Clinical Value of Three Combined Ultrasonography Modalities in Predicting the Risk of Metastasis to Axillary Lymph Nodes in Breast Invasive Ductal Carcinoma

Abstract

ObjectiveThe present study aimed to assess the clinical value of conventional ultrasound (C-US), ultrasound elastography (UE), percutaneous contrast-enhanced ultrasound (P-CUES), and the combination of these three ultrasonography modalities for evaluating the risk of axillary lymph node (ALN) metastasis in breast invasive ductal carcinoma (IDC).MethodsThis retrospective analysis included 120 patients with pathologically confirmed IDC who underwent sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND). Based on the gold standard of postoperative pathology, ALN pathology results were evaluated and compared with findings obtained using C-US, UE, P-CUES, and the three modalities combined.Results(1) There was a statistically significant difference between the histological grade of the tumor and the pathological condition of ALNs. (2) The difference between C-US parameters and UE score were statistically significant. The accuracy of P-CEUS localization of SLNs was 100% (96/96) when compared with localization guided by methylene blue. The difference in the distribution of the four SLN enhancement patterns was statistically significant. (3) The sensitivity, specificity, positive predictive value, and negative predictive value of C-US and UE were 75%, 71%, 58%, and 89%, and 71%, 72%, 50%, and 86%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of P-CUES were 91%, 82%, 78%, 92%, respectively. When all three modalities were combined, the sensitivity, specificity, positive predictive value, and negative predictive value were 94%, 89%, 86%, and 95%, respectively. In the detection of ALN metastasis, there was a good correlation between histopathological results and evaluations based on the three combined ultrasonography modalities (kappa: 0.82, p<0.001).ConclusionsWhen compared to C-US, UE, or P-CEUS alone, the combination of the three ultrasonography modalities was found to be superior in distinguishing metastatic and non-metastatic ALNs. This combined strategy may aid physicians in determining the most appropriate approach to ALN surgery as well as the prognosis of breast IDC.

Accuracy and Utility of Preoperative Ultrasound-Guided Axillary Lymph Node Biopsy for Invasive Breast Cancer: A Systematic Review and Meta-Analysis

“…By comparing with the status of biopsy lymph nodes, it is concluded that the accuracy of ultrasound diagnosis of the supraclavicular region, suspicious supraclavicular lymph nodes, and the IM region is more than 93%, and the overall accuracy of other imaging examinations is lower than that of ultrasound. Zhang et al [ 48 ] compared three ultrasound techniques to detect and predict the risk of axillary lymph node (AlN) metastasis of breast invasive ductal carcinoma. They found that when conventional ultrasound (C-US), ultrasonic elastography (UE), and percutaneous contrast-enhanced ultrasound (P-CUES) were combined, their sensitivity, specificity, positive predictive value, and negative predictive value were 94%, 89%, 86%, and 95%, respectively, which were higher than the detection and prediction results.…”

The Value of Shear Wave Elastography in the Diagnosis of Breast Cancer Axillary Lymph Node Metastasis and Its Correlation With Molecular Classification of Breast Masses

“…A score was evaluated based on the aspect ratio and the short axis diameter of the lymph node ( 42 ). Plus, the maximum value (Emax), average value (Emean), and minimum value (Emin) of Young’s modulus were assessed by SWE, and a static image was kept ( 43 , 44 ). Afterwards, univariate analysis was performed using ALN metastasis as a dependent variable and the CUE scores.…”

Differentiation Between Granulomatous Lobular Mastitis and Breast Cancer Using Quantitative Parameters on Contrast-Enhanced Ultrasound

“…The kinetic parameters of tumor tissue in CEUS can also be quantified by generating the time-intensity (T/I) curve with specialized software. Several studies have shown that CEUS can help distinguish between benign and malignant breast lesions (5)(6)(7). Because the current imaging modalities are not sufficient to establish a definitive diagnosis of GLM in most patients.…”