European Radiology

, Volume 28, Issue 4, pp 1654–1661 | Cite as

The value of contrast-enhanced ultrasound for sentinel lymph node identification and characterisation in pre-operative breast cancer patients: A prospective study

  • Jing Zhao
  • Jing Zhang
  • Qing-Li Zhu
  • Yu-Xin JiangEmail author
  • Qiang Sun
  • Yi-Dong Zhou
  • Miao-Qian Wang
  • Zhi-Lan Meng
  • Xin-Xin Mao



To explore the feasibility of sentinel lymph node (SLN) identification by contrast-enhanced ultrasound (CEUS) in pre-operative breast cancer patients and the value of enhancement patterns for diagnosing lymph node metastases and characterising axillary nodal burden.


110 consecutive breast cancer patients were enrolled. Before the surgery, microbubbles were injected intradermally. The lymphatic drainage pathway was detected to identify the SLNs. Blue dye and indocyanine green (ICG) fluorescence were used to trace SLNs during the operation. The enhancement patterns of SLNs were recorded and compared with the final pathological diagnosis.


SLN detection rate was 96.4 % of 110 patients, 134 SLNs were detected in total. The sensitivity, specificity, positive-predictive value, negative-predictive value and accuracy of predicting SLNs metastases by CEUS enhancement patterns were 100 %, 52.0 %, 43.4 %, 100 % and 64.9 %, respectively. No metastatic SLNs were presented as homogeneous enhancement. Low nodal burden with 0–2 SLN metastases in 92.5 % nodes presented as heterogeneous enhancement. No enhancement pattern was proved to be SLN metastases in 100 % patients.


CEUS is a feasible approach for SLN identification. CEUS enhancement patterns can be helpful in recognising metastatic SLNs and nodal burden.

Key Points

CEUS is a feasible approach for SLN identification and characterisation.

The enhancement patterns on CEUS can be helpful in recognising metastasised SLNs.

Homogeneous enhancement pattern has the highest negative-predictive value.


Sentinel lymph node Contrast-enhanced ultrasound Enhancement pattern Breast cancer Nodal burden 



Contrast-enhanced ultrasound


Indocyanine green


Sentinel lymph node



This study has received funding by the National Natural Science Foundation of China (81371557 and 81201112).

Compliance with ethical standards


The scientific guarantor of this publication is Yu-Xin Jiang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.


• prospective

• cross-sectional study

• performed at one institution


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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Jing Zhao
    • 1
  • Jing Zhang
    • 1
  • Qing-Li Zhu
    • 1
  • Yu-Xin Jiang
    • 1
    Email author
  • Qiang Sun
    • 2
  • Yi-Dong Zhou
    • 2
  • Miao-Qian Wang
    • 1
  • Zhi-Lan Meng
    • 3
  • Xin-Xin Mao
    • 3
  1. 1.Department of UltrasoundPeking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
  2. 2.Department of Breast SurgeryPeking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
  3. 3.Department of PathologyPeking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina

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