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

Zhu, Anqi; Li, Xiao‐Long; An, Liwei; Guo, Le‐Hang; Fu, Hui‐Jun; Sun, Liping; Xu, Hui‐Xiong

doi:10.1002/jum.15314

Cited by 13 publications

(21 citation statements)

References 26 publications

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“…Metastatic LNs often exhibit heterogeneous enhancement, slight enhancement, or no enhancement. The sensitivity, specificity, positive predictive value, and negative predictive value were 82%, 91%, 78%, and 92%, which was consistent with the findings of relevant studies (24)(25)(26).…”

Section: Discussionsupporting

confidence: 89%

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

et al. 2021

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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.

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Section: Discussionsupporting

confidence: 89%

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

et al. 2021

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“…A previous study revealed that tumor staging was an independent predictor of breast cancer LN metastasis ( 30 ). A tumor size of 20 mm or greater on ultrasound was an independent predictor of LN metastasis ( 31 ). In the present study, however, there was no significant difference in the number of tumors evaluated as T1 and T2/T3 in LN-positive and -negative groups ( p = 0.340), which was similar to the results of the previous study; that is, tumor size on ultrasound was not an independent predictor of axillary LN metastasis ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

Comprehensive Risk System Based on Shear Wave Elastography and BI-RADS Categories in Assessing Axillary Lymph Node Metastasis of Invasive Breast Cancer—A Multicenter Study

et al. 2022

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PurposeTo develop a risk stratification system that can predict axillary lymph node (LN) metastasis in invasive breast cancer based on the combination of shear wave elastography (SWE) and conventional ultrasound.Materials and MethodsA total of 619 participants pathologically diagnosed with invasive breast cancer underwent breast ultrasound examinations were recruited from a multicenter of 17 hospitals in China from August 2016 to August 2017. Conventional ultrasound and SWE features were compared between positive and negative LN metastasis groups. The regression equation, the weighting, and the counting methods were used to predict axillary LN metastasis. The sensitivity, specificity, and the areas under the receiver operating characteristic curve (AUC) were calculated.ResultsA significant difference was found in the Breast Imaging Reporting and Data System (BI-RADS) category, the “stiff rim” sign, minimum elastic modulusof the internal tumor and peritumor region of 3 mm between positive and negative LN groups (p < 0.05 for all). There was no significant difference in the diagnostic performance of the regression equation, the weighting, and the counting methods (p > 0.05 for all). Using the counting method, a 0–4 grade risk stratification system based on the four characteristics was established, which yielded an AUC of 0.656 (95% CI, 0.617–0.693, p < 0.001), a sensitivity of 54.60% (95% CI, 46.9%–62.1%), and a specificity of 68.99% (95% CI, 64.5%–73.3%) in predicting axillary LN metastasis.ConclusionA 0–4 grade risk stratification system was developed based on SWE characteristics and BI-RADS categories, and this system has the potential to predict axillary LN metastases in invasive breast cancer.

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“…19 CEUS is an emerging imaging technology that provides more diagnostic information compared with conventional grayscale ultrasound. 20 CEUS perfusion parameters were found to correlate with vascular endothelial growth factor (VEGF) expression and predictors of poor prognosis, 21 in addition, it can provide excellent predictive value for high-grade malignancy of BC and might help to determine appropriate therapeutic strategies. 22 Although previous studies have explored the correlation between CEUS characteristics and certain histopathological features of BC, 23,24 few studies have focused on the identification of BC molecular subtypes based on CEUS characteristics.…”

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confidence: 99%

“…In addition, some studies have shown that CEUS can make up for the limitations of color Doppler ultrasound in terms of tumor microvascular differentiation, and realize the possibility of a more precise and even functional diagnosis 19 . CEUS is an emerging imaging technology that provides more diagnostic information compared with conventional gray‐scale ultrasound 20 . CEUS perfusion parameters were found to correlate with vascular endothelial growth factor (VEGF) expression and predictors of poor prognosis, 21 in addition, it can provide excellent predictive value for high‐grade malignancy of BC and might help to determine appropriate therapeutic strategies 22 .…”

mentioning

confidence: 99%

Association Between Contrast‐Enhanced Ultrasound Characteristics and Molecular Subtypes of Breast Cancer

Wen

Kong

Zhang

et al. 2021

J of Ultrasound Medicine

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Objective This study aimed to investigate the correlation between contrast‐enhanced ultrasound (CEUS) features and molecular subtypes of breast cancer (BC). Methods A total of 116 patients (116 lesions) with pathologically diagnosed BC who received conventional ultrasound and CEUS before surgery were enrolled in this study. BC molecular subtypes were identified by postoperative pathological and immunohistochemical analysis as Luminal A (LA), Luminal B (LB), HER2 (H2) over‐expression, and triple‐negative (TN). Qualitative and quantitative CEUS characteristics were analyzed by one‐way analysis of variance (continuous variables) or Pearson's χ2 test or Fisher's exact probability method (categorical variables). Results There were significant differences in enhancement speed and enhancement degree among the four subtypes (P < .05). The area under the curve (AUC), time to peak (TTP), and peak intensity (PI) differed among the four subtypes (P < .05). The AUC of the LA subtype (305.1 ± 188.4) was significantly smaller compared with the H2 (535.7 ± 222.0, P = .007) and TN subtypes (496.6 ± 254.7, P = .019). In addition, TTP was shorter in the H2 subtype (19.8 ± 4.9) compared with the other subtypes, and was significantly shorter than in the LA subtype (26.3 ± 7.2, P = .008) and LB subtype (23.1 ± 6.7, P = .036). The PI of the LA subtype (4.7 ± 2.3) was significantly lower than that of the LB (6.6 ± 2.3, P = .027), H2 (7.4 ± 2.2, P = .005), and TN subtypes (6.9 ± 2.6, P = .014). Conclusions CEUS features differed significantly among different molecular subtypes of BC. The enhancement patterns and parameters may be important predictive features of different subtypes of BC.

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

Cited by 13 publications

References 26 publications

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

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

Comprehensive Risk System Based on Shear Wave Elastography and BI-RADS Categories in Assessing Axillary Lymph Node Metastasis of Invasive Breast Cancer—A Multicenter Study

Association Between Contrast‐Enhanced Ultrasound Characteristics and Molecular Subtypes of Breast Cancer

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