Breast cancer: comparison of quantitative dual-layer spectral CT and axillary ultrasonography for preoperative diagnosis of metastatic axillary lymph nodes

Abstract

Background Our aim was to compare the diagnostic performance of quantitative dual-layer spectral computed tomography (DLSCT) and axillary ultrasound (US) for diagnosing lymph node metastases in breast cancer patients. Methods DLSCT and axillary US were prospectively performed in 70 needle biopsy-verified breast cancer patients. Histopathology and imaging data were available for evaluation in 36 axillae from 34 patients. In each patient, ipsilateral, contralateral, and inguinal lymph nodes (LNs) were semiautomatically segmented, and iodine density, spectral slope, Z effective, virtual non-contrast (VNC), conventional CT HU values, and Δ contrast enhancement (ΔCE, conventional CT HU minus VNC) were measured. Using histopathology as reference, the diagnostic performance of DLSCT and axillary US was compared. Results Of 36 axillae, 23 had metastatic lymph nodes. Compared with non-metastatic LNs, metastatic LNs had significantly different iodine density (p = 0.021), spectral slope (p < 0.001), Z effective (p < 0.001), conventional CT HU values (p < 0.01), and ΔCE (p < 0.01). All DLSCT parameters were significantly different between arterial phase and portal-venous phase (p < 0.001) except for VNC (p = 0.092). ΔCE had the highest diagnostic performance (sensitivity 0.79, specificity 0.92, positive predictive value 0.95, negative predictive value 0.69) with a significantly increased sensitivity compared with conventional CT HU (p = 0.027). There were no significant differences between ΔCE and axillary US for sensitivity (p = 1.000) or specificity (p = 0.320). Conclusions DLSCT is a promising quantitative technique for evaluating LN metastases and could potentially reduce the need for sentinel LN biopsy.

Spectral CT - a new supplementary method for preoperative assessment of pathological grades of esophageal squamous cell carcinoma

“…Additionally, Eff-Z, another quantitative index for different materials which represents the composite atom for a compound or mixture of various materials and is important to predict how x-rays interact with a substance [7], was analyzed in the current study. Previous studies have indicated that Eff-Z could depict lesion characterization and could be used to differentiate tumors[16, [23][24][25]. In our study, the same conclusions were reached.…”

Different Imaging Modalities for the Diagnosis of Axillary Lymph Node Metastases in Breast Cancer: A Systematic Review and Network Meta‐Analysis of Diagnostic Test Accuracy

“…One thousand two hundred and thirty‐seven duplicate records were removed. After screening 2631 titles and abstracts and 94 full texts, 61 articles 15,17–26,41–90 proved eligible. The detail of the study selection process is illustrated in Fig.…”

Dual‐Energy CT in Breast Cancer: Current Applications and Future Outlooks

“…In a study, 12 the online arterial phase λ Hu and NIC, the venous phase λ Hu , NIC, and nZeff of metastatic sentinel lymph node were higher than those of nonmetastatic sentinel lymph nodes. Other studies 12,19 have also shown that λ Hu at venous phase obtained through DECT had a high diagnostic performance for the preoperative diagnosis of sentinel lymph node metastases in participants with breast cancer. Zhang et al 15 also found axillary lymph node metastasis and primary tumor λ Hu were basically the same.…”