Article Data

  • Views 1167
  • Dowloads 154

Original Research

Open Access

Diagnostic potential of conventional ultrasonography combined with elastography in assessing the properties of axillary lymph nodes in breast cancer

  • Yingbin Chen1
  • Jun Chang1,*,
  • Na Chen1
  • Jingjing Qiao1
  • Xiaoli Lu1
  • Congyan Xia1

1Department of Ultrasound Medicine, Nanjing First Hospital, Nanjing Medical University, 210001 Nanjing, Jiangsu, China

DOI: 10.22514/ejgo.2023.102 Vol.44,Issue 6,December 2023 pp.81-85

Submitted: 04 July 2023 Accepted: 22 September 2023

Published: 15 December 2023

*Corresponding Author(s): Jun Chang E-mail: cj04_dr@163.com

Abstract

This study was done to assess the potential of conventional ultrasound combined with ultrasound elastography (UE) for diagnosing the nature of lymph nodes in breast cancer. The study included 45 breast cancer patients who underwent axillary lymph node dissection. Routine ultrasound and UE were conducted one week before the surgery. Logistic regression analysis was used to examine the factors that influence the nature of axillary lymph nodes. It also assessed whether patients with breast cancer needed axillary lymph node dissection. Forty-five breast cancer patients underwent axillary lymph node dissection and were diagnosed by surgical pathology as 20 metastatic and 25 reactive axillary lymph nodes. Statistically significant differences from univariate analysis were found between the metastatic and reactive lymph nodes in breast cancer patients regarding length to short axis ratio (L/S), cortical thickness, lymph node grading, blood flow type, and elasticity score. Breast cancer lymph node metastases were associated with the variables included by univariate analysis into the binary logistic regression model (p < 0.05). Logistic regression model: Logit (p) = −1.894 + 1.554X1 + 0.789X3 + 2.174X4. Plotting the receiver operating characteristic (ROC) curve revealed that the area under the curve (AUC) of the regression model for diagnosing metastatic lymph nodes in breast cancer was: 0.880, 95% Confidence Interval (0.783–0.977), and the performance was good.


Keywords

Breast cancer; Lymph nodes; Conventional ultrasound; Ultrasound elastography; Application value


Cite and Share

Yingbin Chen, Jun Chang,Na Chen,Jingjing Qiao,Xiaoli Lu,Congyan Xia. Diagnostic potential of conventional ultrasonography combined with elastography in assessing the properties of axillary lymph nodes in breast cancer. European Journal of Gynaecological Oncology. 2023. 44(6);81-85.

References

[1] Cao S, Liu X, Cui J, Liu X, Zhong J, Yang Z, et al. Feasibility and reliability of sentinel lymph node biopsy after neoadjuvant chemotherapy in breast cancer patients with positive axillary nodes at initial diagnosis: an up-to-date meta-analysis of 3,578 patients. The Breast. 2021; 59: 256–269.

[2] Ferroni G, Sabeti S, Abdus-Shakur T, Scalise L, Carter JM, Fazzio RT, et al. Noninvasive prediction of axillary lymph node breast cancer metastasis using morphometric analysis of nodal tumor microvessels in a contrast-free ultrasound approach. Breast Cancer Research. 2023; 25: 65.

[3] Zhang L, Wang XZ, Li C, Yu Q, Liu Z, Yu ZY. Contralateral axillary lymph node metastasis of breast cancer: retrospective analysis and literature review. Frontiers in Oncology. 2022; 12: 869397.

[4] Yur M, Aygen E, İlhan YS, Lale A, Ebiloğlu MF. The effect of the tumor-to-skin distance on axillary lymph node metastasis in breast cancer. Revista da Associação Médica Brasileira. 2023; 69: e20221277.

[5] Haraguchi T, Goto Y, Furuya Y, Nagai MT, Kanemaki Y, Tsugawa K, et al. Use of machine learning with two-dimensional synthetic mammography for axillary lymph node metastasis prediction in breast cancer: a preliminary study. Translational Cancer Research. 2023; 12: 1232–1240.

[6] Holt AC, Haji F, McCloskey S, Baker JL. De-escalation of surgery for occult breast cancer with axillary metastasis. Surgery. 2023; 174: 410–412.

[7] Zhou J, Zhang Q, Zhang Q, Yan L, Gao Q. Evaluation of the property of axillary lymph nodes and analysis of lymph node metastasis factors in breast cancer by ultrasound elastography. Computational and Mathematical Methods in Medicine. 2022; 2022: 1–7.

[8] Zhu Y, Jia Y, Pang W, Duan Y, Chen K, Nie F. Ultrasound contrast-enhanced patterns of sentinel lymph nodes: predictive value for nodal status and metastatic burden in early breast cancer. Quantitative Imaging in Medicine and Surgery. 2023; 13: 160–170.

[9] Luo C, Lu L, Zhang W, Li X, Zhou P, Ran Z. 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. Frontiers in Oncology. 2022; 12: 846568.

[10] Huang XW, Huang QX, Huang H, Cheng MQ, Tong WJ, Xian MF, et al. Diagnostic performance of quantitative and qualitative elastography for axillary lymph node metastasis in breast cancer: a systematic review and meta-analysis. Frontiers in Oncology. 2020; 10: 552177.

[11] Li B, Zhao X, Wang Q, Jing H, Shao H, Zhang L, et al. Prediction of high nodal burden in invasive breast cancer by quantitative shear wave elastography. Quantitative Imaging in Medicine and Surgery. 2022; 12: 1336–1347.

[12] Pan H, Zhang Q, Wu W, Li X. Preoperative neoadjuvant chemotherapy in patients with breast cancer evaluated using strain ultrasonic elastography. World Journal of Clinical Cases. 2022; 10: 7293–7301.

[13] Adler DD, Carson PL, Rubin JM, Quinn-Reid D. Doppler ultrasound color flow imaging in the study of breast cancer: preliminary findings. Ultrasound in Medicine & Biology. 1990; 16: 553–559.

[14] Choi JJ, Kang BJ, Kim SH, Lee JH, Jeong SH, Yim HW, et al. Role of sonographic elastography in the differential diagnosis of axillary lymph nodes in breast cancer. Journal of Ultrasound in Medicine. 2011; 30: 429–436.

[15] Giammarile F, Vidal-Sicart S, Paez D, Pellet O, Enrique E, Mikhail-Lette M, et al. Sentinel lymph node methods in breast cancer. Seminars in Nuclear Medicine. 2022; 52: 551–560.

[16] Morrissey SM, Zhang F, Ding C, Montoya-Durango DE, Hu X, Yang C, et al. Tumor-derived exosomes drive immunosuppressive macrophages in a pre-metastatic niche through glycolytic dominant metabolic reprogramming. Cell Metabolism. 2021; 33: 2040–2058.e10.

[17] Di Paola V, Mazzotta G, Conti M, Palma S, Orsini F, Mola L, et al. Image-guided localization techniques for metastatic axillary lymph nodes in breast cancer; what radiologists should know. Cancers. 2023; 15: 2130.

[18] Liu T, Liu C, Yan M, Zhang L, Zhang J, Xiao M, et al. Single cell profiling of primary and paired metastatic lymph node tumors in breast cancer patients. Nature Communications. 2022; 13: 6823.

[19] Luo SY, Yao GY, Hong Z, Zhang SY, Wang WZ, Zhang JW, et al. Qualitative classification of shear wave elastography for differential diagnosis between benign and metastatic axillary lymph nodes in breast cancer. Frontiers in Oncology. 2019; 9: 533.

[20] Salama AMF, Nawar AM, Zayed ME, Essa MS. Evaluation of ultrasonic axillary dissection in preservation of intercostobrachial nerve and lymphatic sealing in breast cancer patients: randomized controlled trial. Annals of Medicine and Surgery. 2020; 60: 255–260.

[21] Vasigh M, Meshkati Yazd SM, Karoobi M, Hajebi R, Yazdankhah Kenari A. Does ultrasound evaluation of the axilla increase the rate of axillary lymph node dissection in early stage clinically node negative breast cancer patients? BMC Surgery. 2022; 22: 80.

[22] Cui QX, Dai L, Li JL, Shen Y, Tao HJ, Zhou XF, et al. Contrast-enhanced ultrasound-guided sentinel lymph node biopsy in early-stage breast cancer: a prospective cohort study. World Journal of Surgical Oncology. 2023; 21: 143.

[23] Xu Y, Liu X, Zhu Y, Lu H. Preoperative localization of sentinel lymph nodes using percutaneous contrast-enhanced ultrasonography in patients with breast cancer. Gland Surgery. 2022; 11: 369–377.

[24] Zhang L, Jia Z, Leng X, Ma F. Artificial intelligence algorithm-based ultrasound image segmentation technology in the diagnosis of breast cancer axillary lymph node metastasis. Journal of Healthcare Engineering. 2021; 2021: 1–8.

[25] Zhu XQ, Lu P, Xu ZL, Zhou Q, Zhang J, Wang ZB, et al. Alterations in immune response profile of tumor-draining lymph nodes after high-intensity focused ultrasound ablation of breast cancer patients. Cells. 2021; 10: 3346.

[26] Du L, Liu H, Gong H, Ling L, Wang S, Li C, et al. Adding contrast-enhanced ultrasound markers to conventional axillary ultrasound improves specificity for predicting axillary lymph node metastasis in patients with breast cancer. The British Journal of Radiology. 2021; 94: 20200874.

[27] Chen B, Jiang Y, Luo C, Bao Y, Tan N, Li T, et al. Significant efficacy of paclitaxel plus carboplatin (TP) as a neoadjuvant regimen for metaplastic squamous cell carcinoma of the breast: a rare case report and literature review. Translational Cancer Research. 2022; 11: 2953–2959.

[28] Wang J, Ben Z, Gao S, Lyu S, Wei X. The role of ultrasound elastography and virtual touch tissue imaging in the personalized prediction of lymph node metastasis of breast cancer. Gland Surgery. 2021; 10: 1460–1469.

[29] Song KH, Stein EW, Margenthaler JA, Wang LV. Noninvasive photoacoustic identification of sentinel lymph nodes containing methylene blue in vivo in a rat model. Journal of Biomedical Optics. 2008; 13: 054033.

[30] Gu L, Zhang R, Wang Y, Liu X, Ma F, Wang J, et al. Characteristics of contrast-enhanced ultrasonography and strain elastography of locally advanced breast cancer. Journal of Thoracic Disease. 2019; 11: 5274–5289.


Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.

Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.

JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Submission Turnaround Time

Conferences

Top