Role of sonoelastography in assessment of axillary lymph nodes in breast cancer: a systematic review and meta-analysis

Wang, R.Y.; Zhang, Y.W.; Gao, Zhiqiang; Wang, X.M.

doi:10.1016/j.crad.2019.11.016

Cited by 21 publications

(16 citation statements)

References 35 publications

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“…9 A 45-year-old lady with positive maternal family history, presenting for screening values < 0.001. This agrees with those of several other studies [13,14].…”

Section: Discussionsupporting

confidence: 94%

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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“…9 A 45-year-old lady with positive maternal family history, presenting for screening values < 0.001. This agrees with those of several other studies [13,14].…”

Section: Discussionsupporting

confidence: 94%

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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“…Previously SWE has been mainly used to evaluate axillary and cervical LN regions [ 2 , 3 , 7 , 15 , 31 – 34 ]. The first report where SWE was used solely to investigate inguinal LNs was published by Kawahara et al in patients with metastatic skin cancer [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

2D-shear wave elastography in the evaluation of suspicious superficial inguinal lymph nodes: Reproducibility and region of interest selection

et al. 2022

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Purpose To assess the ability of 2D-Shear wave elastography (2D-SWE) to evaluate its reproducibility, to define the optimal orientation and size of the region of interest (ROI), and to differentiate benign from malignant inguinal lymph nodes (LNs). Method Thirty-two suspicious inguinal LNs from 21 patients were evaluated with 2D-SWE. SWE measurements were obtained in two orthogonal planes. To investigate reproducibility, sensitivity and specificity, circular ROIs with a diameter of 1 mm, 2 mm, 3 mm and 5 mm were placed on the cortex of the LNs. Additionally, one freehand ROI was drawn covering majority of the LN. Two observers performed five sets of SWE measurements for each ROI size. All LNs underwent core needle biopsy or were surgically removed. Results The 3 mm ROI for Mean-E in axial plane showed high interrater agreement [intraclass correlation coefficient (ICC) 0.899] with the cut-off value of 7.31 kPa resulting in 88.9% sensitivity and 60.9% specificity for differentiating malignant from benign LNs. In benign LNs, mean elasticity of the ROI was lower (7.68 ± 3.82 kPa; range, 3.41–15.40 kPa) compared to the malignant LNs (15.81 ± 10.61 kPa; range, 3.86–36.45 kPa). Conclusions The most reproducible way to measure stiffness in inguinal LNs is a 3 mm circular ROI centered on the cortex of the LN in axial plane. Elasticity values were higher in the malignant LNs reflecting the stiffer nature of the metastatic LNs. 2D-SWE offers a noninvasive ultrasonographic tool to assess superficial inguinal lymph nodes with high reproducibility.

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“…All selected studies were conducted in either cervical or axillary lymph nodes, and existing systematic reviews have analysed the use of elastography for both types of lymph node malignancy individually, for example cervical lymphadenopathy by Suh et al [ 43 ] and axillary lymphadenopathy by Huang et al and Wang et al [ 44 , 45 ]. However, a mixed choice of SWE parameters was pooled in analysis [ 43 , 45 ], and no comparisons were made between lymph node malignancies in different anatomical positions.…”

Section: Discussionmentioning

confidence: 99%

Evaluating Different Quantitative Shear Wave Parameters of Ultrasound Elastography in the Diagnosis of Lymph Node Malignancies: A Systematic Review and Meta-Analysis

Gao

Zhao

Choi

et al. 2022

Cancers

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Shear wave elastography (SWE) has shown promise in distinguishing lymph node malignancies. However, the diagnostic accuracies of various SWE parameters that quantify tissue stiffness are yet to be demonstrated. To evaluate the pooled diagnostic accuracy of different SWE parameters for differentiating lymph node malignancies, we conducted a systematic screening of four databases using the PRISMA guidelines. Lymph node biopsy was adopted as the reference standard. Emax (maximum stiffness), Emean (mean stiffness), Emin (minimum stiffness), and Esd (standard deviation) SWE parameters were subjected to separate meta-analyses. A sub-group analysis comparing the use of Emax in cervical (including thyroid) and axillary lymph node malignancies was also conducted. Sixteen studies were included in this meta-analysis. Emax and Esd demonstrated the highest pooled sensitivity (0.78 (95% CI: 0.69–0.87); 0.78 (95% CI: 0.68–0.87)), while Emean demonstrated the highest pooled specificity (0.93 (95% CI: 0.88–0.98)). From the sub-group analysis, the diagnostic performance did not differ significantly in cervical and axillary LN malignancies. In conclusion, SWE is a promising adjunct imaging technique to conventional ultrasonography in the diagnosis of lymph node malignancy. SWE parameters of Emax and Esd have been identified as better choices of parameters for screening clinical purposes.

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Role of sonoelastography in assessment of axillary lymph nodes in breast cancer: a systematic review and meta-analysis

Cited by 21 publications

References 35 publications

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

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

2D-shear wave elastography in the evaluation of suspicious superficial inguinal lymph nodes: Reproducibility and region of interest selection

Evaluating Different Quantitative Shear Wave Parameters of Ultrasound Elastography in the Diagnosis of Lymph Node Malignancies: A Systematic Review and Meta-Analysis

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