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Combining conventional ultrasound and sonoelastography to predict axillary status after neoadjuvant chemotherapy for breast cancer

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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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Author notes

  1. Jia-Xin Huang and Shi-Yang Lin contributed equally to this work.

Authors and Affiliations

  1. Department of Medical Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651 Dongfeng Road East, Guangzhou, 510000, China

    Jia-Xin Huang, Yuan Zhong, Ming-Jie Wei & Xiao-Qing Pei

  2. Department of Medical Ultrasound, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510000, China

    Shi-Yang Lin

  3. Department of Medical Ultrasound, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518000, China

    Yan Ou

  4. Department of Medical Ultrasound, Liuzhou People’s Hospital, Liuzhou, 545000, China

    Cai-Gou Shi

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  1. Jia-Xin Huang
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  3. Yan Ou
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Correspondence to Xiao-Qing Pei.

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The scientific guarantor of this publication is Xiao-Qing Pei.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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No complex statistical methods were necessary for this paper.

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Written informed consent was obtained from all subjects (patients) in this study.

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• prospective

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• performed at one institution

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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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