Preoperative needle biopsy of sentinel lymph nodes using intradermal microbubbles and contrast-enhanced ultrasound in patients with breast cancer.

Abstract

OBJECTIVE:

The purpose of this study was to assess whether sentinel lymph nodes (SLNs) that undergo targeted needle biopsy after identification by contrast-enhanced ultrasound (CEUS) using intradermally injected microbubbles results in more node-positive breast cancer patients being diagnosed preoperatively. Furthermore, we sought to determine whether the addition of CEUS to gray-scale sonography of the axilla reduces the number of patients having axillary lymph node (ALN) dissection as a second procedure.

SUBJECTS AND METHODS:

Intradermal microbubble injection was performed in 136 breast cancer patients who had no abnormal ALNs on routine gray-scale axillary sonography. When an enhancing ALN was visualized, percutaneous sonography-guided fine-needle aspiration cytology or core needle biopsy was performed. Depending on the biopsy results, patients underwent SLN biopsy or ALN dissection. If the putative SLN biopsy was positive or a biopsy tract was seen in the excised SLN, the procedure was defined as successful.

RESULTS:

SLNs were identified and biopsied in 126 of the 136 cases (93%). Seventeen patients had positive sonography-guided biopsy results (13%) and were treated with immediate ALN dissection. In seven patients, the biopsied node was the only positive node. The remaining 109 patients underwent SLN biopsy. In nine cases (8%), a positive lymph node was identified. Four of these false-negative cases had only micrometastases.

CONCLUSION:

SLNs can be identified and biopsied using CEUS to increase the accuracy of preoperative axillary staging. If the needle biopsy result is negative, conventional SLN biopsy is indicated.

• Authors: Ali R Sever, Philippa Mills, Jennifer Weeks, Susan E Jones, David Fish, Peter A Jones, Willem Mali
• Journal: AJR. American journal of roentgenology (AJR Am J Roentgenol) Vol. 199 Issue 2 Pg. 465-70 (Aug 2012) ISSN: 1546-3141 [Electronic] United States
• PMID: 22826414 (Publication Type: Journal Article)

Chemical References

• Contrast Media
• Phospholipids
• contrast agent BR1
• Sulfur Hexafluoride

Topics

• Adult
• Aged
• Aged, 80 and over
• Biopsy, Needle
• Breast Neoplasms (diagnostic imaging, pathology)
• Breast Neoplasms, Male (diagnostic imaging, pathology)
• Contrast Media
• Female
• Humans
• Lymph Node Excision
• Male
• Microbubbles
• Middle Aged
• Neoplasm Staging
• Phospholipids
• Prospective Studies
• Sentinel Lymph Node Biopsy (methods)
• Sulfur Hexafluoride
• Ultrasonography, Interventional
• Ultrasonography, Mammary