Contrast-enhanced ultrasound using intradermal microbubble sulfur hexafluoride for identification of sentinel lymph nodes during breast cancer surgery: a clinical trial

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• dc.contributor.author Buonomo, Oreste Claudio
• dc.contributor.author Materazzo, Marco
• dc.contributor.author Pellicciaro, Marco
• dc.contributor.author Iafrate, Giada
• dc.contributor.author Ielpo, Benedetto
• dc.contributor.author Rizza, Stefano
• dc.contributor.author Pistolese, Chiara Adriana
• dc.contributor.author Perretta, Tommaso
• dc.contributor.author Meucci, Rosaria
• dc.contributor.author Longo, Benedetto
• dc.contributor.author Cervelli, Valerio
• dc.contributor.author Vanni, Gianluca
• dc.date.accessioned 2024-05-23T07:13:51Z
• dc.date.available 2024-05-23T07:13:51Z
• dc.date.issued 2023
• dc.description.abstract Background/aim: Sentinel lymph node (SLN) procedures have gained popularity in early breast cancer thanks to the reduction of surgical side-effects. The standard SLN mapping procedure uses 99mTc-nanocolloid human serum albumin with/without blue dye; limitations include logistical challenges and adverse reactions. Recently, contrast-enhanced ultrasound (CEUS) using sulfur hexafluoride has emerged as a promising technique for SLN mapping. Our study aimed to compare the CEUS technique with the standard isotope method. Materials and methods: AX-CES, a prospective, monocentric, single-arm phase-3 study was designed (EudraCT: 2020-000393-20). Inclusion criteria were histologically diagnosed early breast cancer eligible for upfront surgery and SLN resection, bodyweight 40-85 kg, and no prior history of ipsilateral surgery or radiotherapy. All patients underwent CEUS prior to surgery and blue dye injection was performed in areas with contrast accumulation. After the experimental procedure, all patients underwent the standard mapping procedure and SLN frozen section assessment was performed. Data on the success rate, systemic reactions, mean procedure time, CEUS appearance, SLN number, and concordance with standard mapping procedure were collected. Results: Among 16 cases, a median of two SLNs were identified during CEUS. In all cases, at least one SLN was identified by CEUS (100%). In six cases, SLNs were classified during CEUS as abnormal, which was confirmed by definitive staining in four cases. After the standard mapping technique, in 15 out of the 16 cases (87.50%), at least one SLN from the standard mapping procedure was marked with blue dye in the CEUS procedure. In our series, sensitivity and specificity of SLN detection by CEUS were 75% and 100%, respectively. Conclusion: CEUS is a safe and manageable intraoperative procedure. When compared with standard techniques, US appearance during CEUS may provide additional information when associated with histological assessment.
• dc.format.mimetype application/pdf
• dc.identifier.citation Buonomo OC, Materazzo M, Pellicciaro M, Iafrate G, Ielpo B, Rizza S, et al. Contrast-enhanced ultrasound using intradermal microbubble sulfur hexafluoride for identification of sentinel lymph nodes during breast cancer surgery: a clinical trial. Anticancer Res. 2023 Feb;43(2):557-67. DOI: 10.21873/anticanres.16192
• dc.identifier.doi http://dx.doi.org/10.21873/anticanres.16192
• dc.identifier.issn 0250-7005
• dc.identifier.uri http://hdl.handle.net/10230/60223
• dc.language.iso eng
• dc.publisher International Institute of Anticancer Research (IIAR)
• dc.relation.ispartof Anticancer Res. 2023 Feb;43(2):557-67
• dc.rights This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY-NC-ND) 4.0 international license (http://creativecommons.org/licenses/by-nc-nd/4.0).
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/4.0
• dc.subject.keyword Sentinel lymph node
• dc.subject.keyword Axillary imaging
• dc.subject.keyword Breast neoplasm
• dc.subject.keyword Contrast-enhanced ultrasound
• dc.subject.keyword Lymphoscintigraphy
• dc.subject.keyword Mammary
• dc.subject.keyword Sentinel lymph node biopsy
• dc.subject.keyword Ultrasonography
• dc.subject.keyword Ultrasound
• dc.title Contrast-enhanced ultrasound using intradermal microbubble sulfur hexafluoride for identification of sentinel lymph nodes during breast cancer surgery: a clinical trial
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion