The value of quantitative shear wave elastography combined with conventional ultrasound in evaluating and guiding fine needle aspiration biopsy of axillary lymph node for early breast cancer: implication for axillary surgical stage

Abstract

Objectives To investigate the value of conventional ultrasonography (US) combined with quantitative shear wave elastography (SWE) in evaluating and identifying target axillary lymph node (TALN) for fine needle aspiration biopsy (FNAB) of early breast cancer patients. Materials and methods A total of 222 patients with 223 ALNs were prospectively recruited from January 2018 to December 2021. All TALNs were evaluated by US, SWE and subsequently underwent FNAB. The diagnostic performances of US, SWE, two combination methods of US and SWE (“US or SWE” and “US and SWE”), and FNAB guided by the above four methods for evaluating ALN status were assessed using receiver operator characteristic curve analyses. Univariate and multivariate logistic regression analyses used to determine the independent predictors of axillary burden. Results The area under the ROC curve (AUC) for the ability of conventional US and SWE in diagnosing ALNs were 0.70 and 0.66, with a sensitivity of 78.00% and 65.00%, a specificity of 60.98% and 66.67%. Using the SWE to combined with US, the “US or SWE” achieved significantly improved sensitivity of 86.00%. The AUC of the “US or SWE”-guided FNAB [0.85 (95% CI, 0.80–0.90)] was significantly higher than that of US-guided FNAB [0.83 (95% CI, 0.78–0.88), p = 0.042], SWE-guided FNAB [0.79 (95% CI, 0.73–0.84), p = 0.001], and US and SWE-guided FNAB [0.77 (95% CI, 0.71–0.82), p < 0.001]. Multivariate logistic regression showed that FNAB and number of suspicious ALNs were found independent predictors of axillary burden in early breast cancer patients. Conclusion The "US or SWE" had superior sensitivity compared to US or SWE alone in ALN diagnosis. The "US or SWE"-guided FNAB achieved a lower false-negative rate compared to FNAB guided solely by US or SWE, which may be a promising tool for the preoperative diagnosis of ALNs in early breast cancer, and had the potential implication for the selection of axillary surgical modality.