Enhanced pre-operative axillary staging using intradermal microbubbles and contrast-enhanced ultrasound to detect biopsy sentinel lymph nodes in breast cancer: does molecular subtype matter?

To The Editor,

I want to congratulate Cox and colleagues for their article¹ in which they compare the experience of four UK centres in the use of intradermal microbubbles and contrast-enhanced ultrasound (CEUS) to pre-operatively identify and biopsy sentinel lymph nodes in patients with breast cancer. They concluded that the identification and biopsy of sentinel lymph nodes using CEUS is a reproducible technique. Reyal et al² investigated the interaction between molecular subtypes and the probability of a positive sentinel node biopsy in breast cancer patients. They found that tumour size, lymphovascular invasion, molecular subtypes and age at diagnosis were determinants for the probability of sentinel node positivity. Therefore, it would be interesting to know whether outcome of CEUS for identification of sentinel lymph node detection is affected by molecular subtype in the current study.