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

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 adve...

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Autores: Buonomo, Oreste Claudio, Materazzo, Marco, Pellicciaro, Marco, Iafrate, Giada, Ielpo, Benedetto, Rizza, Stefano, Pistolese, Chiara Adriana, Perretta, Tommaso, Meucci, Rosaria, Longo, Benedetto, Cervelli, Valerio, Vanni, Gianluca
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2023
País:España
Institución:Universitat Pompeu Fabra
Repositorio:Repositorio Digital de la UPF
OAI Identifier:oai:repositori.upf.edu:10230/60223
Acceso en línea:http://hdl.handle.net/10230/60223
http://dx.doi.org/10.21873/anticanres.16192
Access Level:acceso abierto
Palabra clave:Sentinel lymph node
Axillary imaging
Breast neoplasm
Contrast-enhanced ultrasound
Lymphoscintigraphy
Mammary
Sentinel lymph node biopsy
Ultrasonography
Ultrasound
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spelling Contrast-enhanced ultrasound using intradermal microbubble sulfur hexafluoride for identification of sentinel lymph nodes during breast cancer surgery: a clinical trialBuonomo, Oreste ClaudioMaterazzo, MarcoPellicciaro, MarcoIafrate, GiadaIelpo, BenedettoRizza, StefanoPistolese, Chiara AdrianaPerretta, TommasoMeucci, RosariaLongo, BenedettoCervelli, ValerioVanni, GianlucaSentinel lymph nodeAxillary imagingBreast neoplasmContrast-enhanced ultrasoundLymphoscintigraphyMammarySentinel lymph node biopsyUltrasonographyUltrasoundBackground/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.International Institute of Anticancer Research (IIAR)202420242023info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttp://hdl.handle.net/10230/60223http://dx.doi.org/10.21873/anticanres.16192reponame:Repositorio Digital de la UPFinstname:Universitat Pompeu FabraInglésAnticancer Res. 2023 Feb;43(2):557-67This 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).http://creativecommons.org/licenses/by-nc-nd/4.0info:eu-repo/semantics/openAccessoai:repositori.upf.edu:10230/602232026-06-12T07:21:37Z
dc.title.none.fl_str_mv Contrast-enhanced ultrasound using intradermal microbubble sulfur hexafluoride for identification of sentinel lymph nodes during breast cancer surgery: a clinical trial
title Contrast-enhanced ultrasound using intradermal microbubble sulfur hexafluoride for identification of sentinel lymph nodes during breast cancer surgery: a clinical trial
spellingShingle Contrast-enhanced ultrasound using intradermal microbubble sulfur hexafluoride for identification of sentinel lymph nodes during breast cancer surgery: a clinical trial
Buonomo, Oreste Claudio
Sentinel lymph node
Axillary imaging
Breast neoplasm
Contrast-enhanced ultrasound
Lymphoscintigraphy
Mammary
Sentinel lymph node biopsy
Ultrasonography
Ultrasound
title_short Contrast-enhanced ultrasound using intradermal microbubble sulfur hexafluoride for identification of sentinel lymph nodes during breast cancer surgery: a clinical trial
title_full Contrast-enhanced ultrasound using intradermal microbubble sulfur hexafluoride for identification of sentinel lymph nodes during breast cancer surgery: a clinical trial
title_fullStr Contrast-enhanced ultrasound using intradermal microbubble sulfur hexafluoride for identification of sentinel lymph nodes during breast cancer surgery: a clinical trial
title_full_unstemmed Contrast-enhanced ultrasound using intradermal microbubble sulfur hexafluoride for identification of sentinel lymph nodes during breast cancer surgery: a clinical trial
title_sort Contrast-enhanced ultrasound using intradermal microbubble sulfur hexafluoride for identification of sentinel lymph nodes during breast cancer surgery: a clinical trial
dc.creator.none.fl_str_mv Buonomo, Oreste Claudio
Materazzo, Marco
Pellicciaro, Marco
Iafrate, Giada
Ielpo, Benedetto
Rizza, Stefano
Pistolese, Chiara Adriana
Perretta, Tommaso
Meucci, Rosaria
Longo, Benedetto
Cervelli, Valerio
Vanni, Gianluca
author Buonomo, Oreste Claudio
author_facet Buonomo, Oreste Claudio
Materazzo, Marco
Pellicciaro, Marco
Iafrate, Giada
Ielpo, Benedetto
Rizza, Stefano
Pistolese, Chiara Adriana
Perretta, Tommaso
Meucci, Rosaria
Longo, Benedetto
Cervelli, Valerio
Vanni, Gianluca
author_role author
author2 Materazzo, Marco
Pellicciaro, Marco
Iafrate, Giada
Ielpo, Benedetto
Rizza, Stefano
Pistolese, Chiara Adriana
Perretta, Tommaso
Meucci, Rosaria
Longo, Benedetto
Cervelli, Valerio
Vanni, Gianluca
author2_role author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Sentinel lymph node
Axillary imaging
Breast neoplasm
Contrast-enhanced ultrasound
Lymphoscintigraphy
Mammary
Sentinel lymph node biopsy
Ultrasonography
Ultrasound
topic Sentinel lymph node
Axillary imaging
Breast neoplasm
Contrast-enhanced ultrasound
Lymphoscintigraphy
Mammary
Sentinel lymph node biopsy
Ultrasonography
Ultrasound
description 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.
publishDate 2023
dc.date.none.fl_str_mv 2023
2024
2024
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10230/60223
http://dx.doi.org/10.21873/anticanres.16192
url http://hdl.handle.net/10230/60223
http://dx.doi.org/10.21873/anticanres.16192
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Anticancer Res. 2023 Feb;43(2):557-67
dc.rights.none.fl_str_mv http://creativecommons.org/licenses/by-nc-nd/4.0
info:eu-repo/semantics/openAccess
rights_invalid_str_mv http://creativecommons.org/licenses/by-nc-nd/4.0
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv International Institute of Anticancer Research (IIAR)
publisher.none.fl_str_mv International Institute of Anticancer Research (IIAR)
dc.source.none.fl_str_mv reponame:Repositorio Digital de la UPF
instname:Universitat Pompeu Fabra
instname_str Universitat Pompeu Fabra
reponame_str Repositorio Digital de la UPF
collection Repositorio Digital de la UPF
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15.811543

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