Percutaneous removal of sentinel lymph nodes in a swine model using a breast lesion excision system and contrast-enhanced ultrasound
Tóm tắt
To investigate the feasibility of percutaneous removal of the entire sentinel lymph node (SLN) in an animal model using a breast lesion excision system after identifying these nodes using contrast-enhanced ultrasound (CEUS) and intradermal microbubbles. Animal studies approval was obtained. SLNs were identified using CEUS and intradermal injection of microbubbles in two young pigs. Microbubbles were mixed with blue dye and injected around the mammary papillae to access lymphatic drainage to the superficial inguinal lymph nodes. When enhancing nodes were identified, the breast lesion excision system (BLES) was used to remove these nodes percutaneously. Both animals then underwent surgical lymph node dissection. Histopathological examination of all the samples was performed. Removal of the entire SLN was successful in three groins in the pigs. All three nodes were stained with blue dye. No other stained nodes were observed in the node dissection specimens. The nodal architecture of removed lymph nodes was well preserved on microscopy. There were no signs of excess trauma within the biopsy bed. The results obtained from the swine model demonstrated that it is feasible to remove the entire SLN percutaneously under the guidance of CEUS and microbubbles. • Intradermal injection of microbubbles and CEUS can identify sentinel lymph nodes
• Ultrasound could then guide percutaneous removal of intact and complete SLNs
• We have shown this was feasible in pigs but not yet in humans
• This technique may eventually have the potential to reduce futile SLN biopsies.
Tài liệu tham khảo
Morton DL, Wen DR, Wong JH et al (1992) Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 127:392–399
Cox CE, Pendas S, Cox JM et al (1998) Guidelines for sentinel node biopsy and lymphatic mapping of patients with breast cancer. Ann Surg 227:645–651, discussion 651–653
Martin RC 2nd, Edwards MJ, Wong SL et al (2000) Practical guidelines for optimal gamma probe detection of sentinel lymph nodes in breast cancer: results of a multi-institutional study. For the University of Louisville Breast Cancer Study Group. Surgery 128:139–144
Goldberg BB, Merton DA, Liu JB et al (2004) Sentinel lymph nodes in a swine model with melanoma: contrast-enhanced lymphatic US. Radiology 230:727–734
Wang Y, Wang W, Li J, Tang J (2009) Gray-scale contrast-enhanced ultrasonography of sentinel lymph nodes in a metastatic breast cancer model. Acad Radiol 16:957–962
Sever A, Broillet A, Schneider M et al (2010) Dynamic visualization of lymphatic channels and sentinel lymph nodes using intradermal microbubbles and contrast-enhanced ultrasound in a Swine model and patients with breast cancer. J Ultrasound Med 29:1699–1704
Sever A, Jones S, Cox K, Weeks J, Mills P, Jones P (2009) Preoperative localization of sentinel lymph nodes using intradermal microbubbles and contrast-enhanced ultrasonography in patients with breast cancer. Br J Surg 96:1295–1299
Sever AR, Mills P, Jones SE et al (2011) Preoperative sentinel node identification with ultrasound using microbubbles in patients with breast cancer. AJR Am J Roentgenol 196:251–256
Oruwari JU, Chung MA, Koelliker S, Steinhoff MM, Cady B (2002) Axillary staging using ultrasound-guided fine needle aspiration biopsy in locally advanced breast cancer. Am J Surg 184:307–309
Abe H, Schmidt RA, Kulkarni K, Sennett CA, Mueller JS, Newstead GM (2009) Axillary lymph nodes suspicious for breast cancer metastasis: sampling with US-guided 14-gauge core-needle biopsy–clinical experience in 100 patients. Radiology 250:41–49
Mills P, Sever A, Weeks J, Fish D, Jones S, Jones P (2010) Axillary ultrasound assessment in primary breast cancer: an audit of 653 cases. Breast J 16:460–463
Lee MC, Eatrides J, Chau A et al (2011) Consequences of axillary ultrasound in patients with T2 or greater invasive breast cancers. Ann Surg Oncol 18:72–77
Alvarez S, Añorbe E, Alcorta P, López F, Alonso I, Cortés J (2006) Role of sonography in the diagnosis of axillary lymph node metastases in breast cancer: a systematic review. AJR Am J Roentgenol 186:1342–1348
Britton PD, Goud A, Godward S et al (2009) Use of ultrasound-guided axillary node core biopsy in staging of early breast cancer. Eur Radiol 19:561–569
Britton PD, Provenzano E, Barter S et al (2009) Ultrasound guided percutaneous axillary lymph node core biopsy: how often is the sentinel lymph node being biopsied? Breast 18:13–16
March DE, Coughlin BF, Barham RB et al (2003) Breast masses: removal of all US evidence during biopsy by using a handheld vacuum-assisted device–initial experience. Radiology 227:549–555
Fine RE, Boyd BA, Whitworth PW, Kim JA, Harness JK, Burak WE (2002) Percutaneous removal of benign breast masses using a vacuum-assisted hand-held device with ultrasound guidance. Am J Surg 184:332–336
Makita T, Saito Y, Watanabe M (1985) Regional anatomy of swine. The Yamaguchi J Vet Med 12:33–58
Lyman GH, Giuliano AE, Somerfield MR et al (2005) American Society of Clinical Oncology. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol 23:7703–7720
Kim T, Giuliano AE, Lyman GH (2006) Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a metaanalysis. Cancer 106:4–16
Suga K, Yuan Y, Okada M et al (2004) Breast sentinel lymph node mapping at CT lymphography with iopamidol: preliminary experience. Radiology 230:543–552
Tangoku A, Yamamoto S, Suga K et al (2004) Sentinel lymph node biopsy using computed tomography-lymphography in patients with breast cancer. Surgery 135:258–265
Suga K, Yuan Y, Ogasawara N, Okada M, Matsunaga N (2003) Localization of breast sentinel lymph nodes by MR lymphography with a conventional gadolinium contrast agent. Preliminary observations in dogs and humans. Acta Radiol 44:35–42
Yamagami T, Yuen S, Sawai K, Nishimura T (2004) MR imaging-guided axillary node biopsy for breast cancer: initial findings. Eur Radiol 14:151–156
Yang WT, Chang J, Metreweli C (2000) Patients with breast cancer: differences in color Doppler flow and gray-scale US features of benign and malignant axillary lymph nodes. Radiology 215:568–573
Nathanson SD, Burke M, Slater R, Kapke A (2007) Preoperative identification of the sentinel lymph node in breast cancer. Ann Surg Oncol 14:3102–3110
Allen SD, Nerurkar A, Della Rovere GU (2011) The breast lesion excision system (BLES): a novel technique in the diagnostic and therapeutic management of small indeterminate breast lesions? Eur Radiol 21:919–924
Seror JY, Lesieur B, Scheuer-Niro B, Zerat L, Rouzier R, Uzan S (2011) Predictive factors for complete excision and underestimation of one-pass en bloc excision of non-palpable breast lesions with the Intact® breast lesion excision system. Eur J Radiol. doi:10.1016/j.ejrad.2011.01.049