Abstract
BackgroundOur aim was to compare the diagnostic performance of quantitative dual-layer spectral computed tomography (DLSCT) and axillary ultrasound (US) for diagnosing lymph node metastases in breast cancer patients.MethodsDLSCT and axillary US were prospectively performed in 70 needle biopsy-verified breast cancer patients. Histopathology and imaging data were available for evaluation in 36 axillae from 34 patients. In each patient, ipsilateral, contralateral, and inguinal lymph nodes (LNs) were semiautomatically segmented, and iodine density, spectral slope, Z effective, virtual non-contrast (VNC), conventional CT HU values, and Δ contrast enhancement (ΔCE, conventional CT HU minus VNC) were measured. Using histopathology as reference, the diagnostic performance of DLSCT and axillary US was compared.ResultsOf 36 axillae, 23 had metastatic lymph nodes. Compared with non-metastatic LNs, metastatic LNs had significantly different iodine density (p = 0.021), spectral slope (p < 0.001), Z effective (p < 0.001), conventional CT HU values (p < 0.01), and ΔCE (p < 0.01). All DLSCT parameters were significantly different between arterial phase and portal-venous phase (p < 0.001) except for VNC (p = 0.092). ΔCE had the highest diagnostic performance (sensitivity 0.79, specificity 0.92, positive predictive value 0.95, negative predictive value 0.69) with a significantly increased sensitivity compared with conventional CT HU (p = 0.027). There were no significant differences between ΔCE and axillary US for sensitivity (p = 1.000) or specificity (p = 0.320).ConclusionsDLSCT is a promising quantitative technique for evaluating LN metastases and could potentially reduce the need for sentinel LN biopsy.
Highlights
Our aim was to compare the diagnostic performance of quantitative dual-layer spectral computed tomography (DLSCT) and axillary ultrasound (US) for diagnosing lymph node metastases in breast cancer patients
Ultrasonography (US) of the breasts and axillae with fine needle aspiration (FNA) from morphologically suspicious axillary lymph nodes is often used for preoperative staging of the axilla
In the 36 axillae, 29 sentinel lymph node biopsy (SNB) and 7 axillary lymph node dissection (ALND) were performed within 4 weeks from the DLSCT examination
Summary
Our aim was to compare the diagnostic performance of quantitative dual-layer spectral computed tomography (DLSCT) and axillary ultrasound (US) for diagnosing lymph node metastases in breast cancer patients. US is usually followed by sentinel lymph node biopsy (SNB), which, if negative, rules out axillary lymph node metastases with high accuracy [7]. Patients with clinically positive lymph nodes, ≥ T3 tumour, ≥ 3 positive nodes on SNB, or planned mastectomy will often receive axillary lymph node dissection (ALND) [10]. Since both SNB and ALND are invasive surgical procedures (which may cause immediate complications such as infection or, in a few cases, long-term effects such as lymphedema, shoulder impairment, or pain [11,12,13]), non-invasive methods to reduce the need for SNB and ALND are highly desired
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
