Role of Elastography in Axillary Examination of Patients With Breast Cancer

Chang, Wan-Ying; Wei, Jia; Junni, Shi,; Yuan, Congcong; Zhang, Yuzhu; Chen, Man

doi:10.1002/jum.14538

Cited by 23 publications

(23 citation statements)

References 32 publications

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“…Elastography may improve the sensitivity and specificity of axilla sampling in breast cancer . Evans et al demonstrated that using shear wave elastography (SWE), nodal involvement rates ranged from 7% for tumors with a mean stiffness less than 50 kPa to 41% for tumors with a mean stiffness greater than 150 kPa, indicating that the mean stiffness on SWE is an independent predictor of axilla metastasis.…”

Section: Axillary Lymph Node Assessmentmentioning

confidence: 99%

Lymph Node Imaging in Patients with Primary Breast Cancer: Concurrent Diagnostic Tools

Marino

Avendaño

Zapata³

et al. 2019

The Oncologist

142

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The detection of lymph node metastasis affects the management of patients with primary breast cancer significantly in terms of staging, treatment, and prognosis. The main goal for the radiologist is to determine and detect the presence of metastatic disease in nonpalpable axillary lymph nodes with a positive predictive value that is high enough to initially select patients for upfront axillary lymph node dissection. Features that are suggestive of axillary adenopathy may be seen with different imaging modalities, but ultrasound is the method of choice for evaluating axillary lymph nodes and for performing image-guided lymph node interventions. This review aims to provide a comprehensive overview of the available imaging modalities for lymph node assessment in patients diagnosed with primary breast cancer. The Oncologist 2020;25:e231-e242Implications for Practice: The detection of lymph node metastasis affects the management of patients with primary breast cancer. The main goal for the radiologist is to detect lymph node metastasis in patients to allow for the selection of patients who should undergo upfront axillary lymph node dissection. Features that are suggestive of axillary adenopathy may be seen with mammography, computed tomography, and magnetic resonance imaging, but ultrasonography is the imaging modality of choice for evaluating axillary lymph nodes. A normal axillary lymph node is characterized by a reniform shape, a maximal cortical thickness of 3 mm without focal bulging, smooth margins, and, depending on size, a discernable central fatty hilum.The Oncologist 2020;25:e231-e242 www.TheOncologist.com Breast Cancer Figure 7. Radiomics workflow. Reprinted by permission from Springer Nature, from Han et al., Radiomic nomogram for prediction of axillary lymph node metastasis in breast cancer. European Radiology 2019;7:3820-3829 [76].

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Section: Axillary Lymph Node Assessmentmentioning

confidence: 99%

Lymph Node Imaging in Patients with Primary Breast Cancer: Concurrent Diagnostic Tools

Marino

Avendaño

Zapata³

et al. 2019

The Oncologist

142

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“…The common two practices are to directly evaluate the hard area ratio or to convert the hard area ratio to an elasticity score to assess the stiffness of lymph nodes. In the qualitative elastography meta-analysis, four studies directly evaluated the hard area ratio (10,12,25,26), while four others converted the hard area ratio as the elasticity score (23,24,27,28). We found that the optimal cutoff values of the hard area ratio were all 50%, and the optimal cutoff values of elasticity score were all 3.…”

Section: Discussionmentioning

confidence: 91%

“…Therefore, the seven studies that reported quantitative elastography measurements were included in the quantitative elastography meta-analysis (8,(17)(18)(19)(20)(21)(22). The 11 studies that reported qualitative elastography measurements were included in the qualitative elastography meta-analysis (8)(9)(10)(11)(12)(23)(24)(25)(26)(27)(28). The inclusion and exclusion processes are summarized in Figure 1.…”

Section: Search Resultsmentioning

confidence: 99%

Diagnostic Performance of Quantitative and Qualitative Elastography for Axillary Lymph Node Metastasis in Breast Cancer: A Systematic Review and Meta-Analysis

Huang

et al. 2020

Front. Oncol.

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Background: Studies have shown inconsistent results regarding the diagnostic performance of ultrasound elastography for axillary lymph node metastasis (ALNM) in breast cancer. This meta-analysis aimed to estimate the diagnostic performance of ultrasound elastography (divided into quantitative and qualitative elastography) for ALNM in patients with breast cancer. Methods: The PubMed and Embase databases were searched for eligible studies exploring the diagnostic performance of ultrasound elastography for ALNM in patients with breast cancer. The included studies were divided into quantitative and qualitative elastography groups to perform separate meta-analyses. The diagnostic performance was investigated with pooled sensitivity and specificity and diagnostic odds ratio (DOR) using a bivariate mixed-effects regression model. A summary receiver operating characteristic curve was constructed, and the area under the curve (AUC) was calculated. Results: Seven and 11 studies were included in the quantitative and qualitative elastography meta-analyses, respectively. The pooled sensitivity and specificity, DOR, and AUC with their corresponding 95% confidence intervals were 0.82 (0.75, 0.87), 0.88 (0.78, 0.93), 33 (13, 83), and 0.89 (0.86, 0.91), respectively, for quantitative elastography and 0.81 (0.69, 0.89), 0.92 (0.79, 0.97), 46 (12, 181), and 0.92 (0.89, 0.94), respectively, for qualitative elastography. No significant publication bias existed. Fagan plots demonstrated good clinical utility. However, substantial heterogeneity existed among studies. Study design, measurement, and reference standard served as potential sources of heterogeneity for quantitative studies, which were measurement and reference standard for qualitative studies. Conclusions: Both quantitative and qualitative elastography seem to be feasible, non-invasive diagnostic tools for ALNM in breast cancer. Nevertheless, the results Huang et al. Meta-Analysis of Elastography for ALNM must be interpreted carefully, paying attention to heterogeneity issues, especially for quantitative elastography studies.

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“…Yet, as a result of the moderate sensitivity and false-negative results, this can lead to unessential sentinel nodal sampling, which can cause related upper limb morbidities. Therefore, a need has emerged for a non-invasive tool that can accurately stage axillary lymph nodes preoperatively [3].…”

Section: Introductionmentioning

confidence: 99%

“…For breast US, it can be either strain elastography (SE) or shear wave elastography (SWE) [1]. Both exploit the fact that malignant tissues are usually stiffer than benign ones, and thus, elastography can be utilized to ameliorate the specificity of US diagnosis [3]. Strain elastography relies on the operating hand where it utilizes freehand compression to estimate elasticity of tissues [1].…”

Section: Introductionmentioning

confidence: 99%

Axillary lymph node status in BIRADS 4-5 female patients: can shear wave and strain ultrasound elastography help?

Elmesidy

Eissa

Hamed

et al. 2021

Egypt J Radiol Nucl Med

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Background The status of axillary nodes is a determining factor of management and prognosis for patients having a recent diagnosis of breast cancer. Axillary nodes are usually evaluated by ultrasonography (US) and biopsy, if indicated. Ultrasound-guided sampling and intraoperative or sentinel nodal sampling are available options, however, are invasive and hold risks of potential complications, calling for reliable, non-invasive axillary imaging. In the current prospective study, we assessed the performance of shear wave (SWE) and strain (SE) ultrasound elastography regarding preoperative axillary assessment. Sixty axillary nodes from 60 patients (age 28–65 years, mean 49.88 ± 7.61 SD) were included, all scoring BIRADS 4–5 on sonomammography. Results For US, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 100%, 66.67%, 84.78%, 100%, and 88.33%, respectively. Cortical thickness and vascularity were the most sensitive. For qualitative SWE, indices were 76.92%, 80.95%, 88.24%, 65.38% and 78.33%, respectively. Calculated cut-off for Emax was 59.3 and for Eratio was 4.56, giving statistical indices of 76.9%, 90.5%, 93.75%, 67.86%, and 81.67% for Emax and 76.9%, 100%, 100%, 70% and 85% respectively for Eratio. Both Emax and Eratio were greater for malignant (Emax 81.77 ± 1.904, Eratio 8.95 ± 5.69) than for benign nodes (Emax 37.59 ± 33.37, Eratio 2.5 ± 1.37) (P values < 0.001). For qualitative SE, sensitivity and specificity were 92.31% and 57.14%, while PPV, NPV, and accuracy were 80% each (P values < 0.001). The calculated cut-off value for SR was 3.85, giving indices of 87.2%, 76.2%, 76.19%, 87.18% and 83.33% respectively. Conclusion Adding elastography evaluation to conventional US positively impacts the specificity and accuracy of the preoperative axillary nodal status assessment in patients having newly diagnosed breast cancer.

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Role of Elastography in Axillary Examination of Patients With Breast Cancer

Cited by 23 publications

References 32 publications

Lymph Node Imaging in Patients with Primary Breast Cancer: Concurrent Diagnostic Tools

Lymph Node Imaging in Patients with Primary Breast Cancer: Concurrent Diagnostic Tools

Diagnostic Performance of Quantitative and Qualitative Elastography for Axillary Lymph Node Metastasis in Breast Cancer: A Systematic Review and Meta-Analysis

Axillary lymph node status in BIRADS 4-5 female patients: can shear wave and strain ultrasound elastography help?

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