SENTINEL NODE DETECTION METHOD USING CONTRAST-ENHANCED ULTRASONOGRAPHY WITH SONAZOID IN BREAST CANCER: PRELIMINARY CLINICAL STUDY
SENTINEL NODE DETECTION METHOD USING CONTRAST-ENHANCED ULTRASONOGRAPHY WITH SONAZOID IN BREAST CANCER: PRELIMINARY CLINICAL STUDY
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DOI：
10.1016/j.ultrasmedbio.2009.02.004
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发表时间：
2009-08-01
影响因子：
2.9
通讯作者：
Kawano, Mikihiko
中科院分区：
文献类型：
--
作者：
Omoto, Kiyoka;Matsunaga, Hiroaki;Kawano, Mikihiko
本研究旨在评价乳晕下注射超声造影(CEUS)检测乳腺癌前哨淋巴结(SLN)的价值。研究对象为20例乳腺癌患者。诱导全身麻醉，乳晕下注射索那唑2mL。注射部位按摩后，用编码反相谐波超声对腋窝区域进行经皮观察，力学指数为0.15~0.19。对比剂增强的淋巴结(LN)被定义为CE-SLN。另外两种SLN检测方法--伽马探头引导和染料引导方法--一起进行。我们对每种方法检测的SLN进行评估，以确定它们是否相互对应，并计算SLN的发现率。切除SLN后，行病理检查。超声造影引导法、染料引导法和伽马探头引导法对SLN的检出率分别为70%、75%和100%。CEUS导引和染料导引的成功率差异无统计学意义(p=0.99)，但CEUS导引的成功率明显低于伽玛探头导引的方法(p=0.020)，染料导引的方法也显著低于探头导引的方法(p=0.047)。CE-SLN数目为1个或2个(平均1.1个)，每个数目需要2~20分钟(平均5.3分钟)。CE-SLN与伽马探针法和染料引导法检测的SLN基本一致。病理结果显示，20例中15例切除的SLN无转移。然而，CEUS引导的方法发现了这15例中的12例，在其余5例转移病例中有2例检测到CE-SLN。综上所述，在乳腺癌患者中，在乳晕下注射索那唑后，超声实时观察到增强后的淋巴结。在20例的初步临床研究中，CEUS引导的方法的检出率低于伽玛探头引导的方法。提示在CEUS引导下使用Sonazid的方法可能是一种有用的识别前哨节点的新方法，但有一些改进。(电子邮件：kiyoka@jichi.ac.jp)(C)2009年世界医学和生物学超声联合会。
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 gamma-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 gamma-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 gamma-probe-guided method (p = 0.020), and dye-guided method also showed a significantly lower rate than they-probe-guided method (p = 0.047). The number of CE-SLNs was I 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 gamma-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 gamma-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) (C) 2009 World Federation for Ultrasound in Medicine & Biology.