Sentinel lymph node detection with contrast enhanced ultrasound – initial experience

Background The sentinel lymph node (SLN) is the first lymph node (LN) in lymphatic drainage of a tumor and therefore the first potentially metastatically altered LN. To determine this, scintigraphy is commonly used. CEUS lymphography (CEUS-SLN) offers an innovative alternative/supplement. Here, contrast agent (CA) is absorbed and transported away through peritumoral lymph vessels. Only small "proof of concept" studies are available for carcinomas in the head and neck area [1] [2].

Methods We demonstrate the method in a patient with pT1cN0cM0 squamous cell carcinoma of the lip. After intramucosal application of the CA around the tumor, the CA was followed in the lymphatic vessels until the first receiving LN was identified. The patient also underwent scintigraphy with SPECT/CT so results could be compared.

Results Scintigraphy identified two LN as possible SLNs. The first CA-enhanced LN in the CEUS-SLN corresponded to one of these two, the second node picked up CA more than one minute later. Procedure was completed without complications in about 10 minutes.

Discussion CEUS-SLN offers an innovative addition to the detection of the SLN without radiation exposure. Potential added value exists in particular when primary tumor and SLN are close by. Systematic studies comparing the method with the gold standard of scintigraphy are still lacking.

Publication History

Article published online:
19 April 2024

• References

• 1 Huang J. et al. Trans-lymphatic contrast-enhanced ultrasound with sentinel lymph node biopsy for detecting cervical skip metastasis to lymph nodes in early-stage oral tongue squamous cell carcinoma. Dentomaxillofacial Radiology 2022; 51 (02) 20210107
• 2 Gvetadze SR. et al. Contrast-enhanced ultrasound mapping of sentinel lymph nodes in oral tongue cancer—a pilot study. Dentomaxillofacial Radiology 2017; 46 (03) 20160345