Rabinowitz Mindy R, Merton Daniel A, Liu Ji-Bin, Saxena Shivam, Pluta John, Eisenbrey John R, Baker Adam L, Rabinowitz Michael P, Lally Sara, Cognetti David, Goldberg Barry B, Pribitkin Edmund A, Curry Joseph M
Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
Laryngoscope. 2014 Nov;124(11):2531-6. doi: 10.1002/lary.24789. Epub 2014 Jun 13.
OBJECTIVES/HYPOTHESIS: Sentinel lymph node biopsy (SLNB) has been utilized for cutaneous melanoma and other malignancies arising from the eye and ocular adnexa. Currently, SLNB requires blue dyes and/or radiopharmaceuticals; both of which have significant shortcomings. This study sought to evaluate the feasibility of SLNB with the use of real-time, contrast-enhanced ultrasound (CEUS) as an alternative technique for tumors arising in the conjunctiva.
Prospective feasibility study in a porcine model.
Twelve experiments were performed on six non-tumor-bearing Yorkshire swine. An ultrasound contrast agent, Sonazoid (GE Healthcare, Oslo, Norway), (99m) technetium ((99m) Tc), and methylene blue (MB) (Covidien, Mansfield, MA) were injected in the ocular conjunctiva. Sentinel lymph nodes (SLNs) were localized with CEUS and findings were compared to that of MB and (99m) Tc. Fisher exact test was used.
Contrast-enhanced SLNs were identified within an average of 6.2 minutes from time of injection of Sonazoid. A total of 17 SLNs were identified by at least one of the three techniques. Correlation between Sonazoid and (99m) Tc was 94.1% (16/17 SLNs). Correlation between (99m) Tc and MB was 88.2% (15/17). One SLN that was positive for (99m) Tc but negative for Sonazoid and was considered to be a false positive (1/17); findings were similar for MB (1/17). Differences between the three techniques were not significant (P = .886).
CEUS-guided injection of conjunctiva for SLNB is technically feasible and correlates well with standard detection techniques. This technique shows promise for rapid, real-time, intraoperative imaging for SLNB, using a widely available imaging modality and avoiding the need for radiopharmaceuticals.
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目的/假设：前哨淋巴结活检（SLNB）已用于皮肤黑色素瘤以及眼和眼附属器产生的其他恶性肿瘤。目前，SLNB需要使用蓝色染料和/或放射性药物，而这两者都有明显的缺点。本研究旨在评估使用实时、对比增强超声（CEUS）作为结膜肿瘤替代技术进行SLNB的可行性。
在猪模型中进行的前瞻性可行性研究。
对6只无肿瘤的约克夏猪进行了12次实验。将超声造影剂声诺维（通用电气医疗集团，挪威奥斯陆）、锝（99m）Tc和亚甲蓝（MB）（柯惠医疗，马萨诸塞州曼斯菲尔德）注射到眼结膜中。用CEUS定位前哨淋巴结（SLN），并将结果与MB和（99m）Tc的结果进行比较。采用Fisher精确检验。
注射声诺维后平均6.2分钟内即可识别出对比增强的SLN。三种技术中至少有一种共识别出17个SLN。声诺维和（99m）Tc之间的相关性为94.1%（16/17个SLN）。（99m）Tc与MB之间的相关性为88.2%（15/17）。一个对（99m）Tc呈阳性但对声诺维呈阴性的SLN被认为是假阳性（1/17）；MB的结果相似（1/17）。三种技术之间的差异不显著（P = 0.886）。
CEUS引导下结膜注射用于SLNB在技术上是可行的，并且与标准检测技术具有良好的相关性。该技术有望使用广泛可用的成像方式，快速、实时地进行术中SLNB成像，并且无需使用放射性药物。
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