Identification of sentinel lymph nodes by contrast‐enhanced ultrasonography with Sonazoid in patients with breast cancer: a feasibility study in three hospitals

Abstract

The aim of this prospective study was to evaluate the feasibility of periareolar injection of the contrast agent Sonazoid (SNZ) followed by ultrasonography (US) for the identification of sentinel lymph node (SLN) in breast cancer patients with clinically negative node. Patients (n = 100) with T1‐2N0M0 breast cancer received a periareolar injection of SNZ followed by US to identify contrast‐enhanced SLN. Each contrast‐enhanced SLN underwent fine needle aspiration cytology (FNAC) followed by SLN biopsy with a conventional method using blue dye and/or radiocolloid (B/R). In almost all cases, contrast‐enhanced lymphatic vessels were clearly visualized by US soon after the periareolar injection of SNZ and the SLNs were easily identified with an identification rate of 98% (98/100) for SNZ and 100% (100/100) for B/R. The number of SLNs identified by SNZ (SNZ‐SLN) (mean per patient, 1.52) was significantly lower than that identified by B/R (B/R‐SLN) (2.19) (P < 0.0001). Twenty‐five patients with positive SLNs had at least one positive SNZ‐SLN. On a node‐by‐node basis, sensitivity, specificity, and accuracy of FNAC for SNZ‐SLNs (n = 149) were 33.3%, 99.2%, and 85.9%, respectively. Identification of SLN by periareolar injection of SNZ is a technically simple method with an identification rate as high as 98%. SNZ‐SLN thus seems to be a good target for FNAC, but sensitivity of FNAC for SNZ‐SLNs needs to be improved.

Axillary Nodal Staging with Contrast-Enhanced Ultrasound

“…The Sonazoid stays within the lymph node much longer, allowing for real-time localization of the SLN under ultrasound guidance, whereas the SonoVue contrast agent remains in the lymph node for 1–3 min. Shimazu et al (2016) [ 15 ] compared CEUS using Sonazoid with SLNB using blue dye and/or radioisotope. The identification rate of SLN was 98% with CEUS and 100% with standard technique.…”

Contrast‐Enhanced Ultrasound With Perflubutane for Sentinel Lymph Node Mapping in Cutaneous Melanoma: A Pilot Study

“…Perflubutane (Sonazoid, GE Healthcare) is a new ultrasound contrast agent that is safe and has a low risk of adverse events in both animals and humans . It has been increasingly used for detection of lymph node and liver metastases in multiple tumor types due to preferential uptake by cells of the reticuloendothelial system. Our results are consistent with the findings of Goldberg et al that CEUS with perflubutane can identify SLN associated with cutaneous melanoma.…”

Advanced Ultrasound Technologies for Diagnosis and Therapy

“…The microbubbles are injected periareolarly and then travel to regional lymphatic sites via subcutaneous lymphatic drainage after tissue massage ( Fig. 1C) (11). Shimazu et al claimed that the rate for detecting the primary draining lymph node is 98% and that the accuracy of CEUS may even be higher than that of standard clinical methods (injection of blue dye or radiotracer) (11).…”