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The combination of contrast-enhanced ultrasonography with blue dye for sentinel lymph node detection in clinically negative node breast cancer

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

The aim of this prospective study was to evaluate the value of the combination of contrast-enhanced ultrasonography (CEUS) and blue dye (BD) for SLN detection in patients with clinically negative node breast cancer.

Methods

Patients with clinically negative node breast cancer were randomized into two cohorts for SLN biopsy (SLNB): the combination method cohort using CEUS and BD together, and the single BD method cohort. Standard axillary lymph node dissection was performed if any of the SLNs confirmed positive by pathology. The identification rate, the number of SLNs removed and recurrence-free survival (RFS) rates were evaluated between two cohorts. In addition, we assessed the sensitivity, specificity, accuracy, false-negative rate of CEUS for diagnosis of SLNs based on patterns of CEUS enhancement.

Results

144 consecutive patients with clinically negative node breast cancer were randomized into two cohorts. Each cohort consisted of 72 cases. In the combination method cohort, contrast-enhanced lymphatic vessels were clearly visualized and SLNs were accurately localized in 72 cases. The identification rate and the mean number of SLNs detected by the combination method were 100% (72/72) and 3.26 (1–9), respectively. In contrast, in the single BD method cohort, SLNs in 69 cases were successfully identified. The identification rate and the mean number of SLNs using BD alone were 95.8% (69/72) and 2.21 (1–4), respectively. According to patterns of CEUS enhancement, the sensitivity, specificity, accuracy, and the FNR of CEUS for SLN diagnosis were 69.2%, 96.6%, 91.7%, and 30.8%, respectively. After a median follow-up of 50 months for the combination method cohort and 51 months for the blue dye alone cohort, five patients in the combination method cohort and nine in the blue dye alone cohort had recurrence. RFS rates showed no significant difference (P = 0.26) between two cohorts.

Conclusion

The combination of CEUS and BD is more effective than BD alone for SLNB in clinically negative node patients with an identification rate as high as 100%. Use of BD and CEUS in combination may provide the possibility of a non-radioactive alternative method for SLNB in centers without access to radioisotope.

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Funding

This work was sponsored by the Natural Science Foundation of Fujian Province (2018J01264), Fujian provincial health technology project (2017-CXB-2), and Joint Funds for the innovation of science and Technology, Fujian province (2017Y9076, 2018Y9113), and Science and Technology Program of Fujian Province(2018Y2003), Fujian provincial health and family planning research talent training program (2016-ZQN-17). Project of Innovation and Entrepreneurship Training Program for College Students of Fujian Medical University (S201910392009). Startup Fund for scientific research, Fujian Medical University (2017XQ1212). National Natural Science Foundation of China (81802631).

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Authors and Affiliations

  1. Department of Molecular Pathology, Department of Breast Surgical Oncology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, No. 420 Fuma Road, Fuzhou, 350014, People’s Republic of China

    Xiaojiang Wang

  2. Department of Ultrasound, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, 350014, Fujian, People’s Republic of China

    Lina Tang, Weiqin Huang & Zhaoming Zhong

  3. Laboratory of Biochemistry and Molecular Biology Research, Fujian Provincial Key Laboratory of Tumor Biotherapy, Department of Clinical Laboratory, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, 350014, Fujian, People’s Republic of China

    Zhaolei Cui

  4. Department of Pathology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, 350014, Fujian, People’s Republic of China

    Dan Hu

  5. Department of Breast Surgical Oncology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, 350014, Fujian, People’s Republic of China

    Xiufeng Wu

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  1. Xiaojiang Wang
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  2. Lina Tang
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Contributions

Conceived and designed the experiments: Xiufeng Wu. Performed the experiments: Xiaojiang Wang, Lina Tang, Weiqin Huang, Zhaoming Zhong, Dan Hu, Zhaolei Cui, Xiufeng Wu. Analyzed the data: Xiufeng Wu, Xiaojiang Wang, Lina Tang. Contributed reagents/materials/analysis tools: Xiufeng Wu, Zhaolei Cui, Dan Hu, Xiaojiang Wang. Wrote the paper: Xiufeng Wu, Xiaojiang Wang.

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Correspondence to Xiufeng Wu.

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The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Ethical approval

This study was approved by Institutional Review Board of Fujian Medical University Cancer Hospital & Fujian Cancer Hospital.

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Informed consent was obtained from all individual participants included in the study.

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Wang, X., Tang, L., Huang, W. et al. The combination of contrast-enhanced ultrasonography with blue dye for sentinel lymph node detection in clinically negative node breast cancer. Arch Gynecol Obstet 304, 1551–1559 (2021). https://doi.org/10.1007/s00404-021-06021-x

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