Application of Contrast Enhanced Ultrasound in Sentinel Lymph Node Biopsy of Breast Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 FUMing-gang ¹ , GUOChen-ming ¹ , GAOJun-xi ²

1. Department of Breast Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China;
2. Department of Ultrasound, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China;

Corresponding?author：

FUMing-gang, Email: xjfuminggang@126.com

Keywords：

Breast cancer; Sentinel lymph node; Contrast enhanced ultrasound

DOI：

10.7507/1007-9424.20150115

Video：

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Objective To evaluate the diagnostic value of contrast enhanced ultrasound (CEUS) to the sentinel lymph node (SLN) of breast cancer. Methods Seventy-two operable breast cancer patients with clinically negative axillary lymph node were enrolled.Sulphur hexafluoride microbubbles for injection (SonoVue) was used alone as the tracer agent for the sentinel lymph node biopsy (SLNB), and axillary dissection was performed after the methylene blue location.All SLNs were examined pathologically with HE staining.The SLN diagnosis result of contrast enhanced ultrasound and postoperative pathological examination result were comparative analyzed. Results After the injection of SonoVue can obtain a clear image of the lymphatic vessels and SLN.The success rate of CEUS imaging was 84.72% (61/72) in this group of 72 patients, and the false negative rate was 12.12% (4/33).The sensitivity and specificity of diagnosis by CEUS was 92.50% (37/40) and 92.59% (50/54), respectively, the diagnostic odds ratio (DOR) was 154.17.By the pathology results as the gold standard, the internal consistency of these two methods was good (Kappa value=0.848, P < 0.01). Conclusion CEUS may be a useful orientation and determination method for SLNs.

Citation： FUMing-gang, GUOChen-ming, GAOJun-xi. Application of Contrast Enhanced Ultrasound in Sentinel Lymph Node Biopsy of Breast Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(4): 439-442. doi: 10.7507/1007-9424.20150115 Copy

1.	Demartini WB, Eby PR, Peacock S, et al.Utility of targeted sonography for breast lesions that were suspicious on MRI.AJR Am J Roentgenol, 2009, 192(4):1128-1134.
2.	李學茹, 王文, 楊銀學, 等.超聲造影實時動態觀察豬結腸前哨淋巴結.中國醫學影像技術, 2012, 28(4):1945-1948.
3.	Goldberg BB, Merton DA, Liu JB, et al.Sentinel lymph nodes in a swine model with melanoma:contrast-enhanced lymphatic US.Radiology, 2004, 230(3):727-734.
4.	尤厚成, 劉健, 尤楠.超聲造影對乳腺良惡性腫塊鑒別診斷的價值.中國普外基礎與臨床雜志, 2011, 18(8):861-865.
5.	嚴婷, 王文, 李海.超聲造影在結直腸癌術中前哨淋巴結顯像中的應用研究.中華超聲影像雜志, 2013, 11(22):962-964.
6.	Low KS, Littlejohn DR.Optimal number of sentinel nodes after intradermal injection isotope and blue dye.ANZ J Surg, 2006, 76(6):472-475.
7.	李太玉, 孫曉, 王永勝, 等.單用藍染料示蹤劑在乳腺癌前哨淋巴結活檢中的價值.中國普外基礎與臨床雜志, 2010, 17(12):1235-1239.
8.	盧振鐸, 劉真真, 楊輝, 等.核素標記法聯合亞甲藍在早期乳腺癌前哨淋巴結活檢中的應用價值.腫瘤學雜志, 2012, 18(8):602-604.
9.	Zetterlund L, Stemme S, Arnrup H, et al.Incidence of and risk factors for sentinel lymph node metastasis in patients with a postoperative diagnosis of ductal carcinoma in situ.Br J Surg, 2014, 101(5):488-494.
10.	Ogasawara Y, Doihara H, Shiraiwa M, et al.Multidetector-row computed tomography for the preoperative evaluation of axillary nodal status in patients with breast cancer.Surg Today, 2008, 38(2):104-108.
11.	鐘麗瑤, 周平, 李瑞珍, 等.經皮下注射超聲造影劑在乳腺癌前哨淋巴結診斷中的價值.中華超聲影像學雜志, 2007, 16(9):771-772.
12.	Hill AD, Tran KN, Akhurst T, et al.Lessons learned from 500 cases of lymphatic mapping for breast cancer.Ann Surg, 1999, 229(4):528-535.
13.	Jansen L, Doting MH, Rutgers EJ, et al.Clinical relevance of sentinel lymph nodes outside the axilla in patients with breast cancer.Br J Surg, 2000, 87(7):920-925.
14.	Lee AH, Ellis IO, Pinder SE, et al.Pathological assessment of sentinel lymph-node biopsies in patients with breast cancer.Virchows Arch, 2000, 436(2):97-101.
15.	Mansel RE, Khonji NI, Clarke D.History, present status and future of sentinel node biopsy in breast cancer.The Mary Beves Lecture.Acta Oncol, 2000, 39(3):265-268.
16.	Alconchel Gonzaga SP, Fernández Amigo N, Perozo Limones M, et al.Hypersensitivity reaction after injection of patent blue V dye in saline for sentinal node detection.Rev Esp Anestesiol Reanim, 2010, 57(9):607-609.
17.	Eshima D, Fauconnier T, Eshima L, et al.Radiopharmaceuticals for lymphoscintigraphy:including dosimetry and radiation considerations.Semin Nucl Med, 2000, 30(1):25-32.
18.	Yokota T, Saito T, Narushima Y, et al.Lymph node staining with activated carbon CH40:a new method for axillary lymph node dissection in breast cancer.Can J Surg, 2000, 43(3):191-196.
19.	孫軒, 葛潔, 曹旭晨.納米炭與美蘭在乳腺癌前哨淋巴結活檢中的應用.天津醫藥, 2013, 41(8):828-829.
20.	Buchholz TA, Strom EA, McNeese MD, et al.Radiation therapy as an adjuvant treatment after sentinel lymph node surgery for breast cancer.Surg Clin North Am, 2003, 83(4):911-930.
21.	Kim T, Giuliano AE, Lyman GH.Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma:a meta analysis.Cancer, 2006, 106(1):4-16.
22.	鄭剛, 楊靖, 左文述, 等.中國乳腺癌前哨淋巴結活檢驗證階段研究結果的系統評價.中華醫學雜志, 2011, 91(6):361-365.
23.	王永勝.乳腺癌前哨淋巴結活檢:共識與展望.中國普外基礎與臨床雜志, 2009, 16(7):505-509.
24.	Terrier C, Tariel O, Coutant C, et al.Comparison of three models to predict non-sentinel lymph node status in breast cancer patients with metastatic sentinel lymph nodes:a retrospective study of 77 patients.J Gynecol Obstet Biol Reprod (Paris), 2012, 41(3):227-234.
25.	Krag D, Weaver D, Ashikaga T, et al.The sentinel node in breast cancer-a multicenter validation study.N Engl J Med, 1998, 339(14):941-946.
26.	Ricci P, Cantisani V, Ballesio L, et al.Benign and malignant breast lesions:efficacy of real time contrast?enhanced ultrasound vs.magnetic resonance imaging.Ultraschall Med, 2007, 28(1):57-62.
27.	Jung EM, Jungius KP, Rupp N, et al.Contrast enhanced harmonic ultrasound for differentiating breast tumors-first results.Clin Hemorheol Microcirc, 2005, 33(2):109-120.

1. Demartini WB, Eby PR, Peacock S, et al.Utility of targeted sonography for breast lesions that were suspicious on MRI.AJR Am J Roentgenol, 2009, 192(4):1128-1134.
2. 李學茹, 王文, 楊銀學, 等.超聲造影實時動態觀察豬結腸前哨淋巴結.中國醫學影像技術, 2012, 28(4):1945-1948.
3. Goldberg BB, Merton DA, Liu JB, et al.Sentinel lymph nodes in a swine model with melanoma:contrast-enhanced lymphatic US.Radiology, 2004, 230(3):727-734.
4. 尤厚成, 劉健, 尤楠.超聲造影對乳腺良惡性腫塊鑒別診斷的價值.中國普外基礎與臨床雜志, 2011, 18(8):861-865.
5. 嚴婷, 王文, 李海.超聲造影在結直腸癌術中前哨淋巴結顯像中的應用研究.中華超聲影像雜志, 2013, 11(22):962-964.
6. Low KS, Littlejohn DR.Optimal number of sentinel nodes after intradermal injection isotope and blue dye.ANZ J Surg, 2006, 76(6):472-475.
7. 李太玉, 孫曉, 王永勝, 等.單用藍染料示蹤劑在乳腺癌前哨淋巴結活檢中的價值.中國普外基礎與臨床雜志, 2010, 17(12):1235-1239.
8. 盧振鐸, 劉真真, 楊輝, 等.核素標記法聯合亞甲藍在早期乳腺癌前哨淋巴結活檢中的應用價值.腫瘤學雜志, 2012, 18(8):602-604.
9. Zetterlund L, Stemme S, Arnrup H, et al.Incidence of and risk factors for sentinel lymph node metastasis in patients with a postoperative diagnosis of ductal carcinoma in situ.Br J Surg, 2014, 101(5):488-494.
10. Ogasawara Y, Doihara H, Shiraiwa M, et al.Multidetector-row computed tomography for the preoperative evaluation of axillary nodal status in patients with breast cancer.Surg Today, 2008, 38(2):104-108.
11. 鐘麗瑤, 周平, 李瑞珍, 等.經皮下注射超聲造影劑在乳腺癌前哨淋巴結診斷中的價值.中華超聲影像學雜志, 2007, 16(9):771-772.
12. Hill AD, Tran KN, Akhurst T, et al.Lessons learned from 500 cases of lymphatic mapping for breast cancer.Ann Surg, 1999, 229(4):528-535.
13. Jansen L, Doting MH, Rutgers EJ, et al.Clinical relevance of sentinel lymph nodes outside the axilla in patients with breast cancer.Br J Surg, 2000, 87(7):920-925.
14. Lee AH, Ellis IO, Pinder SE, et al.Pathological assessment of sentinel lymph-node biopsies in patients with breast cancer.Virchows Arch, 2000, 436(2):97-101.
15. Mansel RE, Khonji NI, Clarke D.History, present status and future of sentinel node biopsy in breast cancer.The Mary Beves Lecture.Acta Oncol, 2000, 39(3):265-268.
16. Alconchel Gonzaga SP, Fernández Amigo N, Perozo Limones M, et al.Hypersensitivity reaction after injection of patent blue V dye in saline for sentinal node detection.Rev Esp Anestesiol Reanim, 2010, 57(9):607-609.
17. Eshima D, Fauconnier T, Eshima L, et al.Radiopharmaceuticals for lymphoscintigraphy:including dosimetry and radiation considerations.Semin Nucl Med, 2000, 30(1):25-32.
18. Yokota T, Saito T, Narushima Y, et al.Lymph node staining with activated carbon CH40:a new method for axillary lymph node dissection in breast cancer.Can J Surg, 2000, 43(3):191-196.
19. 孫軒, 葛潔, 曹旭晨.納米炭與美蘭在乳腺癌前哨淋巴結活檢中的應用.天津醫藥, 2013, 41(8):828-829.
20. Buchholz TA, Strom EA, McNeese MD, et al.Radiation therapy as an adjuvant treatment after sentinel lymph node surgery for breast cancer.Surg Clin North Am, 2003, 83(4):911-930.
21. Kim T, Giuliano AE, Lyman GH.Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma:a meta analysis.Cancer, 2006, 106(1):4-16.
22. 鄭剛, 楊靖, 左文述, 等.中國乳腺癌前哨淋巴結活檢驗證階段研究結果的系統評價.中華醫學雜志, 2011, 91(6):361-365.
23. 王永勝.乳腺癌前哨淋巴結活檢:共識與展望.中國普外基礎與臨床雜志, 2009, 16(7):505-509.
24. Terrier C, Tariel O, Coutant C, et al.Comparison of three models to predict non-sentinel lymph node status in breast cancer patients with metastatic sentinel lymph nodes:a retrospective study of 77 patients.J Gynecol Obstet Biol Reprod (Paris), 2012, 41(3):227-234.
25. Krag D, Weaver D, Ashikaga T, et al.The sentinel node in breast cancer-a multicenter validation study.N Engl J Med, 1998, 339(14):941-946.
26. Ricci P, Cantisani V, Ballesio L, et al.Benign and malignant breast lesions:efficacy of real time contrast?enhanced ultrasound vs.magnetic resonance imaging.Ultraschall Med, 2007, 28(1):57-62.
27. Jung EM, Jungius KP, Rupp N, et al.Contrast enhanced harmonic ultrasound for differentiating breast tumors-first results.Clin Hemorheol Microcirc, 2005, 33(2):109-120.

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Application of Contrast Enhanced Ultrasound in Sentinel Lymph Node Biopsy of Breast Cancer

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