Diagnostic Performance of Quantitative and Qualitative Elastography for Axillary Lymph Node Metastasis in Breast Cancer: A Systematic Review and Meta-Analysis

Abstract

Background: Studies have shown inconsistent results regarding the diagnostic performance of ultrasound elastography for axillary lymph node metastasis (ALNM) in breast cancer. This meta-analysis aimed to estimate the diagnostic performance of ultrasound elastography (divided into quantitative and qualitative elastography) for ALNM in patients with breast cancer. Methods: The PubMed and Embase databases were searched for eligible studies exploring the diagnostic performance of ultrasound elastography for ALNM in patients with breast cancer. The included studies were divided into quantitative and qualitative elastography groups to perform separate meta-analyses. The diagnostic performance was investigated with pooled sensitivity and specificity and diagnostic odds ratio (DOR) using a bivariate mixed-effects regression model. A summary receiver operating characteristic curve was constructed, and the area under the curve (AUC) was calculated. Results: Seven and 11 studies were included in the quantitative and qualitative elastography meta-analyses, respectively. The pooled sensitivity and specificity, DOR, and AUC with their corresponding 95% confidence intervals were 0.82 (0.75, 0.87), 0.88 (0.78, 0.93), 33 (13, 83), and 0.89 (0.86, 0.91), respectively, for quantitative elastography and 0.81 (0.69, 0.89), 0.92 (0.79, 0.97), 46 (12, 181), and 0.92 (0.89, 0.94), respectively, for qualitative elastography. No significant publication bias existed. Fagan plots demonstrated good clinical utility. However, substantial heterogeneity existed among studies. Study design, measurement, and reference standard served as potential sources of heterogeneity for quantitative studies, which were measurement and reference standard for qualitative studies. Conclusions: Both quantitative and qualitative elastography seem to be feasible, non-invasive diagnostic tools for ALNM in breast cancer. Nevertheless, the results Huang et al. Meta-Analysis of Elastography for ALNM must be interpreted carefully, paying attention to heterogeneity issues, especially for quantitative elastography studies.

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

“…The sensitivity of C-US was 82%, while its specificity was 75%. Previous studies have similarly reported C-US sensitivity and specificity values of 80% and 71%, respectively (17). This may be closely related to the pathological basis of LNs: (a) Normal LNs are often characterized by lymphatic hilum structures (e.g., hyperechoic medullary tissue), homogeneous echogenicity, and portal blood flow signal; however, when LN metastasis first begins, invasion first occurs in the marginal lymph sinus in the subscapular area through the input lymphatic vessels, resulting in abnormal proliferation of the marginal sinus, which gradually widens and thickens the cortex.…”

Diagnostic performance of elastography for breast non-mass lesions: A systematic review and meta-analysis

“…The cut-off value of these parameters in each study also differed, potentially resulting in heterogeneity. Qualitative measurement indexes involve naked-eye evaluation of the hard area ratio, and thus are operator-dependent [30]. In contrast, quantitative measurement indexes assess tissue stiffness with specific numerical data, providing objective assessment for clinical practice.…”

Ultrasound Elastography for the Evaluation of Lymph Nodes

“…However, a meta-analysis compared the diagnostic performance of qualitative elastography with quantitative elastography for ALNM in breast cancer and found that quantitative and qualitative elastography had similar diagnostic performance and good clinical utility (32). More studies with SWE should be conducted to get more reliable cutoff values of SWV and elastic value ratio in different sites.…”