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.
