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

Zhang, Huiting; Dong, Yijie; Jia, Xiaohong; Zhang, Jingwen; Li, Zhiyao; Chuan, Zhi-Rui; Xu, Yong; Hu, Bin; Huang, Yao Qi; Chang, Cai; Xu, Jinfeng; Dong, Fajin; Xia, Xiaona; Wu, ChengRong; Hu, Wenjia; Wu, Gang; Li, Qiaoying; Chen, Qin; Deng, Wanyue; Jiang, Qiongchao; Mou, YongLin; Yan, HuanNan; Xu, Xiaojing; Yan, Hongju; Zhou, Ping; Shao, Yang; Cui, Ligang; He, Ping; Qian, Linxue; Liu, Jinping; Shi, Liying; Zhao, Yanan; Xu, Yongfeng; Song, Yanyan; Zhan, Weiwei; Zhou, Jinhua

doi:10.3389/fonc.2022.830910

Cited by 8 publications

(12 citation statements)

References 33 publications

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“…The most signi cant advantage of VTIQ is its objectivity, which eliminates the subjectivity of operators, and provides high reproducibility of tests [35]. Previous research has revealed that the E max of positive ALN was higher than that of negative ALN, and E min was lower [14,21]. The results in the training cohort were consistent with these ndings.…”

Section: Discussionsupporting

confidence: 76%

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A Nomogram for Predicting Occult Axillary Lymph Node Metastasis: Performance in US-diagnosed N0 Breast Cancer Patients

Zhang

Wang

et al. 2023

Preprint

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Background To develop a nomogram model combining gray-scale ultrasound and virtual touch tissue imaging quantification (VTIQ) characteristics to predict axillary lymph node metastasis (ALNM) in ultrasound (US)-diagnosed N0 breast cancer patients. Methods A total of 567 patients enrolled in this study from April 2017 to May 2022, including 395 patients in the primary cohort and 172 patients in the external validation cohort. These are patients who are undergoing upfront surgery (no neoadjuvant treatment). Their preoperative gray-scale ultrasound images and VTIQ parameters were collected and used to develop a nomogram with internal and external validation for the prediction of occult ALNM. Results Three gray-scale ultrasound characteristics (age, margin, and distance from the nipple) and one VTIQ parameter (Emax) were identified as independent risk factors in univariate and multivariate analyses. The nomogram showed an area under the curves of 0.843 and 0.869 in the training and external validation cohorts, respectively, indicating good calibration. Conclusions The nomogram model can predict occult ALNM with relatively high accuracy. It is expected to be a non-invasive, easy, quick, and affordable supplement to traditional axillary ultrasound (AUS), which can help to determine appropriate axillary treatment for US-diagnosed N0 breast cancer patients.

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Section: Discussionsupporting

confidence: 76%

“…VTIQ is a novel technique based on shear wave velocity (SWV) from different tissues, which can provide quantitative information for tumor heterogeneity [12,13]. It shows good e cacy for assessing ALN status, with an accuracy of 0.632 reported by Zhang et al [14].…”

Section: Introductionmentioning

confidence: 99%

A Nomogram for Predicting Occult Axillary Lymph Node Metastasis: Performance in US-diagnosed N0 Breast Cancer Patients

Zhang

Wang

et al. 2023

Preprint

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“…As far as the overall study was concerned, there was no definite evidence to indicate which was better, SE or SWE ( 18 ). However, the role of SWE in the diagnosis, differentiation, efficacy evaluation and prediction of breast cancer was obvious ( 13 , 14 , 27 ). One study demonstrated the superior predictive value of Emax in combination with BI-RADS category 4a in breast cancer screening ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

“…Two main modes of elastography have become established in clinical practice: strain elastography (SE) and shear wave elastography (SWE) (12). SE and SWE have shown significant value in previous studies (13)(14)(15)(16). SWE could provide useful diagnostic information for tissue stiffness to improve the accuracy of B-ultrasound diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Clinical use and adjustment of ultrasound elastography for breast lesions followed WFUMB guidelines and recommendations in the real world

et al. 2022

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ObjectiveThis study aimed to explore the value of strain elastography (SE) and shear wave elastography (SWE) following the World Federation of Ultrasound in Medicine and Biology (WFUMB) guidelines and recommendations in the real world in distinguishing benign and malignant breast lesions and reducing biopsy of BI-RADS (Breast Imaging Reporting and Data System) 4a lesions.MethodsThis prospective study included 274 breast lesions. The elastography score (ES) by the Tsukuba score, the strain ratio (SR) for SE, and Emax for SWE of the lesion(A) and the regions(A’) included the lesion and the margin (0.5-5 mm) surrounding the lesion were measured. The sensitivity, specificity, and AUC were calculated and compared by the cutoff values recommended by WFUMB guidelines.ResultsWhen scores of 1 to 3 were classified as probably benign by WFUMB recommendation, the ES was significantly higher in malignant lesions compared to benign lesions (p < 0.05) in all lesions. For the cohort by size >20 mm, the sensitivity was 100%, and the specificity was 45.5%. ES had the highest AUC: 0.79(95% CI 0.72-0.86) with a sensitivity of 96.2%, and a specificity of 61.8% for the cohort by size ≤20 mm. For the Emax-A’-S2.5mm, when the high stiffness would be considered with Emax above 80 kPa in SWE, the malignant lesions were diagnosed with a sensitivity of 95.8%, a specificity of 43.3% for all lesions, a sensitivity of 88.5% for lesions with size ≤20 mm, and sensitivity of 100.0% for lesions with size >20 mm. In 84 lesions of BI-RADS category 4a, if category 4a lesions with ES of 1-3 points or Emax-A’-S2.5 less than 80 kPa could be downgraded to category 3, 52 (61.9%) lesions could be no biopsy, including two malignancies. If category 4a lesions with ES of 1-3 points and Emax-A’-S2.5 less than 80kPa could be downgraded to category 3, 23 (27.4%) lesions could be no biopsy, with no malignancy.ConclusionsThe elastography score for SE and Emax-A’ for SWE after our modification were beneficial in the diagnosis of breast cancer. The combination of SWE and SE could effectively reduce the biopsy rate of BI-RADS category 4a lesions.

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“…Recent studies showed the use of ultrasound elastography in the examination of many organs, such as lymph nodes, liver, and thyroid ( 15 , 16 ). Shear wave elastography (SWE), a novel elastography technique, provides quantitative information on measuring tissue stiffness ( 17 , 18 ). Recently, SWE was reported to be associated with the axillary lymph node metastasis in breast cancer ( 19 ).…”

Section: Introductionmentioning

confidence: 99%

An improved nomogram including elastography for the prediction of non-sentinel lymph node metastasis in breast cancer patients with 1 or 2 sentinel lymph node metastases

Duan¹,

Zhang²,

Zhang³

et al. 2023

Front. Oncol.

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BackgroundThe rate of breast-conserving surgery is very low in China, compared with that in developed countries; most breast cancer patients receive mastectomy. It is great important to explore the possibility of omitting axillary lymph node dissection (ALND) in early-stage breast cancer patients with 1 or 2 positive sentinel lymph nodes (SLNs) in China. The aim of this study was to develop a nomogram based on elastography for the prediction of the risk of non-SLN (NSLN) metastasis in early-stage breast cancer patients with 1 or 2 positive SLNs.MethodsA total of 601 breast cancer patients were initially recruited. According to the inclusion and exclusion criteria, 118 early-stage breast cancer patients with 1 or 2 positive SLNs were finally enrolled and were assigned to the training cohort (n=82) and the validation cohort (n=36), respectively. In the training cohort, the independent predictors were screened by logistic regression analysis and then were used to conducted the nomogram for the prediction of NSLN metastasis in early-stage breast cancer patients with 1 or 2 positive SLNs. The calibration curves, concordance index (C-index), the area under the receiver operating characteristic (ROC) curve (AUC), and Decision curve analysis (DCA) were used to verified the performance of the nomogram.ResultsThe multivariable analysis showed that the enrolled patients with positive HER2 expression (OR=6.179, P=0.013), Ki67≥14% (OR=8.976, P=0.015), larger lesion size (OR=1.038, P=0.045), and higher Emean (OR=2.237, P=0.006) were observed to be the independent factors of NSLN metastasis. Based on the above four independent predictors, a nomogram was conducted to predict the risk of the NSLN metastasis in early-stage breast cancer patients with 1 or 2 positive SLNs. The nomogram showed good discrimination in the prediction of NSLN metastasis, with bias-corrected C-index of 0.855 (95% CI, 0.754-0.956) and 0.853 (95% CI, 0.724-0.983) in the training and validation cohorts, respectively. Furthermore, the AUC was 0.877 (95%CI: 0.776- 0.978) and 0.861 (95%CI: 0.732-0.991), respectively, indicating a good performance of the nomogram. The calibration curve suggested a satisfactory agreement between the predictive and actual risk in both the training (χ2 = 11.484, P=0.176, HL test) and validation (χ2 = 6.247, p = 0.620, HL test) cohorts, and the obvious clinical nets were revealed by DCA.ConclusionsWe conducted a satisfactory nomogram model to evaluate the risk of NSLN metastasis in early-stage breast cancer patients with 1 or 2 SLN metastases. This model could be considered as an ancillary tool to help such patients to be selectively exempted from ALND.

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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

Cited by 8 publications

References 33 publications

A Nomogram for Predicting Occult Axillary Lymph Node Metastasis: Performance in US-diagnosed N0 Breast Cancer Patients

A Nomogram for Predicting Occult Axillary Lymph Node Metastasis: Performance in US-diagnosed N0 Breast Cancer Patients

Clinical use and adjustment of ultrasound elastography for breast lesions followed WFUMB guidelines and recommendations in the real world

An improved nomogram including elastography for the prediction of non-sentinel lymph node metastasis in breast cancer patients with 1 or 2 sentinel lymph node metastases

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