Cox, Karina, Taylor-Phillips, Sian, Sharma, Nisha, Weeks, Jennifer, Mills, Philippa, Sever, Ali, Lim, Adrian, Haigh, Isobel, Hashem, Mohamed, D'Silva, Tania, Satchithananda, Keshthra, Tang, Mengxing and Wallis, Matthew (2017) Enhanced pre-operative axillary staging using intradermal microbubbles and contrast-enhanced ultrasound to detect and biopsy sentinel lymph nodes in breast cancer : a potential replacement for axillary surgery. The British Journal of Radiology, 91 (1082). 20170626. doi:10.1259/bjr.20170626

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Abstract

Objective:
To compare the experience of 4 UK Centres in the use of intradermal microbubbles and contrast enhanced ultrasound (CEUS) to pre-operatively identify and biopsy sentinel lymph nodes (SLN) in patients with breast cancer.

Methods:
In all centres, breast cancer patients had a microbubble/ CEUS SLN core biopsy prior to axillary surgery and patients in Centres 1 and 2 had a normal grey-scale axillary ultrasound. Data was collected between 2010 and 2016; 1361 from Centre 1 (prospective, sequential), 376 from Centre 2 (retrospective, sequential), 122 from Centre 3 (retrospective, selected) and 48 from Centre 4 (prospective, selected).

Results:
SLN were successfully core biopsied in 80% (Centre 1), 79.6% (Centre 2), 77.5% (Centre 3) and 88% (Centre 4). The sensitivities to identify all SLN metastases were 46.9% (95% CI 39.4-55.1), 52.5% (95% CI 39.1-65.7), 46.4% (95% CI 27.5-66.1) and 45.5% (95% CI 16.7-76.6) respectively. Specificities; 99.7% (95% CI 98.9-100), 98.1% (95% CI 94.5-99.6), 100% (95% CI 93.2-100%) and 96.3% (95% CI 81-99.9) respectively. Negative predictive values; 87.0% (95% CI 84.3-89.3), 84.5% (95% CI 78.4-89.5), 86.9% (95% CI 82.4-90.3) and 86.2% (95% CI 78.4-91.5) respectively. At Centres 1 and 2, 12/730 (1.6%) and 7/181 (4%) respectively of patients with a benign microbubble/ CEUS SLN core biopsy had 2 or more lymph node (LN) macrometastases found at the end of primary surgical treatment.

Conclusion:
The identification and biopsy of SLN using CEUS is a reproducible technique.

Advances in Knowledge:
In the era of axillary conservation, microbubble/ CEUS SLN core biopsy has the potential to succeed surgical staging of the axilla.

Item Type:	Journal Article
Subjects:	R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer)
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Cancer -- Breast, Breast -- Needle biopsy, Lymph nodes, Injections, Intradermal
Journal or Publication Title:	The British Journal of Radiology
Publisher:	British Institute of Radiology
ISSN:	0007-1285
Official Date:	5 December 2017
Dates:	Date Event 5 December 2017 Published 10 November 2017 Available 4 November 2017 Accepted
Volume:	91
Number:	1082
Article Number:	20170626
DOI:	10.1259/bjr.20170626
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
RIOXX Funder/Project Grant:	Project/Grant ID RIOXX Funder Name Funder ID UNSPECIFIED Toshiba Medical Systems http://dx.doi.org/10.13039/501100008321
Related URLs:	Publisher

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