Sentinel lymph node localization with contrast-enhanced ultrasound and an I-125 seed: An ideal prospective development study

M. W. Barentsz, H. M. Verkooijen, R. M. Pijnappel, M. A. Fernandez, P. J. van Diest, C. C. van der Pol, A. J. Witkamp, M. G.G. Hobbelink, A. R. Sever, M. A.A.J. van den Bosch

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Introduction: Our aim was to evaluate the development of microbubble-enhanced sentinel lymph node (SLN) localization with placement of an I-125 seed in breast cancer patients as a potential alternative for SLN localization with nanocolloid. The study is conducted and reported following the IDEAL recommendations for evaluation of a new technique at Stage 2a (Prospective Development Study). Methods: Fourteen consecutive patients with 15 lesions underwent microbubble-enhanced SLN localization with placement of an I-125 seed after the standard SLN localization (nanocolloid). We placed an I-125 seed within or near the SLN following its identification using intradermally injected microbubbles. The SLN was excised guided by nanocolloid and the SLN containing the I-125 seed was searched for. All technical modifications are described and standardized outcomes measured. Results: Twelve (80%) microbubble procedures with I-125 seed placements were technically successful. In three cases no microbubble-enhancing lymph node could be detected. Intraoperatively, we found nine I-125 seeds within 0.5cm of the nanocolloid confirmed SLN. One I-125 seed was found next to a non-SLN and two I-125 seeds were not near any lymph node. Overall, the procedure was successful in 60% (9 out of 15) of the cases. Conclusion: Given the low success rate, we conclude that microbubble-enhanced SLN is not a viable alternative to the standard SLN procedure. Modifications to this technique did not improve its performance. Planned study (NTR3690 was stopped early due to this conclusion and results reported in order to provide a full and transparent record of the evolution of technique.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalInternational Journal of Surgery
StatePublished - Feb 1 2015


  • Breast cancer
  • Contrast-enhanced ultrasound
  • IDEAL framework
  • Radioactive seed
  • Sentinel lymph node

ASJC Scopus subject areas

  • Surgery


Dive into the research topics of 'Sentinel lymph node localization with contrast-enhanced ultrasound and an I-125 seed: An ideal prospective development study'. Together they form a unique fingerprint.

Cite this