Real-Time Visualization of Lymphatic Flow to Sentinel Lymph Nodes by Contrast-Enhanced Ultrasonography with Sonazoid in Patients with Breast Cancer

Shimazu, Kenzo; Miyake, Tomohiro; Tanei, Tomonori; Naoi, Yasuto; Shimoda, Masafumi; Kagara, Naofumi; Kim, Seung Jin; Noguchi, Shinzaburo

doi:10.1016/j.ultrasmedbio.2019.07.005

Cited by 23 publications

(40 citation statements)

References 22 publications

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“…In the past decade, a number of clinical studies had explored the identification of sentinel lymph node in early-stage breast cancer by contrast-enhanced ultrasound and its application value in sentinel lymph node biopsy. Some studies showed that CEUS can further improve identification of SLN and reduce SLNB surgical trauma [23][24][25][26]. However, some studies suggested that the false negative rate of SLNB guided by CEUS alone is high and the diagnostic accuracy is low [27,28].…”

Section: Ultrasonography and Contrast-enhanced Ultrasoundmentioning

confidence: 99%

“…Of the 16 selected studies, 9 used SonoVue as CEUS material [26][27][28][39][40][41][42][43][44], 6 used Sonazoid [23][24][25][45][46][47], and 1 used DEFINITY [48]. The administration sites and methods of contrast agents mainly include intradermal [23-28, 39-44, 47] and subcutaneous [45,46] injection around areola or peritumoral parenchyma injection approaching the axilla [48].…”

Section: The Localization Detection Rate Of Ceus For Slnmentioning

confidence: 99%

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Accuracy of CEUS-guided sentinel lymph node biopsy in early-stage breast cancer: a study review and meta-analysis

Cui

et al. 2020

World J Surg Onc

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Objective: To investigate whether preoperative localization of sentinel lymph node (SLN) by contrast-enhanced ultrasound (CEUS) can further improve the accuracy of sentinel lymph node biopsy (SLNB). Method: Collect published literatures or conference reports by searching electronic databases. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) evaluation method is used to evaluate the quality of the screened literatures. The pooled risk ratio of cancer metastasis of SLN identified by CEUS (CE-SLN) compared with SLN not identified by CEUS (nonCE-SLN) is calculated, and the pooled diagnostic accuracy of CE-SLN for pathological status of all SLNs is also evaluated. Result: Through search and screening, a total of 16 studies were included, of which five and seven studies, respectively, entered the meta-analysis of metastatic risk ratio and diagnostic accuracy. The localization rate of preoperative CEUS for sentinel lymph nodes was 70 to 100%. The meta-analysis shows that the risk of metastasis of SLN identified by CEUS is significantly higher than that not identified by CEUS, 26.0% vs 4.6%, and risk ratio (RR) is 6.08 (95% CI 4.17-8.85). In early-stage breast cancer, the pathological status of CE-SLN is a good representative of all SLNs, with a pooled sensitivity of 98% (95% CI 0.94-1.00), pooled specificity of 100% (95% CI 0.99-1.00), diagnostic odds ratio (DOR) of 2153.18 (95% CI 476.53-9729.06), and area under the subject receiver operating characteristic (SROC) curve of 0.9968. Conclusion: In early-stage breast cancer, preoperative localization of SLN by CEUS is expected to further improve the accuracy of sentinel lymph node biopsy (SLNB).

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Section: Ultrasonography and Contrast-enhanced Ultrasoundmentioning

confidence: 99%

Section: The Localization Detection Rate Of Ceus For Slnmentioning

confidence: 99%

Accuracy of CEUS-guided sentinel lymph node biopsy in early-stage breast cancer: a study review and meta-analysis

Cui

et al. 2020

World J Surg Onc

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“…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. 15 It has been increasingly used for detection of lymph node and liver metastases in multiple tumor types [16][17][18] due to preferential uptake by cells of the reticuloendothelial system. Our results are consistent with the findings of Goldberg et al 10 that CEUS with perflubutane can identify SLN associated with cutaneous melanoma.…”

Section: Discussionmentioning

confidence: 99%

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

Bertelsen¹,

King

Swanson³

et al. 2018

The Laryngoscope

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Objective To study the feasibility of contrast‐enhanced ultrasound (CEUS) for identification of SLN associated with cutaneous melanoma. Study Design Single arm pilot study in a swine animal model. Methods One milliliter of perflubutane (Sonazoid, GE Healthcare, Milwaukee, WI) was injected into the peritumoral dermis in five swine with cutaneous melanoma. Ultrasonography was used to follow enhancing lymphatic channels to lymph nodes (LN). Intradermal injection of vital blue (VB) dye was used as a positive control. LN identified by either method were excised and examined histologically. Results There were five primary cutaneous melanomas with mean area of 4.36 ± 4.75 cm2 and Breslow depth of 3.6 ± 1.5 mm. Six possible sentinel lymph node (SLN)s were identified with CEUS, and nine were identified with VB. SLN averaged 12.44 ± 6.15 cm from the primary tumor. Four of six (67%) SLNs identified by CEUS and four of nine (44%) candidate SLNs identified by VB contained histologically confirmed metastatic melanoma. All six CEUS‐identified SLNs were also identified with VB. Two LNs not containing melanoma were identified by CEUS; three were identified with VB. In all SLN with metastases, metastatic cells were scattered throughout the LN and not clustered in a discrete mass. Conclusion CEUS with perflubutane feasibly identifies SLN associated with cutaneous melanoma and may be a useful adjunct technology in facilitating precise SLN dissection. Our work supports a clinical trial investigating the use of CEUS for this application. Level of Evidence NA Laryngoscope, 129:1117–1122, 2019

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“…7,8 There have been studies to detect and characterize SLNs noninvasively. [9][10][11][12][13][14][15] A study by Akers et al 9 showed the feasibility of detecting regional SLNs of rats in vivo with combined fluorescence and photoacoustic imaging. Garcia-Uribe et al 10 developed a dual-modality photoacoustic and ultrasonic imaging system to detect SLNs based on the accumulation of methylene blue dye in patients with breast cancer.…”

mentioning

confidence: 99%

“…12 Contrast-enhanced ultrasound (CEUS) imaging has also been used to detect and characterize SLNs. [13][14][15] Shimazu et al 13 achieved 98% accuracy in SLN detection using CEUS with Sonazoid (GE Healthcare, Oslo, Norway) compared to a blue dye and/or radiocolloid method in 100 patients with breast cancer. Goldberg et al 14 showed 81.8% accuracy of SLN detection using CEUS with Sonazoid compared to a blue dye method in 63 swine with melanoma.…”

mentioning

confidence: 99%

Performance of Molecular Lymphosonography for Detection and Quantification of Metastatic Involvement in Sentinel Lymph Nodes

Nam

Stapp

Liu

et al. 2018

J of Ultrasound Medicine

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Objectives To assess the performance of molecular lymphosonography with dual‐targeted microbubbles in detecting and quantifying the metastatic involvement in sentinel lymph nodes (SLNs) using a swine melanoma model. Methods Targeted microbubbles were labeled with P‐selectin and αVβ3‐integrin antibodies. Control microbubbles were labeled with immunoglobulin G antibodies. First lymphosonography with Sonazoid (GE Healthcare, Oslo, Norway) was used to identify SLNs. Then dual‐targeted and control microbubbles were injected intravenously to detect and quantify metastatic disease in the SLNs. Distant non‐SLNs were imaged as benign controls. All evaluated lymph nodes (LNs) were surgically removed, and metastatic involvement was characterized by a histopathologic analysis. Two radiologists blinded to histopathologic results assessed the baseline B‐mode images of LNs, and the results were compared to the histologic reference standard. The mean intensities of targeted and control microbubbles within the examined LNs were measured and compared to the LN histologic results. Results Thirty‐five SLNs and 34 non‐SLNs from 13 Sinclair swine were included in this study. Twenty‐one SLNs (62%) were malignant, whereas 100% of non‐SLNs were benign. The sensitivity of B‐mode imaging for metastatic LN diagnosis for both readers was relatively high (90% and 71%), but the specificity was very poor (50% and 58%). The sensitivity and specificity of molecular lymphosonography for metastatic LN detection were 91% and 67%, respectively. The mean intensities from dual‐targeted microbubbles correlated well with the degree of metastatic LN involvement (r = 0.6; P < 0.001). Conclusions Molecular lymphosonography can increase the specificity of metastatic LN detection and provide a measure to quantify the degree of metastatic involvement.

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Real-Time Visualization of Lymphatic Flow to Sentinel Lymph Nodes by Contrast-Enhanced Ultrasonography with Sonazoid in Patients with Breast Cancer

Cited by 23 publications

References 22 publications

Accuracy of CEUS-guided sentinel lymph node biopsy in early-stage breast cancer: a study review and meta-analysis

Accuracy of CEUS-guided sentinel lymph node biopsy in early-stage breast cancer: a study review and meta-analysis

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

Performance of Molecular Lymphosonography for Detection and Quantification of Metastatic Involvement in Sentinel Lymph Nodes

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