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Percutaneous removal of sentinel lymph nodes in a swine model using a breast lesion excision system and contrast-enhanced ultrasound

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Abstract

Objectives

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.

Methods

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.

Results

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.

Conclusion

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.

Key Points

• 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.

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Acknowledgments

We would like to thank Prof. François Tranquart and Dr. Michel Schneider from BRACCO Suisse SA Imaging for inviting ARS, PM and HD to visit and perform this animal study in Bracco Suisse SA, Geneva Research Centre, and Dr Xavier Fouillet from Bracco Suisse for the histological analysis. BRACCO Imaging, S.p.A, Milan, Italy manufactured the contrast agent SonoVue™ and financially supported the investigation. Dr. Jean-Marc Hyvelin works for BRACCO Suisse SA in the Geneva Research Centre. The biopsy equipment was supplied the Intact® breast lesion excision system (BLES, Intact Medical, Framingham, MA, USA).

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Authors and Affiliations

  1. Department of Radiology, Maidstone Hospital, Hermitage Lane, ME16 9QQ, Maidstone, UK

    Ali R. Sever, Philippa Mills & Jennifer Weeks

  2. Bracco Suisse SA, Geneva, Switzerland

    Jean-Marc Hyvelin

  3. Department of Radiology, School of Medicine, Dicle University, 21280, Diyarbakir, Turkey

    Hatice Gumus

  4. Department of Pathology, Maidstone Hospital, Hermitage Lane, ME16 9QQ, Maidstone, UK

    David Fish

  5. Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    Willem Mali

  6. Department of Surgery, Maidstone Hospital, Hermitage Lane, ME16 9QQ, Maidstone, UK

    Susan E. Jones, Peter A. Jones & Haresh Devalia

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  1. Ali R. Sever
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  2. Philippa Mills
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  4. Jennifer Weeks
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  8. Susan E. Jones
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Corresponding author

Correspondence to Ali R. Sever.

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Sever, A.R., Mills, P., Hyvelin, JM. et al. Percutaneous removal of sentinel lymph nodes in a swine model using a breast lesion excision system and contrast-enhanced ultrasound. Eur Radiol 22, 545–550 (2012). https://doi.org/10.1007/s00330-011-2293-1

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  • DOI: https://doi.org/10.1007/s00330-011-2293-1

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