Value of contrast<b>-</b>enhanced ultrasound in evaluating axillary and internal mammary lymph node metastasis of breast cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHEN Yan , SHI Yihan , XING Lei ,  YANG Guanglun

Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P. R. China;

Corresponding author：

YANG Guanglun, Email: guanglunyang@ 163.com

Keywords：

contrast-enhanced ultrasonography; axillary lymph node; internal mammary lymph node; diagnostic value

DOI：

10.7507/1007-9424.202210003

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the diagnostic value of contrast-enhanced ultrasonography (CEUS) in axillary and internal mammary lymph node metastasis of invasive breast cancer. Methods A total of 100 patients with invasive breast cancer treated from September 2020 to September 2022 were selected. Preoperative CEUS examination was completed, and the perfusion sequence, enhancement mode and enhancement sequence of lymph nodes were dynamically observed. The CEUS characteristics of metastatic and benign lymph nodes were compared. Using postoperative pathological results as the gold standard, the diagnostic efficacy of CEUS in evaluating lymph node status was analyzed. Results Among the 100 patients, 28 patients were diagnosed with metastatic axillary lymph nodes (ALN) by pathological biopsy. The sensitivity, specificity, accuracy, positive prediction rate and negative prediction rate of CEUS in evaluating ALN status were 71.4%, 87.5%, 83.0%, 69.0% and 88.7%, respectively. In 9 patients, CEUS showed internal mammary lymph node metastasis, and postoperative pathological examination confirmed that 5 patients had internal mammary lymph node metastasis, so the positive predictive rate of CEUS was 55.6%. Conclusion CEUS can evaluate the metastatic status of axillary and internal mammary lymph nodes.

Citation： CHEN Yan, SHI Yihan, XING Lei, YANG Guanglun. Value of contrast-enhanced ultrasound in evaluating axillary and internal mammary lymph node metastasis of breast cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(3): 333-337. doi: 10.7507/1007-9424.202210003 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	Manca G, Rubello D, Tardelli E, et al. Sentinel lymph node biopsy in breast cancer: indications, contraindications, and controversies. Clin Nucl Med, 2016, 41(2): 126-133.
3.	Alex JC, Krag DN. Gamma-probe guided localization of lymph nodes. Surg Oncol, 1993, 2(3): 137-143.
4.	Lyman GH, Giuliano AE, Somerfield MR, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol, 2005, 23(30): 7703-7720.
5.	Motomura K. Sentinel node biopsy for breast cancer: past, present, and future. Breast Cancer, 2015, 22(3): 212-220.
6.	Li Z, Gu X, Tong J, et al. A meta-analysis of internal mammary lymph node metastasis in breast cancer patients. Onkologie, 2013, 36(12): 747-752.
7.	Carcoforo P, Sortini D, Feggi L, et al. Clinical and therapeutic importance of sentinel node biopsy of the internal mammary chain in patients with breast cancer: a single-center study with long-term follow-up. Ann Surg Oncol, 2006, 13(10): 1338-1343.
8.	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.
9.	Omoto K, Hozumi Y, Omoto Y, et al. Sentinel node detection in breast cancer using contrast-enhanced sonography with 25% albumin—Initial clinical experience. J Clin Ultrasound, 2006, 34(7): 317-326.
10.	Zhao J, Zhang J, Zhu QL, et al. The value of contrast-enhanced ultrasound for sentinel lymph node identification and characterisation in pre-operative breast cancer patients: A prospective study. Eur Radiol, 2018, 28(4): 1654-1661.
11.	Jin L, Wang R, Zhuang L, et al. Evaluation of whole axillary status with lymphatic contrast-enhanced ultrasound in patients with breast cancer. Eur Radiol, 2022, 32(1): 630-638.
12.	Nielsen Moody A, Bull J, Culpan AM, et al. Preoperative sentinel lymph node identification, biopsy and localisation using contrast enhanced ultrasound (CEUS) in patients with breast cancer: a systematic review and meta-analysis. Clin Radiol, 2017, 72(11): 959-971.
13.	Xie F, Zhang D, Cheng L, et al. Intradermal microbubbles and contrast-enhanced ultrasound (CEUS) is a feasible approach for sentinel lymph node identification in early-stage breast cancer. World J Surg Oncol, 2015, 13: 319. doi: 10.1186/s12957-015-0736-x.
14.	Zhang J, Hao X, Yang Y, et al. Evaluation of supplementary diagnostic value of contrast-enhanced ultrasound for lymph node puncture biopsy. J Thorac Dis, 2017, 9(11): 4791-4797.
15.	Nwaogu IY, Yan Y, Appleton CM, et al. Predictors of false negative axillary ultrasound in breast cancer. J Surg Res, 2015, 198(2): 351-354.
16.	Reyna C, Lee MC, Frelick A, et al. Axillary burden of disease following false-negative preoperative axillary evaluation. Am J Surg, 2014, 208(4): 577-581.
17.	Yang WT, Ahuja A, Tang A, et al. High resolution sonographic detection of axillary lymph node metastases in breast cancer. J Ultrasound Med, 1996, 15(3): 241-246.
18.	Gursoy M, Sezgin G, Horoz EM, et al. Histopathological and tumor characteristics associated with false negative axillary ultrasonography results in breast cancer. Med Ultrason, 2019, 21(3): 232-238.
19.	Yang WT, Chang J, Metreweli C. Patients with breast cancer: differences in color Doppler flow and gray-scale US features of benign and malignant axillary lymph nodes. Radiology, 2000, 215(2): 568-573.
20.	Sever AR, Mills P, Jones SE, et al. Preoperative sentinel node identification with ultrasound using microbubbles in patients with breast cancer. AJR Am J Roentgenol, 2011, 196(2): 251-256.
21.	Sever AR, Mills P, Weeks J, et al. Preoperative needle biopsy of sentinel lymph nodes using intradermal microbubbles and contrast-enhanced ultrasound in patients with breast cancer. AJR Am J Roentgenol, 2012, 199(2): 465-470.
22.	Li J, Lu M, Cheng X, et al. How pre-operative sentinel lymph node contrast-enhanced ultrasound helps intra-operative sentinel lymph node biopsy in breast cancer: initial experience. Ultrasound Med Biol, 2019, 45(8): 1865-1873.
23.	Poanta L, Serban O, Pascu I, et al. The place of CEUS in distinguishing benign from malignant cervical lymph nodes: a prospective study. Med Ultrason. 2014, 16(1): 7-14.
24.	Stramare R, Scagliori E, Mannucci M, et al. The role of contrast-enhanced gray-scale ultrasonography in the differential diagnosis of superficial lymph nodes. Ultrasound Q, 2010, 26(1): 45-51.
25.	Xu H, Xu GL, Li XD, et al. Correlation between the contrast-enhanced ultrasound image features and axillary lymph node metastasis of primary breast cancer and its diagnostic value. Clin Transl Oncol, 2021, 23(1): 155-163.
26.	Ye F, Gong Y, Tang K, et al. Contrast-enhanced ultrasound characteristics of preoperative central cervical lymph node metastasis in papillary thyroid carcinoma. Front Endocrinol (Lausanne), 2022, 13: 941905. doi: 10.3389/fendo.2022.941905.
27.	Zhuang L, Ming X, Liu J, et al. Comparison of lymphatic contrast-enhanced ultrasound and intravenous contrast-enhanced ultrasound in the preoperative diagnosis of axillary sentinel lymph node metastasis in patients with breast cancer. Br J Radiol, 2022, 95(1130): 20210897. doi: 10.1259/bjr.20210897.
28.	Matsuzawa F, Omoto K, Einama T, et al. Accurate evaluation of axillary sentinel lymph node metastasis using contrast-enhanced ultrasonography with Sonazoid in breast cancer: a preliminary clinical trial. Springerplus, 2015, 4: 509. doi: 10.1186/s40064-015-1291-1.
29.	Wang Y, Zhou W, Li C, et al. Variation of sentinel lymphatic channels (SLCs) and sentinel lymph nodes (SLNs) assessed by contrast-enhanced ultrasound (CEUS) in breast cancer patients. World J Surg Oncol, 2017, 15(1): 127. doi: 10.1186/s12957-017-1195-3.
30.	Cox K, Taylor-Phillips S, Sharma N, et al. Enhanced pre-operative axillary staging using intradermal microbubbles and contrast-enhanced ultrasound to detect and biopsy sentinel lymph nodes in breast cancer: a potential replacement for axillary surgery. Br J Radiol, 2018, 91(1082): 20170626. doi: 10.1259/bjr.20170626.
31.	Cong BB, Cao XS, Cao L, et al. Internal mammary lymph nodes radiotherapy of breast cancer in the era of individualized medicine. Oncotarget, 2017, 8(46): 81583-81590.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Manca G, Rubello D, Tardelli E, et al. Sentinel lymph node biopsy in breast cancer: indications, contraindications, and controversies. Clin Nucl Med, 2016, 41(2): 126-133.
3. Alex JC, Krag DN. Gamma-probe guided localization of lymph nodes. Surg Oncol, 1993, 2(3): 137-143.
4. Lyman GH, Giuliano AE, Somerfield MR, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol, 2005, 23(30): 7703-7720.
5. Motomura K. Sentinel node biopsy for breast cancer: past, present, and future. Breast Cancer, 2015, 22(3): 212-220.
6. Li Z, Gu X, Tong J, et al. A meta-analysis of internal mammary lymph node metastasis in breast cancer patients. Onkologie, 2013, 36(12): 747-752.
7. Carcoforo P, Sortini D, Feggi L, et al. Clinical and therapeutic importance of sentinel node biopsy of the internal mammary chain in patients with breast cancer: a single-center study with long-term follow-up. Ann Surg Oncol, 2006, 13(10): 1338-1343.
8. 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.
9. Omoto K, Hozumi Y, Omoto Y, et al. Sentinel node detection in breast cancer using contrast-enhanced sonography with 25% albumin—Initial clinical experience. J Clin Ultrasound, 2006, 34(7): 317-326.
10. Zhao J, Zhang J, Zhu QL, et al. The value of contrast-enhanced ultrasound for sentinel lymph node identification and characterisation in pre-operative breast cancer patients: A prospective study. Eur Radiol, 2018, 28(4): 1654-1661.
11. Jin L, Wang R, Zhuang L, et al. Evaluation of whole axillary status with lymphatic contrast-enhanced ultrasound in patients with breast cancer. Eur Radiol, 2022, 32(1): 630-638.
12. Nielsen Moody A, Bull J, Culpan AM, et al. Preoperative sentinel lymph node identification, biopsy and localisation using contrast enhanced ultrasound (CEUS) in patients with breast cancer: a systematic review and meta-analysis. Clin Radiol, 2017, 72(11): 959-971.
13. Xie F, Zhang D, Cheng L, et al. Intradermal microbubbles and contrast-enhanced ultrasound (CEUS) is a feasible approach for sentinel lymph node identification in early-stage breast cancer. World J Surg Oncol, 2015, 13: 319. doi: 10.1186/s12957-015-0736-x.
14. Zhang J, Hao X, Yang Y, et al. Evaluation of supplementary diagnostic value of contrast-enhanced ultrasound for lymph node puncture biopsy. J Thorac Dis, 2017, 9(11): 4791-4797.
15. Nwaogu IY, Yan Y, Appleton CM, et al. Predictors of false negative axillary ultrasound in breast cancer. J Surg Res, 2015, 198(2): 351-354.
16. Reyna C, Lee MC, Frelick A, et al. Axillary burden of disease following false-negative preoperative axillary evaluation. Am J Surg, 2014, 208(4): 577-581.
17. Yang WT, Ahuja A, Tang A, et al. High resolution sonographic detection of axillary lymph node metastases in breast cancer. J Ultrasound Med, 1996, 15(3): 241-246.
18. Gursoy M, Sezgin G, Horoz EM, et al. Histopathological and tumor characteristics associated with false negative axillary ultrasonography results in breast cancer. Med Ultrason, 2019, 21(3): 232-238.
19. Yang WT, Chang J, Metreweli C. Patients with breast cancer: differences in color Doppler flow and gray-scale US features of benign and malignant axillary lymph nodes. Radiology, 2000, 215(2): 568-573.
20. Sever AR, Mills P, Jones SE, et al. Preoperative sentinel node identification with ultrasound using microbubbles in patients with breast cancer. AJR Am J Roentgenol, 2011, 196(2): 251-256.
21. Sever AR, Mills P, Weeks J, et al. Preoperative needle biopsy of sentinel lymph nodes using intradermal microbubbles and contrast-enhanced ultrasound in patients with breast cancer. AJR Am J Roentgenol, 2012, 199(2): 465-470.
22. Li J, Lu M, Cheng X, et al. How pre-operative sentinel lymph node contrast-enhanced ultrasound helps intra-operative sentinel lymph node biopsy in breast cancer: initial experience. Ultrasound Med Biol, 2019, 45(8): 1865-1873.
23. Poanta L, Serban O, Pascu I, et al. The place of CEUS in distinguishing benign from malignant cervical lymph nodes: a prospective study. Med Ultrason. 2014, 16(1): 7-14.
24. Stramare R, Scagliori E, Mannucci M, et al. The role of contrast-enhanced gray-scale ultrasonography in the differential diagnosis of superficial lymph nodes. Ultrasound Q, 2010, 26(1): 45-51.
25. Xu H, Xu GL, Li XD, et al. Correlation between the contrast-enhanced ultrasound image features and axillary lymph node metastasis of primary breast cancer and its diagnostic value. Clin Transl Oncol, 2021, 23(1): 155-163.
26. Ye F, Gong Y, Tang K, et al. Contrast-enhanced ultrasound characteristics of preoperative central cervical lymph node metastasis in papillary thyroid carcinoma. Front Endocrinol (Lausanne), 2022, 13: 941905. doi: 10.3389/fendo.2022.941905.
27. Zhuang L, Ming X, Liu J, et al. Comparison of lymphatic contrast-enhanced ultrasound and intravenous contrast-enhanced ultrasound in the preoperative diagnosis of axillary sentinel lymph node metastasis in patients with breast cancer. Br J Radiol, 2022, 95(1130): 20210897. doi: 10.1259/bjr.20210897.
28. Matsuzawa F, Omoto K, Einama T, et al. Accurate evaluation of axillary sentinel lymph node metastasis using contrast-enhanced ultrasonography with Sonazoid in breast cancer: a preliminary clinical trial. Springerplus, 2015, 4: 509. doi: 10.1186/s40064-015-1291-1.
29. Wang Y, Zhou W, Li C, et al. Variation of sentinel lymphatic channels (SLCs) and sentinel lymph nodes (SLNs) assessed by contrast-enhanced ultrasound (CEUS) in breast cancer patients. World J Surg Oncol, 2017, 15(1): 127. doi: 10.1186/s12957-017-1195-3.
30. Cox K, Taylor-Phillips S, Sharma N, et al. Enhanced pre-operative axillary staging using intradermal microbubbles and contrast-enhanced ultrasound to detect and biopsy sentinel lymph nodes in breast cancer: a potential replacement for axillary surgery. Br J Radiol, 2018, 91(1082): 20170626. doi: 10.1259/bjr.20170626.
31. Cong BB, Cao XS, Cao L, et al. Internal mammary lymph nodes radiotherapy of breast cancer in the era of individualized medicine. Oncotarget, 2017, 8(46): 81583-81590.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Value of contrast-enhanced ultrasound in evaluating axillary and internal mammary lymph node metastasis of breast cancer

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content