Ex Vivo Assessment of Sentinel Lymph Nodes in Breast Cancer Using Shear Wave Elastography

Kılıç, Fahrettin; Velidedeoğlu, Mehmet; Öztürk, Tülin; Kandemirli, Sedat Giray; Dikici, Atilla Süleyman; Er, Mehmet Emin; Aydoğan, Fatih; Kantarcı, Fatih; Yılmaz, Mehmet

doi:10.7863/ultra.15.03039

Cited by 31 publications

(28 citation statements)

References 27 publications

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“…In the European Federation of Societies for Ultrasound in Medicine and Biology and World Federation for Ultrasound in Medicine and Biology guidelines for the breast, both strain elastography and SWE were recommended to help in the diagnosis of breast lesions . Meanwhile, two studies investigating sentinel lymph nodes of breast cancer concluded that SWE was not useful since it was difficult to detect micrometastasis similar to our data on MM lesions. In the present study, the elastographic properties were assessed in only one plane, and the percentages of hard tissue were not assessed for the whole lymph node volume, which is a limitation of this study.…”

Section: Discussionsupporting

confidence: 72%

Usefulness of real‐time elastography for diagnosing lymph node metastasis of skin cancer: does elastography potentially eliminate the need for sentinel lymph node biopsy in squamous cell carcinoma?

Tanaka

Kamata

Fukaya

et al. 2019

Acad Dermatol Venereol

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Background The metastatic involvement of regional lymph nodes is the most important prognostic factor for overall survival of skin cancer patients. The sonographic technique of freehand real‐time tissue elastography (RTE), which displays tissue rigidity as a colour overlay of the tissue image, was developed. Objective Our purpose was to evaluate the benefit of RTE for detecting lymph node metastases of skin cancer non‐invasively before operation. Methods We first selected lymph nodes of skin cancer patients which had already been diagnosed by biopsy as being reactive or metastatic, and then retrospectively collected images of RTE and B‐mode and colour Doppler ultrasound on those lymph nodes performed preoperatively. Twenty‐one lymph nodes from 12 patients with squamous cell carcinoma (SCC), 23 lymph nodes from 14 patients with malignant melanoma (MM) and 14 lymph nodes from six patients with extramammary Paget disease (Paget) were investigated. Elastographic images were assessed on a scale of one to four according to the percentage of high elasticity (hard) area (HEA) in the lymph node. Results In all three skin cancers, lymph nodes evaluated as grade 3 or 4 by RTE were metastatic. All lymph nodes evaluated as grade 1 or 2 by RTE were reactive in SCC, whereas some lymph nodes evaluated as grade 1 or 2 were metastatic in MM and Paget. Conclusion Real‐time tissue elastography may aid in distinguishing reactive lymph nodes from metastatic ones especially in SCC.

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Section: Discussionsupporting

confidence: 72%

Usefulness of real‐time elastography for diagnosing lymph node metastasis of skin cancer: does elastography potentially eliminate the need for sentinel lymph node biopsy in squamous cell carcinoma?

Tanaka

Kamata

Fukaya

et al. 2019

Acad Dermatol Venereol

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“…Higher SWV of breast cancer showed higher possibility of ALN metastasis 18,19 . However, the performance of 2D-SWE depends on the placement of regions of interest (ROI) and the AUC was only 0.759 for the prediction of ALN status 17,20 . Therefore, only SWE images of breast cancer might be insufficient to evaluate ALN status accurately.…”

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confidence: 99%

Deep learning radiomics can predict axillary lymph node status in early-stage breast cancer

et al. 2020

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Accurate identification of axillary lymph node (ALN) involvement in patients with early-stage breast cancer is important for determining appropriate axillary treatment options and therefore avoiding unnecessary axillary surgery and complications. Here, we report deep learning radiomics (DLR) of conventional ultrasound and shear wave elastography of breast cancer for predicting ALN status preoperatively in patients with early-stage breast cancer. Clinical parameter combined DLR yields the best diagnostic performance in predicting ALN status between disease-free axilla and any axillary metastasis with areas under the receiver operating characteristic curve (AUC) of 0.902 (95% confidence interval [CI]: 0.843, 0.961) in the test cohort. This clinical parameter combined DLR can also discriminate between low and heavy metastatic burden of axillary disease with AUC of 0.905 (95% CI: 0.814, 0.996) in the test cohort. Our study offers a noninvasive imaging biomarker to predict the metastatic extent of ALN for patients with early-stage breast cancer.

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“…[5,6]. These features can provide valuable information for the characterization of abnormal ALNs [7][8][9], and help identify lymph nodes suitable for needle biopsy [10][11][12][13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

“…Collagen is a very stiff material with an elastic modulus of 37.7 to 42.4-GPa [21], which may change the mechanical properties of metastatic ALNs. Normal ALNs have been reported to have an elastic modulus of 2.4 to 38.9-kPa [13,16].…”

Section: Introductionmentioning

confidence: 99%

Predictive value of comb-push ultrasound shear elastography for the differentiation of reactive and metastatic axillary lymph nodes: A preliminary investigation

et al. 2020

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Objectives To evaluate the predictive performance of comb-push ultrasound shear elastography for the differentiation of reactive and metastatic axillary lymph nodes. Methods From June 2014 through September 2018, 114 female volunteers (mean age 58.1±13.3 years; range 28-88 years) with enlarged axillary lymph nodes identified by palpation or clinical imaging were prospectively enrolled in the study. Mean, standard deviation and maximum shear wave elastography parameters from 117 lymph nodes were obtained and compared to fine needle aspiration biopsy results. Mann-Whitney U test and ROC curve analysis were performed. Results The axillary lymph nodes were classified as reactive or metastatic based on the fine needle aspiration outcomes. A statistically significant difference between reactive and metastatic axillary lymph nodes was observed based on comb-push ultrasound shear elastography (CUSE) results (p<0.0001) from mean and maximum elasticity values. Mean elasticity showed the best separation with a ROC analysis resulting in 90.5% sensitivity, 94.4% specificity, 0.97 area under the curve, 95% positive predictive value, and 89.5% negative predictive value with a 30.2-kPa threshold.

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Ex Vivo Assessment of Sentinel Lymph Nodes in Breast Cancer Using Shear Wave Elastography

Abstract: Shear wave elastography can be used with grayscale sonography for evaluation of cases to decide on needle biopsy sampling. However, it cannot be used as a replacement for fine-needle aspiration or SLN dissection.

Cited by 31 publications

References 27 publications

Usefulness of real‐time elastography for diagnosing lymph node metastasis of skin cancer: does elastography potentially eliminate the need for sentinel lymph node biopsy in squamous cell carcinoma?

Usefulness of real‐time elastography for diagnosing lymph node metastasis of skin cancer: does elastography potentially eliminate the need for sentinel lymph node biopsy in squamous cell carcinoma?

Deep learning radiomics can predict axillary lymph node status in early-stage breast cancer

Predictive value of comb-push ultrasound shear elastography for the differentiation of reactive and metastatic axillary lymph nodes: A preliminary investigation

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