A Risk Model based on Ultrasound, Ultrasound Elastography, and Histologic Parameters for Predicting Axillary Lymph Node Metastasis in Breast Invasive Ductal Carcinoma

Abstract

To develop a risk model for predicting axillary lymph node metastasis (LNM) in patients with breast invasive ductal carcinoma (IDCs) using ultrasound (US), US elastography of virtual touch tissue imaging (VTI) and virtual touch tissue imaging & quantification (VTIQ), and histologic parameters. This study included 162 breast IDCs in 162 patients. Univariate and multivariate analyses were used to identify the risk factors and a risk model was created. The results found that 64 (39.5%) of 162 patients had axillary LNMs. The risk score (RS) for axillary LNM was defined as following: RS = 1.3 × (if lesion size ≥20 mm) + 2.6 × (if taller than wide shape) + 2.2 × (if VTI score ≥5) + 3.9 × (if histological grade III) + 1.9 × (if positive C-erbB-2). The rating system was divided into 6 stages (i.e. Stage I, Stage II, Stage III, Stage IV, Stage V, and Stage VI) and the associated risk rates in terms of axillary LNM were 0% (0/19), 6.1% (2/33), 7.7% (3/39), 65.5% (19/29), 92.3% (24/26), and 100% (16/16), respectively. The risk model for axillary LNM established in the study may facilitate subsequent treatment planning and management in patients with breast IDCs.

Predicting Axillary Lymph Node Metastasis in Patients With Breast Invasive Ductal Carcinoma With Negative Axillary Ultrasound Results Using Conventional Ultrasound and Contrast‐Enhanced Ultrasound

“…This study systemically evaluated 25 clinical characteristics, US features, and CEUS qualitative and quantitative features as potential predictors of ALNM. The univariate and multivariate analyses revealed that a lesion size of 20 mm or greater and an uncircumscribed margin on conventional US were significantly related to ALNM, which were consistent with previous studies . Lesion size and advancement of the lesion edge represent an invasive growth pattern, a rapidly growing and highly malignant tendency.…”

“…As for the RS, the results indicated that patients at stage I were expected to have no ALND. The possibility of ALNM was probably low in patients at stages II and III, but combining other risk factors such as a taller‐than‐wide shape and rich internal flow, reported by previous studies, might be helpful for deciding the strategy of ALND. For stage IV patients, we supposed that the patients should undergo ALND.…”

“…For the conventional US scans, the target lesion was evaluated for tissue composition patterns (homogeneous background echo texture–fat, homogeneous background echo texture–fibroglandular, and heterogeneous background echo texture), lesion size (whether the largest diameter was <20 mm), shape (regular or irregular), margin (circumscribed [distinct borderline between adjacent normal tissue and the tumor] or uncircumscribed, [the boundary was indistinct, angular, microlobular, or spiculated]), orientation (parallel or not parallel compared with skin), internal homogeneity (homogeneous or inhomogeneous), microcalcification (<0.5 mm in diameter), posterior acoustic features (no features, enhancement, or shadowing), echogenic halo (present or absent), and internal flow on color Doppler imaging (rich internal flow [>3 linear or treelike signals] or rare internal flow [dotted signals or no signals on color Doppler imaging]; Table ) …”

Nomograms for Predicting Axillary Lymph Node Status Reconciled With Preoperative Breast Ultrasound Images

“…Moreover, if the breast tumor was not accompanied by any of the above conditions and the ALNs were predicted to be negative, unnecessary preoperative core needle biopsy, SLNB or ALND may be avoided to a certain extent. Despite the rapid development of US technology, traditional US is still dominant and irreplaceable; at the same time, traditional US combined with clinicopathological characteristics for predicting ALN is currently the most practical and concise new method and is easier to perform and more stable than the radiomics method or elastography ( 33 , 34 ). In particular, US is a noninvasive and routine method for evaluating breast cancer and can be widely used, even in some underdeveloped areas.…”

Predicting Axillary Lymph Node Status With a Nomogram Based on Breast Lesion Ultrasound Features: Performance in N1 Breast Cancer Patients

“…Previous studies have demonstrated that some ultrasonic features of breast lesions, such as tumor size, margin, and location might be associated with breast cancer nodal metastases and thus can help predict ALN status (10)(11)(12)(13). However, in those studies, US findings and tumor clinicopathologic characteristics were simultaneously incorporated to predict ALN metastases (11)(12)(13), or a risk model was developed for predicting ALN metastases in a subgroup of patients with invasive ductal carcinoma (10,11,13). Considering that the clinicopathologic characteristics, such as histological type, histological grade, and molecular subtype, might directly be related to the probability of ALN metastases, it is necessary to explore the independent contributions of breast lesion US features in determining the likelihood of positive lymph nodes in a preoperative patient population.…”