ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY >

2018 , Vol. 2 >Issue 2: 94 - 100

DOI: https://doi.org/10.37015/AUDT.2018.180805

Original Research

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

  • Chen, MD Xiangmei ,
  • Zhong, MD Jieyu ,
  • Hu, MD Zhengming ,
  • Wei, MD Wei ,
  • Yin, MD Weihua ,
  • Cui, MD Ligang ,
  • Liu, MD Ji-Bin ,
  • Sun, MD Desheng
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  • a Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen, China
    b Department of Breast and Thyroid Surgery, Peking University Shenzhen Hospital, Shenzhen, China
    c Department of Pathology, Peking University Shenzhen Hospital, Shenzhen, China
    d Department of Ultrasonography, Peking University Third Hospital, Beijing, China
    e Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA

Received date: 2017-12-15

  Online published: 2018-08-19

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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

Cite this article

Chen, MD Xiangmei , Zhong, MD Jieyu , Hu, MD Zhengming , Wei, MD Wei , Yin, MD Weihua , Cui, MD Ligang , Liu, MD Ji-Bin , Sun, MD Desheng . Trans-lymphatic Contrast-Enhanced Ultrasound in Combination with Blue Dye Injection is Feasible for Detection and Biopsy of Sentinel Lymph Nodes in Breast Cancer[J]. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY, 2018 , 2(2) : 94 -100 . DOI: 10.37015/AUDT.2018.180805

References

[1] Noguchi M, Morioka E, Ohno Y, Noguchi M, Nakano Y, Kosaka T. The changing role of axillary lymph node dissection for breast cancer. Breast Cancer 2013; 20:41-6.
[2] Fu Y, Chung D, Cao MA, Apple S, Chang H. Is axillary lymph node dissection necessary after sentinel lymph node biopsy in patients with mastectomy and pathological N1 breast cancer? Ann Surg Oncol 2014; 21:4109-23.
[3] Dixon JM. Sentinel Lymph Node Biopsy in Breast Cancer Surgery. Ann Surg Oncol 2016; 23:3426-8.
[4] Andersson Y, de Boniface J, Jonsson PE, Ingvar C, Liljegren G, Bergkvist L, et al. Axillary recurrence rate 5 years after negative sentinel node biopsy for breast cancer. Br J Surg 2012; 99:226-31.
[5] Kootstra JJ, Hoekstra-Weebers JE, Rietman JS, de Vries J, Baas PC, Geertzen JH, et al. A longitudinal comparison of arm morbidity in stage I-II breast cancer patients treated with sentinel lymph node biopsy, sentinel lymph node biopsy followed by completion lymph node dissection, or axillary lymph node dissection. Ann Surg Oncol 2010; 17:2384-94.
[6] Kuehn T, Bauerfeind I, Fehm T, Fleige B, Hausschild M, Helms G, et al. Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study. Lancet Oncol 2013; 14:609-18.
[7] Takei H, Kurosumi M, Yoshida T, Ishikawa Y, Hayashi Y, Ninomiya J, et al. Axillary lymph node dissection can be avoided in women with breast cancer with intraoperative, false-negative sentinel lymph node biopsies. Breast Cancer 2010; 17:9-16.
[8] Goldhirsch A, Wood WC, Coates AS, Gelber RD, Thurlimann B, Senn HJ. Strategies for subtypes--dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol 2011; 22:1736-47.
[9] Nowikiewicz T, Kurylcio A, Polkowski W, Zegarski W. Imaging methods for the local lymphatic system of the axilla in early breast cancer in patients qualified for sentinel lymph node biopsy. Prz Menopauzalny 2016; 15:52-5.
[10] Goldberg BB, Merton DA, Liu JB, Murphy G, Forsberg F. Contrast-enhanced sonographic imaging of lymphatic channels and sentinel lymph nodes. J Ultrasound Med 2005; 24:953-65.
[11] Cox K, Sever A, Jones S, Weeks J, Mills P, Devalia H, et al. Validation of a technique using microbubbles and contrast enhanced ultrasound (CEUS) to biopsy sentinel lymph nodes (SLN) in pre-operative breast cancer patients with a normal grey-scale axillary ultrasound. Eur J Surg Oncol 2013; 39:760-5.
[12] Cox K, Weeks J, Mills P, Chalmers R, Devalia H, Fish D, et al. Contrast-Enhanced Ultrasound Biopsy of Sentinel Lymph Nodes in Patients with Breast Cancer: Implications for Axillary Metastases and Conservation. Ann Surg Oncol 2016; 23:58-64.
[13] Matsuzawa F, Einama T, Abe H, Suzuki T, Hamaguchi J, Kaga T, et al. Accurate diagnosis of axillary lymph node metastasis using contrast-enhanced ultrasonography with Sonazoid. Mol Clin Oncol 2015; 3:299-302.
[14] Saracco A, Szabo BK, Tanczos E, Bergh J, Hatschek T. Contrast-enhanced ultrasound (CEUS) in assessing early response among patients with invasive breast cancer undergoing neoadjuvant chemotherapy. Acta Radiol 2017; 58:394-402.
[15] Fan L, Strasser-Weippl K, Li JJ, Louis JS, Finkelstein DM, Yu KD, et al. Breast cancer in China. Lancet Oncol 2014; 15:e279-89.
[16] Allemani C, Weir HK, Carreira H, Harewood R, Spika D, Wang XS, et al. Global surveillance of cancer survival 1995-2009: analysis of individual data for 25 676 887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lance 2015; 385:977-1010.
[17] Fujii T, Yajima R, Tatsuki H, Kuwano H. Prediction of Extracapsular Invasion at Metastatic Sentinel Nodes and Non-sentinel Lymph Nodal Metastases by FDG-PET in Cases with Breast Cancer. Anticancer Res 2016; 36:1785-9.
[18] Arslan G, Altintoprak KM, Yirgin IK, Atasoy MM, Celik L. Diagnostic accuracy of metastatic axillary lymph nodes in breast MRI. Springerplus 2016; 5:735.
[19] Pouw JJ, Grootendorst MR, Bezooijen R, Klazen CA, De Bruin WI, Klaase JM, et al. Pre-operative sentinel lymph node localization in breast cancer with superparamagnetic iron oxide MRI: the SentiMAG Multicentre Trial imaging subprotocol. Br J Radiol 2015; 88:20150634.
[20] Borrelli P, Donswijk ML, Stokkel MP, Teixeira SC, van Tinteren H, Rutgers EJ, et al. Contribution of SPECT/CT for sentinel node localization in patients with ipsilateral breast cancer relapse. Eur J Nucl Med Mol Imaging 2016; 44:630-37.
[21] Nakano Y, Noguchi M, Yokoi-Noguchi M, Ohno Y, Morioka E, Kosaka T, et al. The roles of (18)F-FDG-PET/CT and US-guided FNAC in assessment of axillary nodal metastases in breast cancer patients. Breast Cancer 2017; 24:121-7.
[22] Nieciecki M, Dobruch-Sobczak K, Wareluk P, Guminska A, Bialek E, Cacko M, et al. The role of ultrasound and lymphoscintigraphy in the assessment of axillary lymph nodes in patients with breast cancer. J Ultrason 2016; 16:5-15.
[23] Diepstraten SC, Sever AR, Buckens CF, Veldhuis WB, van Dalen T, van den Bosch MA, et al. Value of preoperative ultrasound-guided axillary lymph node biopsy for preventing completion axillary lymph node dissection in breast cancer: a systematic review and meta-analysis. Ann Surg Oncol 2014; 21:51-9.
[24] 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.
[25] Esfehani MH, Yazdankhah-Kenari A, Omranipour R, Mahmoudzadeh HA, Shahriaran S, Zafarghandi MR, et al. 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.
[26] 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.
[27] 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.
[28] Kim T, Giuliano AE, Lyman GH. Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a metaanalysis. Cancer 2006; 106:4-16.
[29] Lyman GH, Temin S, Edge SB, Newman LA, Turner RR, Weaver DL, et al. Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 2014; 32:1365-83.
[30] Han C, Yang L, Zuo W. A mini-review on factors and countermeasures associated with false-negative sentinel lymph node biopsies in breast cancer. Chin J Cancer Res 2016; 28:370-6.
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