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Background <p>Sentinel lymph node biopsy (SLNB) using radioisotopes/blue dye remains limited by radiation exposure and logistical constraints. This study prospectively evaluates lymphatic contrast-enhanced ultrasound (L-CEUS) for SLN mapping and metastasis detection in early-stage breast cancer.</p> Methods <p>A total of 251 consecutive patients underwent L-CEUS-guided SLN biopsy. Enhancement patterns (Types I-V) and filling defects were correlated with histopathology. Diagnostic performance was compared to conventional ultrasound parameters and surgical SLNB (<i>n</i> = 102).</p> Results <p>L-CEUS successfully localized SLNs in 98.4% (247/251) of cases. Using Types III-V enhancement as metastatic criteria, L-CEUS demonstrated 99.0% sensitivity and 88.1% specificity (AUC 0.935). Incorporating filling defects improved specificity to 95.4% (AUC 0.967). Cortical thickness (&gt;3.0 mm) outperformed nodal short-axis in metastasis prediction (AUC 0.874 vs. 0.702, <i>p</i> &lt; 0.001). Compared with blue dye, L-CEUS identified fewer SLNs/patient (3.11 ± 0.81 vs. 3.59 ± 1.2, <i>p</i> = 0.001) with shorter procedural time (4.09 ± 0.25 vs. 12.12 ± 2.75 min, <i>p</i> &lt; 0.001). Eight false-negatives involved micro-metastases (<i>n</i> = 3) and skip lesions (<i>n</i> = 5).</p> Conclusions <p>L-CEUS provides high diagnostic accuracy for SLN evaluation while eliminating radiation exposure. Its real-time imaging capability and rapid procedural time support integration into standard axillary staging protocols, particularly where radioisotopes are unavailable. Prospective validation of long-term outcomes is warranted.</p>

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Lymphatic Contrast-enhanced Ultrasound as a Noninvasive Predictor of Sentinel Lymph Node Metastasis in Breast Cancer: A Prospective Diagnostic Study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年6月23日

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  • Jundong Yao,
  • Husha Li,
  • Hailong Wang,
  • Binbin Liu,
  • Shuai Cui,
  • Qifan Liu,
  • Chang Chang,
  • Miao Deng,
  • Shengjiang Chen

摘要

Background

Sentinel lymph node biopsy (SLNB) using radioisotopes/blue dye remains limited by radiation exposure and logistical constraints. This study prospectively evaluates lymphatic contrast-enhanced ultrasound (L-CEUS) for SLN mapping and metastasis detection in early-stage breast cancer.

Methods

A total of 251 consecutive patients underwent L-CEUS-guided SLN biopsy. Enhancement patterns (Types I-V) and filling defects were correlated with histopathology. Diagnostic performance was compared to conventional ultrasound parameters and surgical SLNB (n = 102).

Results

L-CEUS successfully localized SLNs in 98.4% (247/251) of cases. Using Types III-V enhancement as metastatic criteria, L-CEUS demonstrated 99.0% sensitivity and 88.1% specificity (AUC 0.935). Incorporating filling defects improved specificity to 95.4% (AUC 0.967). Cortical thickness (>3.0 mm) outperformed nodal short-axis in metastasis prediction (AUC 0.874 vs. 0.702, p < 0.001). Compared with blue dye, L-CEUS identified fewer SLNs/patient (3.11 ± 0.81 vs. 3.59 ± 1.2, p = 0.001) with shorter procedural time (4.09 ± 0.25 vs. 12.12 ± 2.75 min, p < 0.001). Eight false-negatives involved micro-metastases (n = 3) and skip lesions (n = 5).

Conclusions

L-CEUS provides high diagnostic accuracy for SLN evaluation while eliminating radiation exposure. Its real-time imaging capability and rapid procedural time support integration into standard axillary staging protocols, particularly where radioisotopes are unavailable. Prospective validation of long-term outcomes is warranted.