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The long-term effects of thermal ablation for benign thyroid nodules: a systematic review and meta-analysis
September 26, 2025Super-resolution ultrasound imaging of intranodal lymphatic sinuses for predicting sentinel lymph node metastasis in breast cancer: a preliminary study
| Background | Squamous cell carcinomas of unknown primary (SCCUP) are often Human Papillomavirus (HPV)-positive. Due to their small size, extensive surgical workup is required to locate the primary tumors. High-frequency transoral ultrasound (US) may provide improved visualization of these small tumors. Our study aimed to explore whether surgeon-performed intraoperative transoral US for patients with HPV-positive SCCUP could improve primary tumor detection during panendoscopy. |
| Authors | Xia S, Hua Q, Song Y, Yuan C, Zheng Y, Tao R, Xu J, Cai E, Zhang Y, Wu F, Guo W, Tian Y, Dong Y, Zhou J. |
| Journal | Eur Radiol. 2025 Oct;35(10):6079-6088. doi: 10.1007/s00330-025-11520-5 |
| Objectives | Accurate preoperative localization and characterization of sentinel lymph nodes (SLNs) is vital in breast cancer management. The application of super-resolution ultrasound (SRUS) imaging to visualize intranodal lymphatic sinuses for the prediction of SLN metastasis has yet to be investigated. The study aimed to assess the value of SRUS imaging of intranodal lymphatic sinuses in predicting SLN metastasis in breast cancer patients. |
| Methods | A total of 154 SLNs from 143 patients with breast cancer were prospectively included. All patients underwent conventional US of axillary lymph nodes and SRUS imaging of lymph sinus by percutaneous microbubble injection. Qualitative and quantitative analysis were performed for SRUS imaging, with qualitative analysis focusing on identifying perfusion defects and quantitative analysis including parameters such as lymphatic sinus density, sinus diameter, sinus distance, and lymph flow velocity. The areas under the receiver operating characteristic curve (AUC), sensitivity, and specificity were calculated for conventional US, SRUS, and combined conventional US and SRUS. |
| Results | Among the 154 SLNs, 73 were metastatic and 81 were reactive. In predicting metastatic SLNs, the AUC for SRUS (0.824; 95% CI: 0.761-0.888) was significantly higher than that for conventional US (0.661; 95% CI: 0.596-0.726) (p < 0.001). The combination of SRUS and conventional US achieved the highest AUC (0.844; 95% CI: 0.785-0.904), which was significantly higher than conventional US alone (p < 0.001), but not significantly different from SRUS alone (p = 0.2). |
| Conclusions | Imaging lymphatic sinuses by SRUS has the potential to predict metastatic SLNs in patients with breast cancer. |
| Key points | Super-resolution ultrasound showed better performance for predicting metastatic sentinel lymph nodes than conventional ultrasound.
Super-resolution ultrasound is a reliable tool to image lymphatic sinuses and characterize metastatic sentinel lymph nodes in patients with breast cancer. It helps diagnosis of lymph node status and clinical decision-making of breast cancer. |
| Link (DOI) | https://dx.doi.org/10.1007/s00330-025-11520-5 |
| Ultrasound speciality | Breast US |
Short-Review by:
Prof. Dr. Jose Luis del Cura
Department of Radiology
Donostia University Hospital
Spain
Strengths:
Use of a novel ultrasound technique, Super-resolution ultrasound, that uses contrast microbubbles for visualization of microvascular structures. This technique purportedly overcomes the limitations of traditional ultrasound in visualizing microvascular structures allowing for a more detailed depiction of microvascular structure and flow dynamics. The authors use the new technique to improve the role of US in a field, the sentinel-node biopsy, in which radioisotopes or colorants must be used to identify the sentinel nodule.
Weaknesses:
There is no comparison with the standard technique. Some exclusions make the setting of the study different from the usual clinical setting: authors exclude the cases in which no microbubble flow is detected in the lymph node due to lymphatic vessel obstruction, and also patients with excessively large or lax breast. These exclusions bias the study in favour of the studied technique. The diagnostic criteria have not been decided before the study, but after the logistic regression of their relationship with malignancy. This is a major source of bias that makes the study needing a validation.
Personally thinking:
The study opens a new area of investigation using a new and potentially promising new US technology, but the results are somewhat disappointing. The authors focus in their conclusions on the AUC to suggest the usefulness of the new technique, but actually, the sensitivity (actually the important parameter in SNB) is the same that conventional US. Although the authors state that the new technique offers significant diagnostic advantages over conventional US, they have demonstrated only a slight improvement in specificity, that has a lower importance here.
And the results need a validation due to the design of the study.
