Contrast-enhanced ultrasound -guided axillary lymph node core biopsy: Diagnostic accuracy in preoperative staging of invasive breast cancer

• CEUS -guided sentinel lymph node biopsy is a feasible and accurate procedure.
• CEUS CB reliably excludes high axillary burden in US node negative disease.
• CEUS CB can be recommended in selective patient populations.

ObjectivesTo evaluate accuracy of contrast enhanced ultrasound (CEUS)-sentinel procedure followed by core biopsy (CB) and marking in patients with breast cancer. To compare the axillary metastatic tumour burden in patients with positive vs. negative CB results.MethodsTwo radiologists in our tertiary care hospital performed axillary CEUS sentinel procedures on consecutive US node negative breast cancer patients. The first enhancing lymph node (LN) was core biopsied and marked with a breast coil. The results were compared to final histopathology. We analysed the diagnostic performance of CEUS CB and its ability to detect patients with higher axillary burden (>2 metastasis).ResultsDuring the study period between January 2013 and December 2014, altogether 54 patients (mean age 60.4 years) were included in the statistical analysis. The sensitivity for CEUS CB was 66.7%, specificity 100%, PPV 100%, NPV 93.8% and overall accuracy 94.4%. The method correctly recognised all the axillae with higher tumour burdens (sensitivity 100%, N = 3) and 59.3% of coils marking the LNs were discovered.ConclusionCEUS -guided axillary CB proved to be feasible and accurate procedure with moderate sensitivity and it clearly identified the higher axillary tumour burden. The coil marking of LNs as used cannot be recommended. In clinical routine, CEUS procedure might be recommended in selective patient populations.