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Performance of Molecular Lymphosonography for Detection and Quantification of Metastatic Involvement in Sentinel Lymph Nodes
Author(s) -
Nam Kibo,
Stapp Robert,
Liu JiBin,
Stanczak Maria,
Forsberg Flemming,
O'Kane Patrick L.,
Lin Zhou,
Zhu Ziyin,
Li Jingzhi,
Solomides Charalambos C.,
Eisenbrey John R.,
Lyshchik Andrej
Publication year - 2019
Publication title -
journal of ultrasound in medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 91
eISSN - 1550-9613
pISSN - 0278-4297
DOI - 10.1002/jum.14906
Subject(s) - medicine , microbubbles , lymph , metastatic melanoma , pathology , melanoma , radiology , nuclear medicine , ultrasound , cancer research
Objectives To assess the performance of molecular lymphosonography with dual‐targeted microbubbles in detecting and quantifying the metastatic involvement in sentinel lymph nodes (SLNs) using a swine melanoma model. Methods Targeted microbubbles were labeled with P‐selectin and α V β 3 ‐integrin antibodies. Control microbubbles were labeled with immunoglobulin G antibodies. First lymphosonography with Sonazoid (GE Healthcare, Oslo, Norway) was used to identify SLNs. Then dual‐targeted and control microbubbles were injected intravenously to detect and quantify metastatic disease in the SLNs. Distant non‐SLNs were imaged as benign controls. All evaluated lymph nodes (LNs) were surgically removed, and metastatic involvement was characterized by a histopathologic analysis. Two radiologists blinded to histopathologic results assessed the baseline B‐mode images of LNs, and the results were compared to the histologic reference standard. The mean intensities of targeted and control microbubbles within the examined LNs were measured and compared to the LN histologic results. Results Thirty‐five SLNs and 34 non‐SLNs from 13 Sinclair swine were included in this study. Twenty‐one SLNs (62%) were malignant, whereas 100% of non‐SLNs were benign. The sensitivity of B‐mode imaging for metastatic LN diagnosis for both readers was relatively high (90% and 71%), but the specificity was very poor (50% and 58%). The sensitivity and specificity of molecular lymphosonography for metastatic LN detection were 91% and 67%, respectively. The mean intensities from dual‐targeted microbubbles correlated well with the degree of metastatic LN involvement ( r = 0.6; P < 0.001). Conclusions Molecular lymphosonography can increase the specificity of metastatic LN detection and provide a measure to quantify the degree of metastatic involvement.