The Value Of Contrast-enhanced Ultrasound For Sentinel Lymph Node In Pre-operative Breast Cancer Patients

ObjectiveTo explore the feasibility of sentinel lymph node(SLN)identification by contrast-enhanced ultrasound(CEUS)in pre-operative breast cancer patients and the value of enhancement patterns for diagnosing lymph node metastases.Methods110 consecutive consenting breast cancer patients were enrolled.Before the surgery,intradermal injection of the ultrasound contrast agent was performed.The lymphatic drainage pathway was detected using CEUS to identify the SLNs,which were localized on the skin surface.During the operation,blue dye and indocyanine green(ICG)fluorescence were used to trace SLNs.The enhancement patterns of SLNs were recorded and then compared with the pathological diagnosis.ResultsA total 134 SLNs were detected in 106 patients,and the SLNs were assessed correctly by CEUS in 96.4%of patients.Fifty-one SLNs presented as type ?(homogeneous enhancement),which were all non-metastatic lymph nodes;76 SLNs presented as type ?(heterogeneous enhancement),of which 29 SLNs were metastatic;7 SLNs presented as type ?(no enhancement),which were all metastatic.The sensitivity,specificity,positive predictive value,negative predictive value and overall accuracy of predicting SLN metastases by the CEUS enhancement pattern(type ? and ?)were 100%,52.0%,43.4%,100%and 64.9%,respectively.ConclusionsCEUS is a feasible approach for SLN identification.The enhancement patterns on CEUS may be helpful in recognizing metastasizing SLNs.Type ? SLNs showed the highest negative predictive value;type ? nodes showed the highest positive predictive value.This novel method may be a promising technique for localization and characterization of SLNs in preoperative breast cancer.ObjectiveTo explore the diagnostic value of contrast-enhanced ultrasound(CEUS)-sentinel procedure followed by fine needle biopsy(FNA)in pre-operative breast cancer patients.Methods63 consecutive consenting breast cancer patients were enrolled.Before the surgery,intradermal microbubble injection was performed.When an enhancing axillary lymph node was visualized,US-guided FNA was performed.Enhancing patterns of SLN(s)and biopsy results were recorded,and then compared with the pathological diagnosis.ResultsOf the 63 cases,73 SLNs in 60 patients were successfully identified by CEUS.25 SLNs presented as type ?(homogeneous enhancement)were all negative,while 23 SLNs FNA negative,2 SLNs FNA suspicious;42 SLNs presented as type ?(heterogeneous enhancement),15 SLNs were positive,both FNA and surgical pathology,27 SLNs FNA negative,which 6 SLNs were positive;6 SLNs presented as type ?(no enhancement)were all positive.The sensitivity of predicting SLNs metastases by CEUS combined with FNA was 71.4%,specificity 100%,PPV 100%,NPV 89.7%and overall accuracy 91.8%.ConclusionsCEUS-guided axillary FNA proved to be a feasible and accurate procedure to recognize the metastatic SLNs.Type ? has high negative predictive value;Type ? has high positive predictive value;Type ? has high degree of overlap of benign and malignant SLNs,which can't predictive SLNs status accurately,but CEUS combine FNA can improve the accuracy.This novel method may be a promising technique for the clinical application.