The use of contrast-enhanced sonography after a periareolar injection of microbubbles can help identify and localize sentinel lymph nodes in women with breast cancer before they undergo biopsy, possibly eliminating the need for a second surgery.

Lymphatic imaging after peritumoral microbubble injection has been explored in animal models, but in a newly reported study, UK investigators used the technique in 80 consecutive women with breast cancer (AJR Am J Roentgenol. 2011;196:251-256). The patients received the intradermal injection of microbubble contrast agent at the areola. Sonography was used to identify the sentinel lymph node, which was then localized with a guidewire. The following day, the women underwent standard tumor excision and biopsy of the sentinel lymph node.

Sentinel lymph nodes were accurately identified and guidewires inserted in 89% of the patients (71 of 80). In the 14 women who were found to have metastases in these nodes, the nodes were correctly identified and localized before surgery.

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“As many as 35% of patients who undergo sentinel lymph node excision will require additional surgery because cancer has spread,” commented Dr. Ali Sever, lead researcher, in a statement describing the study findings. “Using microbubble contrast-enhanced ultrasound preoperatively means that the cancer and cancer spread can be removed during one operation.”