Abstract
Objective
To determine the ability of conventional ultrasound (US) combined with shear wave elastography (SWE) to reveal axillary status after neoadjuvant chemotherapy (NAC) in breast cancer patients.
Methods
From September 2016 to December 2021, 201 patients with node-positive breast cancer who underwent NAC were enrolled in this prospective study. Conventional US features of axillary lymph nodes and SWE characteristics of breast lesions after NAC were analyzed. The diagnostic performances of US, SWE, and their combination were assessed using multivariate logistic regression and receiver operator characteristic curve (ROC) analyses.
Results
The area under the ROC curve (AUC) for the ability of conventional US features to determine axillary status after NAC was 0.82, with a sensitivity of 85.23%, a specificity of 67.39%, and an accuracy of 76.11%. Shear wave velocity (SWV) displayed moderate performance for predicting axilla status after NAC with SWVmean demonstrating an AUC of 0.85. Cortical thickness and shape of axillary nodes and SWVmean of breast tumors were independently associated with axillary nodal metastasis after NAC. Compared to conventional US, the combination of conventional US of axillary lymph nodes with SWE of breast lesions achieved a significantly higher AUC (0.90 vs 0.82, p < 0.01, Delong’s test) with a sensitivity of 87.50%, improved specificity of 82.61% and accuracy of 85.00%.
Conclusions
Breast SWE was independently associated with residual metastasis of axillary node after NAC in patients with initially diagnosed positive axilla. Combining SWE with conventional US showed good diagnostic performance for axillary node disease after NAC.
Key Points
• Breast SWE can serve as a supplement to axilla US for the evaluation of the axilla after NAC.
• The combination of axilla US with breast SWE may be a promising method to facilitate less-invasive treatment in patients receiving NAC.
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Abbreviations
- ALND:
-
Axillary lymph node dissection
- AUC:
-
Area under the ROC
- CI:
-
Confidence interval
- CT:
-
Computerized tomography
- ER:
-
Estrogen receptor
- FNR:
-
False-negative rates
- HE:
-
Hematoxylin and eosin
- HER2:
-
Human epidermal growth factor receptor 2
- IHC:
-
Immunohistochemistry
- LN:
-
Lymph node
- NAC:
-
Neoadjuvant chemotherapy
- MRI:
-
Magnetic resonance imaging
- OR:
-
Odds ratio
- pCR:
-
Pathological complete response
- PET:
-
Positron emission tomography
- PR:
-
Progesterone receptor
- ROC:
-
Receiver operating characteristic
- SE:
-
Strain elastography
- SLNB:
-
Sentinel lymph node biopsy
- SWE:
-
Shear wave elastography
- SWV:
-
Shear wave velocity
- UE:
-
Ultrasound elastography
- US:
-
Ultrasound
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Acknowledgements
The authors would like to thank all the involved study investigators for dedicating their time and skills to the completion of this study. The authors would also like to thank Medjaden Bioscience Limited for their assistance in the preparation of the manuscript.
Funding
This study has received funding from the Science and Technology Project Funds of Guangzhou (No. 1563000308).
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The scientific guarantor of this publication is Xiao-Qing Pei.
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Huang, JX., Lin, SY., Ou, Y. et al. Combining conventional ultrasound and sonoelastography to predict axillary status after neoadjuvant chemotherapy for breast cancer. Eur Radiol 32, 5986–5996 (2022). https://doi.org/10.1007/s00330-022-08751-1
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DOI: https://doi.org/10.1007/s00330-022-08751-1