Contrast-enhancement ultrasound with microbubbles for sentinel node identification: a case report

Lymph node (LN) stage remains the primary prognostic discriminant in breast cancer. Lymphatic mapping with sentinel LN (SLN) represents the gold standard for axillary staging in early breast cancer (EBC), thus identification of a new contrast agent could provide clinicians with an alternative to blue dye. AX-CES 1.2020, a prospective non-inferiority phase III trial designed to evaluate the use of Sonovue (microbubbles with sulphur hexafluoride) under contrast enhanced ultrasound (CEUS) as a SLN contrast agent. We herein present the first patient enrolled in the AX-CES 1.2020 trial. In the present clinical report, CEUS-SLN was a safe and feasible technique that enhanced the same LN identified bym99Tc. Larger series are needed in order to investigate the role of CEUS-SLN in EBC and further studies could evaluate the combination of the pathological and ultrasonographic features of CEUS-SLN to predict axillary involvement.