Contrast-enhanced sonography for detection of secondary lymph nodes in a melanoma tumor animal model

Ji Bin Liu, Daniel A. Merton, Adam C. Berger, Flemming Forsberg, Agnieszka Witkiewicz, Hongjia Zhao, John R. Eisenbrey, Traci B. Fox, Barry B. Goldberg

Research output: Contribution to journalArticle

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Abstract

Objectives-To investigate the use of contrast-enhanced ultrasound imaging (US) for detection of secondary lymph nodes (LNs) in a naturally occurring melanoma swine model compared to surgery and pathologic assessment. Methods-Twenty-seven Sinclair swine were studied. The perfluorobutane microbubble contrast agent Sonazoid (GE Healthcare, Oslo, Norway) was administered (1.0 mL total dose) around the melanoma, and contrast-enhanced US was used to localize contrast-enhanced sentinel lymph nodes (SLNs). Then Sonazoid (dose, 0.25-1.0 mL) was injected into the SLNs to detect contrast-enhanced efferent lymphatic channels and secondary LNs. After peritumoral injection of blue dye, a surgeon (blinded to the contrast-enhanced US results) performed a radical LN dissection. Contrast-enhanced US was used to guide removal of any enhanced secondary LNs left after radical LN dissection. Clustered conditional logistic regression analyzed the benefit of contrastenhanced US-directed secondary LN dissection over radical LN dissection using pathologic findings as the reference standard. Results-A total of 268 secondary LNs were resected, with 59 (22%) containing metastases. Contrast-enhanced US detected 92 secondary LNs; 248 were identified by radical LN dissection; and 68 were identified by both methods. Metastases were detected in 20% (51 of 248) and 40% (37 of 92) of the secondary LNs identified by radical LN dissection and contrast-enhanced US, respectively. Thus, secondary LNs detected by contrast-enhanced US were nearly 5 times more likely to contain metastases than secondary LNs removed by radical LN dissection (odds ratio, 4.8; P <.0001). Twenty-two of the 180 secondary LNs (12%) identified only by radical LN dissection contained metastases, whereas contrast-enhanced US identified 20 secondary LNs after the surgeon completed the radical LN dissection, of which 8 (40%) contained metastases. Conclusions-Secondary LNs can be detected by using contrast-enhanced US after injection of Sonazoid into SLNs. Secondary LNs detected with contrast-enhanced US are significantly more likely to contain metastases than those removed by radical LN dissection.

Original languageEnglish (US)
Pages (from-to)939-947
Number of pages9
JournalJournal of Ultrasound in Medicine
Volume33
Issue number6
DOIs
StatePublished - Jun 1 2014

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Melanoma
Ultrasonography
Lymph Node Excision
Animal Models
Lymph Nodes
Neoplasms
Neoplasm Metastasis
Swine
Microbubbles
Injections
Norway
Contrast Media
Coloring Agents
Logistic Models
Odds Ratio
Delivery of Health Care

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology
  • Medicine(all)

Cite this

Contrast-enhanced sonography for detection of secondary lymph nodes in a melanoma tumor animal model. / Liu, Ji Bin; Merton, Daniel A.; Berger, Adam C.; Forsberg, Flemming; Witkiewicz, Agnieszka; Zhao, Hongjia; Eisenbrey, John R.; Fox, Traci B.; Goldberg, Barry B.

In: Journal of Ultrasound in Medicine, Vol. 33, No. 6, 01.06.2014, p. 939-947.

Research output: Contribution to journalArticle

Liu, JB, Merton, DA, Berger, AC, Forsberg, F, Witkiewicz, A, Zhao, H, Eisenbrey, JR, Fox, TB & Goldberg, BB 2014, 'Contrast-enhanced sonography for detection of secondary lymph nodes in a melanoma tumor animal model', Journal of Ultrasound in Medicine, vol. 33, no. 6, pp. 939-947. https://doi.org/10.7863/ultra.33.6.939
Liu, Ji Bin ; Merton, Daniel A. ; Berger, Adam C. ; Forsberg, Flemming ; Witkiewicz, Agnieszka ; Zhao, Hongjia ; Eisenbrey, John R. ; Fox, Traci B. ; Goldberg, Barry B. / Contrast-enhanced sonography for detection of secondary lymph nodes in a melanoma tumor animal model. In: Journal of Ultrasound in Medicine. 2014 ; Vol. 33, No. 6. pp. 939-947.
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abstract = "Objectives-To investigate the use of contrast-enhanced ultrasound imaging (US) for detection of secondary lymph nodes (LNs) in a naturally occurring melanoma swine model compared to surgery and pathologic assessment. Methods-Twenty-seven Sinclair swine were studied. The perfluorobutane microbubble contrast agent Sonazoid (GE Healthcare, Oslo, Norway) was administered (1.0 mL total dose) around the melanoma, and contrast-enhanced US was used to localize contrast-enhanced sentinel lymph nodes (SLNs). Then Sonazoid (dose, 0.25-1.0 mL) was injected into the SLNs to detect contrast-enhanced efferent lymphatic channels and secondary LNs. After peritumoral injection of blue dye, a surgeon (blinded to the contrast-enhanced US results) performed a radical LN dissection. Contrast-enhanced US was used to guide removal of any enhanced secondary LNs left after radical LN dissection. Clustered conditional logistic regression analyzed the benefit of contrastenhanced US-directed secondary LN dissection over radical LN dissection using pathologic findings as the reference standard. Results-A total of 268 secondary LNs were resected, with 59 (22{\%}) containing metastases. Contrast-enhanced US detected 92 secondary LNs; 248 were identified by radical LN dissection; and 68 were identified by both methods. Metastases were detected in 20{\%} (51 of 248) and 40{\%} (37 of 92) of the secondary LNs identified by radical LN dissection and contrast-enhanced US, respectively. Thus, secondary LNs detected by contrast-enhanced US were nearly 5 times more likely to contain metastases than secondary LNs removed by radical LN dissection (odds ratio, 4.8; P <.0001). Twenty-two of the 180 secondary LNs (12{\%}) identified only by radical LN dissection contained metastases, whereas contrast-enhanced US identified 20 secondary LNs after the surgeon completed the radical LN dissection, of which 8 (40{\%}) contained metastases. Conclusions-Secondary LNs can be detected by using contrast-enhanced US after injection of Sonazoid into SLNs. Secondary LNs detected with contrast-enhanced US are significantly more likely to contain metastases than those removed by radical LN dissection.",
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T1 - Contrast-enhanced sonography for detection of secondary lymph nodes in a melanoma tumor animal model

AU - Liu, Ji Bin

AU - Merton, Daniel A.

AU - Berger, Adam C.

AU - Forsberg, Flemming

AU - Witkiewicz, Agnieszka

AU - Zhao, Hongjia

AU - Eisenbrey, John R.

AU - Fox, Traci B.

AU - Goldberg, Barry B.

PY - 2014/6/1

Y1 - 2014/6/1

N2 - Objectives-To investigate the use of contrast-enhanced ultrasound imaging (US) for detection of secondary lymph nodes (LNs) in a naturally occurring melanoma swine model compared to surgery and pathologic assessment. Methods-Twenty-seven Sinclair swine were studied. The perfluorobutane microbubble contrast agent Sonazoid (GE Healthcare, Oslo, Norway) was administered (1.0 mL total dose) around the melanoma, and contrast-enhanced US was used to localize contrast-enhanced sentinel lymph nodes (SLNs). Then Sonazoid (dose, 0.25-1.0 mL) was injected into the SLNs to detect contrast-enhanced efferent lymphatic channels and secondary LNs. After peritumoral injection of blue dye, a surgeon (blinded to the contrast-enhanced US results) performed a radical LN dissection. Contrast-enhanced US was used to guide removal of any enhanced secondary LNs left after radical LN dissection. Clustered conditional logistic regression analyzed the benefit of contrastenhanced US-directed secondary LN dissection over radical LN dissection using pathologic findings as the reference standard. Results-A total of 268 secondary LNs were resected, with 59 (22%) containing metastases. Contrast-enhanced US detected 92 secondary LNs; 248 were identified by radical LN dissection; and 68 were identified by both methods. Metastases were detected in 20% (51 of 248) and 40% (37 of 92) of the secondary LNs identified by radical LN dissection and contrast-enhanced US, respectively. Thus, secondary LNs detected by contrast-enhanced US were nearly 5 times more likely to contain metastases than secondary LNs removed by radical LN dissection (odds ratio, 4.8; P <.0001). Twenty-two of the 180 secondary LNs (12%) identified only by radical LN dissection contained metastases, whereas contrast-enhanced US identified 20 secondary LNs after the surgeon completed the radical LN dissection, of which 8 (40%) contained metastases. Conclusions-Secondary LNs can be detected by using contrast-enhanced US after injection of Sonazoid into SLNs. Secondary LNs detected with contrast-enhanced US are significantly more likely to contain metastases than those removed by radical LN dissection.

AB - Objectives-To investigate the use of contrast-enhanced ultrasound imaging (US) for detection of secondary lymph nodes (LNs) in a naturally occurring melanoma swine model compared to surgery and pathologic assessment. Methods-Twenty-seven Sinclair swine were studied. The perfluorobutane microbubble contrast agent Sonazoid (GE Healthcare, Oslo, Norway) was administered (1.0 mL total dose) around the melanoma, and contrast-enhanced US was used to localize contrast-enhanced sentinel lymph nodes (SLNs). Then Sonazoid (dose, 0.25-1.0 mL) was injected into the SLNs to detect contrast-enhanced efferent lymphatic channels and secondary LNs. After peritumoral injection of blue dye, a surgeon (blinded to the contrast-enhanced US results) performed a radical LN dissection. Contrast-enhanced US was used to guide removal of any enhanced secondary LNs left after radical LN dissection. Clustered conditional logistic regression analyzed the benefit of contrastenhanced US-directed secondary LN dissection over radical LN dissection using pathologic findings as the reference standard. Results-A total of 268 secondary LNs were resected, with 59 (22%) containing metastases. Contrast-enhanced US detected 92 secondary LNs; 248 were identified by radical LN dissection; and 68 were identified by both methods. Metastases were detected in 20% (51 of 248) and 40% (37 of 92) of the secondary LNs identified by radical LN dissection and contrast-enhanced US, respectively. Thus, secondary LNs detected by contrast-enhanced US were nearly 5 times more likely to contain metastases than secondary LNs removed by radical LN dissection (odds ratio, 4.8; P <.0001). Twenty-two of the 180 secondary LNs (12%) identified only by radical LN dissection contained metastases, whereas contrast-enhanced US identified 20 secondary LNs after the surgeon completed the radical LN dissection, of which 8 (40%) contained metastases. Conclusions-Secondary LNs can be detected by using contrast-enhanced US after injection of Sonazoid into SLNs. Secondary LNs detected with contrast-enhanced US are significantly more likely to contain metastases than those removed by radical LN dissection.

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