Lymph Node of Breast Cancer. Advanced Ultrasound in Diagnosis and Therapy, 2018, 2(2): 113-118.

References

[1]	Yudd AP, Kempf JS, Goydos JS, Stahl TJ, Feinstein RS. Use of sentinel node lymphoscintigraphy in malignant melanoma. Radiographics 1999; 19:343-53.
[2]	Nason KS, Anderson BO, Byrd DR, Dunnwald LK, Eary JF, Mankoff DA, Livingston R, et al. Increased false negative sentinel node biopsy rates after preoperative chemotherapy for invasive breast carcinoma. Cancer 2000; 89:2187-94.
[3]	Xie F, Zhang D, Cheng L, Yu L, Yang L, Tong F, et al. 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.
[4]	Dindyal S, Kyriakides C. Ultrasound microbubble contrast and current clinical applications. Recent Pat Cardiovasc Drug Discov 2011; 6:27-41.
[5]	Morton DL, Wen DR, Wong JH, Economou JS, Cagle LA, Storm FK, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992; 127:392-9.
[6]	Iannace C, Di Libero L, Lepore M, De Stefano N, Buono M, Sciascia V, et al. Prognostic and curative value of sentinel node in breast cancer. A 377 patients experience. Ann Ital Chir 2010; 81:103-11.
[7]	Shivers SC, Wang X, Li W, Joseph E, Messina J, Glass LF, et al. Molecular staging of malignant melanoma: correlation with clinical outcome. JAMA 1998; 280:1410-5.
[8]	Albertini JJ, Lyman GH, Cox C, Yeatman T, Balducci L, Ku N, Shivers S, et al. Lymphatic mapping and sentinel node biopsy in the patient with breast cancer. JAMA 1996; 276:1818-22.
[9]	Alazraki NP, Styblo T, Grant SF, Cohen C, Larsen T, Waldrop S, et al. Sentinel node staging of early breast cancer using lymphoscintigraphy and the intraoperative gamma detecting probe. Radiol Clin North Am 2001; 39:947-56.
[10]	Cochran AJ, Wen DR, Morton DL. Management of the regional lymph nodes in patients with cutaneous malignant melanoma. World J Surg 1992; 16:214-22.
[11]	Ecanow JS, Abe H, Newstead GM, Ecanow DB, Jeske JM. Axillary staging of breast cancer: what the radiologist should know. Radiographics 2013; 33:1589-612.
[12]	Bostick PJ, Giuliano AE. Vital dyes in sentinel node localization. Semin Nucl Med 2000; 30:18-24.
[13]	Eshima D, Fauconnier T, Eshima L, Thornback JR. Radiopharmaceuticals for lymphoscintigraphy: including dosimetry and radiation considerations. Semin Nucl Med 2000; 30:25-32.
[14]	Goldberg BB, Merton DA, Liu JB, Thakur M, Murphy GF, Needleman L, et al. Sentinel lymph nodes in a swine model with melanoma: contrast-enhanced lymphatic US. Radiology 2004; 230:727-34.
[15]	Gelb HR, Freeman LJ, Rohleder JJ, Snyder PW. Feasibility of contrast-enhanced ultrasound-guided biopsy of sentinel lymph nodes in dogs. Vet Radiol Ultrasound 2010; 51:628-33.
[16]	Lurie DM, Seguin B, Schneider PD, Verstraete FJ, Wisner ER. Contrast-assisted ultrasound for sentinel lymph node detection in spontaneously arising canine head and neck tumors. Invest Radiol 2006; 41:415-21.
[17]	Zhang D, Cheng W, Han X, Sun Y, Jin H, Guo D. Drainage path of sentinel lymph node in rabbit models with VX2 breast cancer by percutaneous contrast-enhanced ultrasonography. Chinese J Ultrasound Med 2013; 29:549-52.
[18]	Wei G, Fan Y, Chen F, Yan X, Sun H. The value of percutaneous injection of ultrasound contrast imaging and metastasis of sentinel lymph node in breast cancer. Chin J Surg Onco 2013; 5:303-5.
[19]	Zhang Y, Wang X, Kang S, Li X, Geng J. Contrast-enhanced ultrasonography in qualitative diagnosis of sentinel lymph node metastasis in breast cancer: A meta-analysis. J Cancer Res Ther 2015; 11:697-703.
[20]	Yu Y, Liu J, Yin L. Application progress of lymphography in oncology. Front Med China 2009; 3:13-9.
[21]	Sever AR, Mills P, Weeks J, Jones SE, Fish D, Jones PA, et al. Preoperative needle biopsy of sentinel lymph nodes using intradermal microbubbles and contrast-enhanced ultrasound in patients with breast cancer. AJR Am J Roentgenol 2012; 199:465-70.
[22]	Sever A, Broillet A, Schneider M, Cox K, Jones S, Weeks J, et al. Dynamic visualization of lymphatic channels and sentinel lymph nodes using intradermal microbubbles and contrast-enhanced ultrasound in a swine model and patients with breast cancer. J Ultrasound Med 2010; 29:1699-704.
[23]	Mattrey RF, Kono Y, Baker K, Peterson T. Sentinel lymph node imaging with microbubble ultrasound contrast material. Acad Radiol 2002; 9:S231-5.