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DOI: 10.1148/radiol.2303021440
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(Radiology 2004;230:727-734.)
© RSNA, 2004

Experimental Studies

Sentinel Lymph Nodes in a Swine Model with Melanoma: Contrast-enhanced Lymphatic US1

Barry B. Goldberg, MD, Daniel A. Merton, BS, RDMS, Ji-Bin Liu, MD, Mathew Thakur, PhD, George F. Murphy, MD, Larry Needleman, MD, Audun Tornes, MS and Flemming Forsberg, PhD

1 From the Departments of Radiology (B.B.G., D.A.M., J.B.L., M.T., L.N., F.F.) and Pathology (G.F.M.), Thomas Jefferson University Hospital, 7th Floor Main Bldg, 132 S 10th St, Philadelphia, PA 19107; and Amersham Health, Oslo, Norway (A.T.). From the 2002 RSNA scientific assembly. Received November 8, 2002; revision requested January 15, 2003; final revision received June 13; accepted July 3. Supported by a grant from Amersham Health, Oslo, Norway. Address correspondence to B.B.G. (e-mail: barry.b.goldberg@jefferson.edu).

PURPOSE: To determine if lymphatic channels and sentinel lymph nodes (SLNs) with and without metastases can be detected with lymphatic ultrasonography (US) after peritumoral injection of a US contrast agent and to determine if lymphatic US can be used to assess SLNs for the presence of metastatic infiltration.

MATERIALS AND METHODS: Six swine with 17 melanomas were evaluated. Conventional gray-scale, color flow, and gray-scale phase-inversion harmonic US examinations were performed. A US contrast agent was administered in four sites around each melanoma (1-mL total dose). Lymphoscintigraphy was followed by injection of a blue dye and then dissection. SLNs identified at lymphatic US were characterized by two readers in consensus as normal or as having metastases; results were compared with histologic findings. Statistical analyses included the sign test and the {kappa} statistic.

RESULTS: Lymphatic US depicted 28 SLNs, while lymphoscintigraphy depicted 27 "hot spots" suspected of representing SLNs (including two false-positive findings). Dissection after blue dye injection helped identify 31 SLNs. There were no false-positive US findings for SLN detection. Five of six nodes not seen with lymphoscintigraphy were detected with lymphatic US. The accuracy of SLN detection was 90% (28 of 31) for lymphatic US and 81% (25 of 31) for lymphoscintigraphy (P = .29). Lymphatic US correctly depicted metastases in 19 of 20 SLNs, and five of the eight normal SLNs were correctly characterized, with an accuracy of 86% ({kappa} = 0.62).

CONCLUSION: Detection of SLNs with lymphatic US compared favorably with that at lymphoscintigraphy. Lymphatic US can depict metastases within the SLN, which was not possible with lymphoscintigraphy.

© RSNA, 2004

Index terms: Animals • Lymphatic system, radionuclide studies, 997.12974 • Lymphatic system, US, 997.12981, 997.12983, 997.12988 • Melanoma, 997.329, 997.33


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