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Pathological results served as the gold standard. Multivariate logistic regression analysis was used to identify independent risk factors for SLN metastasis. Areas under the receiver-operating characteristic curve (AUC) were used to evaluate the ability of CEUS to diagnose SLN metastasis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      134 patients were enrolled (CEUS Group: 76 patients, Blue Staining Group: 58 patients). CEUS Group achieved a 100.0% success rate in detecting SLNs, with identifying a median of 1 SLN, while Blue Staining Group identifying a median of 4 SLNs per case (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). CEUS enhancement pattern was the only factor independently linked to SLN metastasis (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), showing a sensitivity of 90.5% and a specificity of 94.5%. The AUC for identifying SLN metastasis was 0.925.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CEUS enhancement pattern is helpful to determine the SLN metastasis. Preoperative CEUS, combined with MB injections into lymph nodes and intracutaneous ICG injections during surgery, provides a reliable method for localizing SLNs. This approach minimizes the risk of non-SLNs excisions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Despite the critical role of sentinel lymph node (SLN) detection in surgical outcomes, current preoperative imaging-guided SLN tracing remains in the exploratory stage.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Contrast-enhanced (CE) US achieved 100% SLN detection success with fewer non-target lymph nodes excised versus blue dye, demonstrating superior sensitivity and specificity metastatic prediction.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Preoperative SLN-CEUS, combined with intralymphatic methylene blue injection and intracutaneous indocyanine green administration during surgery, enables precise SLN identification and metastasis prediction. This approach minimizes the risk of unnecessary non-SLN resection during SLNB.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-025-11932-3","type":"journal-article","created":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T18:17:44Z","timestamp":1755800264000},"page":"863-873","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Preoperative contrast-enhanced ultrasound combined with intra-lymph node methylene blue injection for sentinel lymph node identification: a minimally invasive sentinel lymph node biopsy tracing approach"],"prefix":"10.1007","volume":"36","author":[{"given":"Yang","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjie","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tielin","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuang","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7666-8459","authenticated-orcid":false,"given":"Ying","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,21]]},"reference":[{"key":"11932_CR1","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1016\/j.canlet.2017.04.024","volume":"401","author":"W Chen","year":"2017","unstructured":"Chen W, Zheng R, Zhang S et al (2017) Cancer incidence and mortality in China, 2013. 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