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.

“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.”


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