Sentinel Node Detection Method Using Contrast-Enhanced Ultrasonography with Sonazoid in Breast Cancer: Preliminary Clinical Study

Omoto, Kiyoka; Matsunaga, Hiroaki; Take, Natsuki; Hozumi, Yasuo; Takehara, Megumi; Omoto, Yawara; Shiozawa, Mikio; Mizunuma, Hirobumi; Harashima, Hiroki; Taniguchi, Nobuyuki; Kawano, Mikihiko

doi:10.1016/j.ultrasmedbio.2009.02.004

« Previous Next »Ultrasound in Medicine and Biology
Volume 35, Issue 8 , Pages 1249-1256, August 2009

Sentinel Node Detection Method Using Contrast-Enhanced Ultrasonography with Sonazoid in Breast Cancer: Preliminary Clinical Study

Kiyoka Omoto
- Department of Laboratory Medicine, Diagnostic Ultrasound Division, Saitama Medical Center, Jichi Medical University, Saitama, Japan
- Department of Clinical Laboratory Medicine, Jichi Medical University, Tochigi, Japan
- Address correspondence to: Author: Kiyoka Omoto, M.D., Ph.D., 1st Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Amanuma-cho 1-847, Omiya-ku, Saitama-shi, Saitama-ken 330-8503, Japan.
Hiroaki Matsunaga
- Department of Clinical Laboratory Medicine, Jichi Medical University, Tochigi, Japan
Natsuki Take
- Department of Clinical Laboratory Medicine, Jichi Medical University, Tochigi, Japan
Yasuo Hozumi
- Department of Surgery, Jichi Medical University, Tochigi, Japan
Megumi Takehara
- Department of Surgery, Jichi Medical University, Tochigi, Japan
Yawara Omoto
- Department of Surgery, Jichi Medical University, Tochigi, Japan
Mikio Shiozawa
- Department of Surgery, Jichi Medical University, Tochigi, Japan
Hirobumi Mizunuma
- Department of Surgery, Jichi Medical University, Tochigi, Japan
Hiroki Harashima
- Department of Pathology, Jichi Medical University, Tochigi, Japan
Nobuyuki Taniguchi
- Department of Clinical Laboratory Medicine, Jichi Medical University, Tochigi, Japan
Mikihiko Kawano
- Department of Laboratory Medicine, Diagnostic Ultrasound Division, Saitama Medical Center, Jichi Medical University, Saitama, Japan

Received 11 June 2008; received in revised form 31 January 2009; accepted 10 February 2009. published online 11 June 2009.

Abstract

This study aimed to evaluate the usefulness of sentinel lymph node (SLN) detection in breast cancer using contrast-enhanced ultrasonography (CEUS) with subareolar Sonazoid injection. The subjects were 20 breast cancer patients. General anesthesia was induced and 2 mL of Sonazoid was injected subareolarly. After massage of the injection site, the axillary area was observed transdermally using coded phase inversion harmonic ultrasonography with mechanical indices of 0.15 to 0.19. When contrast-enhanced lymph nodes (LNs) were seen, they were defined as CE-SLN. Two other SLN detection methods, the γ-probe-guided and dye-guided methods, were performed together. We evaluated the SLNs detected by each method to determine if they corresponded with each other and calculated the SLN detection rate. After the SLNs were resected, pathologic examinations were done. The SLN detection rate of the CEUS-guided method, the dye-guided method and the γ-probe-guided method were 70%, 75% and 100%, respectively. There was no statistically significant difference in these rates between the CEUS-guided and dye-guided methods (p = 0.99) but the CEUS-guided method showed a significantly lower rate than the γ-probe-guided method (p = 0.020), and dye-guided method also showed a significantly lower rate than the γ-probe-guided method (p = 0.047). The number of CE-SLNs was 1 or 2 (average 1.1) and each took 2 to 20 (average 5.3) min to detect. The CE-SLNs corresponded grossly with SLNs detected by the γ-probe-guided and dye-guided methods. The pathologic results indicated no metastasis from the resected SLNs in 15 of 20 cases. However, the CEUS-guided method detected 12 cases of these 15 and CE-SLNs were detected in two of the remaining five metastasis cases. In summary, in breast cancer patients, after subareolar injection of Sonazoid, contrast-enhanced LNs were observed in real time with ultrasonography. In an initial clinical study of 20 cases, the detection rate of the CEUS-guided method was less than that of the γ-probe-guided method. It is suggested that the CEUS-guided method using Sonazoid may, with some improvements, be a useful new modality for sentinel node identification. (E-mail: kiyoka@jichi.ac.jp)

Key Words: Sentinel lymph node (SLN), Sentinel node detection, Ultrasound contrast agent, Sonazoid, Perfluorobutane microbubbles, Breast cancer, Contrast-enhanced ultrasonography (CEUS), CEUS-guided method