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Contrast‐Enhanced Ultrasound Imaging of Sentinel Lymph Nodes After Peritumoral Administration of Sonazoid in a Melanoma Tumor Animal Model
Author(s) -
Goldberg Barry B.,
Merton Daniel A.,
Liu Ji-Bin,
Forsberg Flemming,
Zhang Kaijun,
Thakur Madhukar,
Schulz Stephanie,
Schanche Robin,
Murphy George F.,
Waldman Scott A.
Publication year - 2011
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 - 10.7863/jum.2011.30.4.441
Subject(s) - medicine , lymph , micrometastasis , radiology , sentinel lymph node , nuclear medicine , mcnemar's test , contrast enhanced ultrasound , melanoma , ultrasound , false positive paradox , metastasis , pathology , cancer , breast cancer , statistics , mathematics , cancer research , machine learning , computer science
Objectives The purpose of this study was to compare lymphosonography (ie, contrast‐enhanced ultrasound imaging [US] after interstitial injection of a US contrast agent) for the detection of sentinel lymph nodes (SLNs) in swine with naturally occurring melanoma tumors to lymphoscintigraphy using blue dye‐guided surgical dissection as the reference standard. Also, we sought to determine if lymphosonography can be used to characterize SLNs. Methods Sixty‐three swine with 104 melanomas were evaluated. Contrast‐specific US was performed after peritumoral injection (1 mL dose) of Sonazoid (GE Healthcare, Oslo, Norway). Lymphoscintigraphy was performed after peritumoral injections of technetium Tc 99m sulfur colloid. Peritumoral injection of 1% Lymphazurin (Ben Venue Labs, Inc, Bedford, OH) was used to guide SLN resection. The accuracy of SLN detection with the two imaging modalities was compared using the McNemar test. The SLNs were qualitatively and quantitatively characterized as benign or malignant based on the lymphosonography results with histopathology and RNA analyses used as the reference standards. Results Blue dye‐guided surgery identified 351 SLNs. Lymphosonography detected 293 SLNs and 11 false‐positives, while lymphoscintigraphy detected 231 SLNs and 20 false‐positives. The accuracy of SLN detection was 81.8% for lymphosonography, which was significantly higher than the 63.2% achieved with lymphoscintigraphy ( P < .0001). The accuracy of lymphosonography for SLN characterization was 80%. When the size of the enhanced SLN was taken into consideration to characterize SLNs, the accuracy was 86%. Conclusions Lymphosonography is statistically better than lymphoscintigraphy for the detection of SLNs in this animal model. The ability to use lymphosonography as a means to characterize SLNs as benign or malignant is limited.