Detecting Metastasis of Lymph Nodes and Predicting Aggressiveness in Patients With Breast Carcinomas

Abstract

Objective. The purpose of this study was to evaluate the contrast-enhanced ultrasonographic (CEUS) characteristics of metastatic lymph nodes (LNs) and to determine the correlation of CEUS parameters with the tumor aggressiveness in patients with breast cancer. Methods. Real-time gray scale CEUS of axillary LNs was preoperatively performed in 51 consecutive patients with breast carcinoma who were scheduled for axillary lymph node dissection. The CEUS characteristics assessed by a direct visualization method and quantification software were compared with pathologic findings. Expression of human epidermal growth factor receptor 2 (HER-2/neu) in the primary tumor was detected by immunohistochemical analysis. Correlation analysis of CEUS parameters with HER-2/neu expression and the LN stage was performed. Results. Of the LNs examined, 27 were metastatic, and 25 were diagnosed as reactive hyperplasia. Lymph nodes with metastasis were characterized by centripetal progress (66.7%) and a heterogeneous pattern (55.6%) or no or scarce perfusion (25.9%). However, LNs with nonmetastases were characterized by with centrifugal enhancement (56.0%) and a homogeneous pattern (80.0%). The difference between the hyperintense and hypointense regions was higher in metastatic LNs than nonmetastatic ones (P < .001). No significant differences were found in the arrival time, time to peak intensity, and peak intensity between the two groups. A histopathologic diagnosis could be predicted with sensitivity, specificity, and accuracy of 92.6%, 76.0%, and 84.6% respectively, by a standardized difference between maximum and minimum signal intensity (SI max -SI min ) value of 28. Human epidermal growth factor receptor 2 expression and the LN histopathologic stage were significantly associated with the SI max -SI min . In metastatic LNs, the relationship between the diagnostic sensitivity of CEUS and the transverse diameter of LNs remained statistically significant (P < .05). Conclusions. Noninvasive CEUS can play a role in discriminating metastatic from nonmetastatic LNs and predicting the aggressiveness in patients with breast cancer. Key words: breast neoplasm; contrast-enhanced ultrasonography; human epidermal growth factor receptor 2; lymph node metastasis; reactive hyperplasia lymph node. Abbreviations ALND, axillary lymph node dissection; AT, arrival time; CEUS, contrast-enhanced ultrasonography; HER-2/neu, human epidermal growth factor receptor 2; LN, lymph node; MRI, magnetic resonance imaging; PI, peak signal intensity; PT, time to peak intensity; ROC, receiver operating characteristic; SI max -SI min , difference between maximum and minimum signal intensity he detection of metastasis in lymph nodes (LNs) is critical for tumor staging and preoperative planning in patients with breast cancer. Because of the lack of accurate noninvasive methods for diagnosing LN metastasis, axillary lymph node dissection (ALND) is performed routinely in cases of invasive breast cancer.1 However, ALND is a costly procedure associated with various side ef...

The place of CEUS in distinguishing benign from malignant cervical lymph nodes: a prospective study

“…They underlined that even in metastatic nodes blood flow may be decreased due to vascular compression by neoplastic tissue, or vascular encasement. The blood in metastatic nodes may be affected also by encasement of the surrounding parenchyma [22]. This may explain the fact that peak intensity (DPI) varies widely among studies.…”

“…Other studies [22] showed no differences between CEUS parameters (DPI, TTP and AUC) in benign versus malignant nodes, but only for the difference between maximum and minimum signal intensity (SImax -SImin). According to Quifang et al [22] CEUS patterns differ considerably in benign versus malignant as nodes with metastases are vascularized with a heterogeneous centripetal enhancement pattern, and benign nodes have a homogenous centrifugal enhancement pattern.…”

“…According to Quifang et al [22] CEUS patterns differ considerably in benign versus malignant as nodes with metastases are vascularized with a heterogeneous centripetal enhancement pattern, and benign nodes have a homogenous centrifugal enhancement pattern. They underlined that even in metastatic nodes blood flow may be decreased due to vascular compression by neoplastic tissue, or vascular encasement.…”

“…We established the criteria we used for malignancy from existing literature [8,9,23,24] and we also established cutoff values for RI, PI, DPI and RBV, from our ROC analysis. When we compared the results from all three techniques used in our study, we demonstrated that the correct diagnosis of uncertain nodes after grey scale and Doppler US was significantly increased by adding CEUS.…”

Contrast-Enhanced Color Doppler Ultrasonography for Preoperative Evaluation of Sentinel Lymph Node in Breast Cancer Patients

“…It facilitates the estimation of blood volume variations in different regions of LNs, which is of importance for the radiologist in defining malignant features [17]. Breast cancer is known to have a higher microvessel density than benign lesions.…”