European radiology · 2026
Sonazoid-enhanced ultrasound for preoperative localization and characterization of sentinel lymph nodes in patients with cutaneous melanoma.
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Jiang Binbin, Sun Liqi, Si Lu, Liu Jiayong, Cui Chuanliang, Yan Kun, Yin Shanshan
Аннотация
OBJECTIVE: Accurate sentinel lymph node (SLN) identification is essential for the staging of cutaneous melanoma. Contrast-enhanced ultrasound using Sonazoid (Sonazoid-CEUS), which is based on a perfluorobutane microbubble contrast agent with reticuloendothelial uptake properties, was evaluated for SLN detection in patients with stage Ib-II melanoma.
MATERIALS AND METHODS: In this prospective single-arm cohort study, 71 eligible subjects underwent perilesional intradermal Sonazoid-CEUS, followed by lymphoscintigraphy and SLN biopsy. The numbers of SLNs detected via CEUS and lymphoscintigraphy were compared by using non-parametric paired analysis (Wilcoxon signed-rank test). The diagnostic accuracy of CEUS for metastatic involvement was evaluated against histopathological results.
RESULTS: Sonazoid-CEUS achieved a 97.3% success rate in identifying SLNs, detecting 148 SLNs, with an average of 2.1 ± 1.1 SLNs per patient. Most patients (93.0%) had single-basin lymphatic drainage. For metastasis detection, CEUS demonstrated 82.1% sensitivity, 88.4% specificity, and 85.9% accuracy. Ulceration, high mitotic count, and HMB45 positivity in primary lesions were significantly associated with SLN metastasis. No contrast-related adverse events were observed.
CONCLUSION: Sonazoid-CEUS is a safe and accurate non-radioactive technique for SLN identification and preoperative diagnosis in patients with cutaneous melanoma; moreover, it exhibits potential value as a complementary imaging modality within established SLNB workflows.
KEY POINTS: Question Can a non-radioactive contrast-enhanced ultrasound technique using Sonazoid improve preoperative localization and characterization of sentinel lymph nodes in patients with cutaneous melanoma? Findings In this prospective study, Sonazoid-CEUS identified sentinel lymph nodes in 97.3% of patients and showed high diagnostic accuracy without contrast-related adverse events. Clinical relevance Sonazoid-CEUS provides a non-radioactive adjunct for preoperative sentinel lymph node mapping and characterization in cutaneous melanoma, thereby potentially improving surgical planning while offering complementary functional information alongside conventional lymphoscintigraphy.
MATERIALS AND METHODS: In this prospective single-arm cohort study, 71 eligible subjects underwent perilesional intradermal Sonazoid-CEUS, followed by lymphoscintigraphy and SLN biopsy. The numbers of SLNs detected via CEUS and lymphoscintigraphy were compared by using non-parametric paired analysis (Wilcoxon signed-rank test). The diagnostic accuracy of CEUS for metastatic involvement was evaluated against histopathological results.
RESULTS: Sonazoid-CEUS achieved a 97.3% success rate in identifying SLNs, detecting 148 SLNs, with an average of 2.1 ± 1.1 SLNs per patient. Most patients (93.0%) had single-basin lymphatic drainage. For metastasis detection, CEUS demonstrated 82.1% sensitivity, 88.4% specificity, and 85.9% accuracy. Ulceration, high mitotic count, and HMB45 positivity in primary lesions were significantly associated with SLN metastasis. No contrast-related adverse events were observed.
CONCLUSION: Sonazoid-CEUS is a safe and accurate non-radioactive technique for SLN identification and preoperative diagnosis in patients with cutaneous melanoma; moreover, it exhibits potential value as a complementary imaging modality within established SLNB workflows.
KEY POINTS: Question Can a non-radioactive contrast-enhanced ultrasound technique using Sonazoid improve preoperative localization and characterization of sentinel lymph nodes in patients with cutaneous melanoma? Findings In this prospective study, Sonazoid-CEUS identified sentinel lymph nodes in 97.3% of patients and showed high diagnostic accuracy without contrast-related adverse events. Clinical relevance Sonazoid-CEUS provides a non-radioactive adjunct for preoperative sentinel lymph node mapping and characterization in cutaneous melanoma, thereby potentially improving surgical planning while offering complementary functional information alongside conventional lymphoscintigraphy.