Accurate evaluation of axillary sentinel lymph node metastasis using contrast-enhanced ultrasonography with Sonazoid in breast cancer: a preliminary clinical trial

Fumihiko Matsuzawa,Kiyoka Omoto,Takashi Suzuki,Terumi Kaga,Hironori Abe,Takahiro Einama,Masako Oomura,Akinobu Taketomi,Kenichi Kyuno,Etsuya Tamura,Jun Hamaguchi,Chie Takeda,Mami Sato,Yumiko Takata,Ayako Fujibe

doi:10.1186/s40064-015-1291-1

Abstract

Breast cancer is the most common type of cancer in women. The 5-year survival rate in patients with breast cancer ranges from 74 to 82 %. Sentinel lymph node biopsy has become an alternative to axillary lymph node dissection for nodal staging. We evaluated the detection of the sentinel lymph node and metastasis of the lymph node using contrast enhanced ultrasonography with Sonazoid. Between December 2013 and May 2014, 32 patients with operable breast cancer were enrolled in this study. We evaluated the detection of axillary sentinel lymph nodes and the evaluation of axillary lymph nodes metastasis using contrast enhanced computed tomography, color Doppler ultrasonography and contrast enhanced ultrasonography with Sonazoid. All the sentinel lymph nodes were identified, and the sentinel lymph nodes detected by contrast enhanced ultrasonography with Sonazoid corresponded with those detected by computed tomography lymphography and indigo carmine method. The detection of metastasis based on contrast enhanced computed tomography were sensitivity 20.0 %, specificity 88.2 %, PPV 60.0 %, NPV 55.6 %, accuracy 56.3 %. Based on color Doppler ultrasonography, the results were sensitivity 36.4 %, specificity 95.2 %, PPV 80.0 %, NPV 74.1 %, accuracy 75.0 %. Based on contrast enhanced ultrasonography with Sonazoid, the results were sensitivity 81.8 %, specificity 95.2 %, PPV 90.0 %, NPV 90.9 %, accuracy 90.6 %. The results suggested that contrast enhanced ultrasonography with Sonazoid was the most accurate among the evaluations of these modalities. In the future, we believe that our method would take the place of conventional sentinel lymph node biopsy for an axillary staging method.

Highlights

For nodal staging of breast cancer, sentinel lymph node biopsy (SLNB) has become an alternative to axillary lymph node dissection (ALND) (Lyman et al 2005; McCready et al 2005)
We evaluated the usefulness of SLNs detection using contrast enhanced ultrasonography (CEUS) with Sonazoid injected subareolarly and the presence of metastasis of SLNs using CEUS by intravenous injection of Sonazoid in breast cancer patients
Identification of SLN using CEUS with Sonazoid administering subareolarly All the SLNs were identified by using CEUS with Sonazoid administering subareolarly, and these SLNs corresponded with the SLNs detected by CT lymphography and indigo carmine method

Summary

Introduction

For nodal staging of breast cancer, sentinel lymph node biopsy (SLNB) has become an alternative to axillary lymph node dissection (ALND) (Lyman et al 2005; McCready et al 2005). SLNB for breast cancer is usually undertaken using dye and/or radioisotope labeling. These methods have the problem, for example, high costs, requirement of a high skill (Yamamoto et al 2015). A new method of SLN detection using contrast enhanced ultrasonography (CEUS) with Sonazoid was reported. The advantages of this method are this CEUS with Sonazoid method requires only a ultrasonography (US) apparatus and a contrast agent readily available on market and does not need radioactive materials (Omoto et al 2009)

Methods

Results

Discussion

Conclusion