Abstract
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.
Highlights
Breast cancer is among the tumors with the highest incidence in women and usually causes the most serious harm among female patients
3.2 Comparison of axillary lymph node (ALN) Metastasis Risk Predicted Based on conventional ultrasound (C-US), ultrasound elastography (UE) Score, and percutaneous contrast-enhanced ultrasound (P-CEUS) Parameters
C-US revealed the following for metastatic ALNs: disappearance of lymphatic hilum structure, thickening of the cortex (>3 mm), change in the proportion of uniform echo, L/T
Summary
Breast cancer is among the tumors with the highest incidence in women and usually causes the most serious harm among female patients. The most important factors determining prognosis include tumor size, histological grade, hormonal receptor (HR) status, human epidermal growth factor receptor 2 (HER-2) status, axillary lymph node (ALN) involvement, and metastasis [1, 2]. Sentinel lymph node biopsy (SLNB) has gradually replaced traditional axillary lymph node dissection (ALND) and has become the standard technique for diagnosing the pathological status of ALNs in breast cancer. Given that LN metastasis is one of the most critical prognostic factors, the status of SLNs in patients with breast cancer is critical. MRI is expensive and requires long imaging times. Ultrasound examination is non-invasive, nonionizing, and inexpensive, it can provide real-time information, and is widely available and flexible for use in clinical practice when compared to other imaging modalities
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