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Su S, Ye J, Ke H, Zhong H, Lyu G, Xu Z. Multimodal ultrasound imaging: a method to improve the accuracy of sentinel lymph node diagnosis in breast cancer. Front Oncol 2024; 14:1366876. [PMID: 38590661 PMCID: PMC10999636 DOI: 10.3389/fonc.2024.1366876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 03/08/2024] [Indexed: 04/10/2024] Open
Abstract
Aim This study assessed the utility of multimodal ultrasound in enhancing the accuracy of breast cancer sentinel lymph node (SLN) assessment and compared it with single-modality ultrasound. Methods Preoperative examinations, including two-dimensional ultrasound (2D US), intradermal contrast-enhanced ultrasound (CEUS), intravenous CEUS, shear-wave elastography (SWE), and surface localization, were conducted on 86 SLNs from breast cancer patients. The diagnostic performance of single and multimodal approaches for detecting metastatic SLNs was compared to postoperative pathological results. Results Among the 86 SLNs, 29 were pathologically diagnosed as metastatic, and 57 as non-metastatic. Single-modality ultrasounds had AUC values of 0.826 (intradermal CEUS), 0.705 (intravenous CEUS), 0.678 (2D US), and 0.677 (SWE), respectively. Intradermal CEUS significantly outperformed the other methods (p<0.05), while the remaining three methods had no statistically significant differences (p>0.05). Multimodal ultrasound, combining intradermal CEUS, intravenous CEUS, 2D US, and SWE, achieved an AUC of 0.893, with 86.21% sensitivity and 84.21% specificity. The DeLong test confirmed that multimodal ultrasound was significantly better than the four single-modal ultrasound methods (p<0.05). Decision curve analysis and clinical impact curves demonstrated the superior performance of multimodal ultrasound in identifying high-risk SLN patients. Conclusion Multimodal ultrasound improves breast cancer SLN identification and diagnostic accuracy.
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Affiliation(s)
- Shanshan Su
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Jiayi Ye
- Department of Radiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Helin Ke
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Huohu Zhong
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Guorong Lyu
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Zhirong Xu
- Department of Ultrasound in Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
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Kim MJ, Eun NL, Ahn SG, Kim JH, Youk JH, Son EJ, Jeong J, Cha YJ, Bae SJ. Elasticity Values as a Predictive Modality for Response to Neoadjuvant Chemotherapy in Breast Cancer. Cancers (Basel) 2024; 16:377. [PMID: 38254866 PMCID: PMC10814692 DOI: 10.3390/cancers16020377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/15/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
Shear-wave elastography (SWE) is an effective tool in discriminating malignant lesions of breast and axillary lymph node metastasis in patients with breast cancer. However, the association between the baseline elasticity value of breast cancer and the treatment response of neoadjuvant chemotherapy is yet to be elucidated. Baseline SWE measured mean stiffness (E-mean) and maximum stiffness (E-max) in 830 patients who underwent neoadjuvant chemotherapy and surgery from January 2012 to December 2022. Association of elasticity values with breast pCR (defined as ypTis/T0), pCR (defined as ypTis/T0, N0), and tumor-infiltrating lymphocytes (TILs) was analyzed. Of 830 patients, 356 (42.9%) achieved breast pCR, and 324 (39.0%) achieved pCR. The patients with low elasticity values had higher breast pCR and pCR rates than those with high elasticity values. A low E-mean (adjusted odds ratio (OR): 0.620; 95% confidence interval (CI): 0.437 to 0.878; p = 0.007) and low E-max (adjusted OR: 0.701; 95% CI: 0.494 to 0.996; p = 0.047) were independent predictive factors for breast pCR. Low elasticity values were significantly correlated with high TILs. Pretreatment elasticity values measured using SWE were significantly associated with treatment response and inversely correlated with TILs, particularly in HR+HER2- breast cancer and TNBC.
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Affiliation(s)
- Min Ji Kim
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea; (M.J.K.); (S.G.A.); (J.J.)
- Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul 06273, Republic of Korea;
| | - Na Lae Eun
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea; (N.L.E.); (J.H.Y.); (E.J.S.)
| | - Sung Gwe Ahn
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea; (M.J.K.); (S.G.A.); (J.J.)
- Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul 06273, Republic of Korea;
| | - Jee Hung Kim
- Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul 06273, Republic of Korea;
- Division of Medical Oncology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Ji Hyun Youk
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea; (N.L.E.); (J.H.Y.); (E.J.S.)
| | - Eun Ju Son
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea; (N.L.E.); (J.H.Y.); (E.J.S.)
| | - Joon Jeong
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea; (M.J.K.); (S.G.A.); (J.J.)
- Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul 06273, Republic of Korea;
| | - Yoon Jin Cha
- Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul 06273, Republic of Korea;
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Soong June Bae
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea; (M.J.K.); (S.G.A.); (J.J.)
- Institute for Breast Cancer Precision Medicine, Yonsei University College of Medicine, Seoul 06273, Republic of Korea;
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Yur M, Aygen E, İlhan YS, Lale A, Ebiloğlu MF. The effect of the tumor-to-skin distance on axillary lymph node metastasis in breast cancer. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20221277. [PMID: 37098931 PMCID: PMC10176633 DOI: 10.1590/1806-9282.20221277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/20/2023] [Indexed: 04/27/2023]
Abstract
OBJECTIVE Tumor-to-skin distance is known to have an effect on axillary lymph node metastasis but has no clinical use with nomograms. This study aimed to investigate the effect of tumor-to-skin distance on axillary lymph node metastasis alone and in combination with nomogram for clinical use. METHODS A total of 145 patients who underwent surgery for breast cancer (T1-T2 stage) and whose axillary lymph nodes were evaluated (axillary dissection or sentinel lymph node biopsy) between January 2010 and December 2020 were included in the study. Tumor-to-skin distance and other pathological data of the patients were evaluated. RESULTS Of the 145 patients, 83 (57.2%) had metastatic lymph nodes in the axilla. Tumor-to-skin distance was different in terms of lymph node metastasis (p=0.045). In the receiver operating characteristic curve for tumor-to-skin distance, area under curve was 0.597 (95%CI 0.513-0.678, p=0.046), area under curve of the nomogram was 0.740 (95%CI 0.660-0.809), p<0.001) and nomogram+tumor-to-skin distance was 0.753 (95%CI 0.674-0.820), p<0.001). No statistical difference was found for axillary lymph node metastasis between the nomogram+tumor-to-skin distance and the nomogram alone (p=0.433). CONCLUSION Although tumor-to-skin distance demonstrated a significant difference in axillary lymph node metastasis, it had a poor association with an area under curve value of 0.597 and did not produce a significant improvement in predicting lymph node metastasis when combined with the nomogram. The tumor-to-skin distance may be unlikely to enter clinical practice.
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Affiliation(s)
- Mesut Yur
- Firat Üniversitesi, Department of Surgical Oncology - Elâzığ, Turkey
| | - Erhan Aygen
- Firat Üniversitesi, Department of Surgical Oncology - Elâzığ, Turkey
| | - Yavuz Selim İlhan
- Firat Üniversitesi, Department of Surgical Oncology - Elâzığ, Turkey
| | - Azmi Lale
- Fethi Sekin State Hospital, Department of Surgical Oncology - Elâzığ, Turkey
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Liu X, Zhang J, Zhou J, He Y, Xu Y, Zhang Z, Cao G, Miao H, Chen Z, Zhao Y, Jin X, Wang M. Multi-modality radiomics nomogram based on DCE-MRI and ultrasound images for benign and malignant breast lesion classification. Front Oncol 2022; 12:992509. [PMID: 36531052 PMCID: PMC9755840 DOI: 10.3389/fonc.2022.992509] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/11/2022] [Indexed: 10/25/2023] Open
Abstract
OBJECTIVE To develop a multi-modality radiomics nomogram based on DCE-MRI, B-mode ultrasound (BMUS) and strain elastography (SE) images for classifying benign and malignant breast lesions. MATERIAL AND METHODS In this retrospective study, 345 breast lesions from 305 patients who underwent DCE-MRI, BMUS and SE examinations were randomly divided into training (n = 241) and testing (n = 104) datasets. Radiomics features were extracted from manually contoured images. The inter-class correlation coefficient (ICC), Mann-Whitney U test and the least absolute shrinkage and selection operator (LASSO) regression were applied for feature selection and radiomics signature building. Multivariable logistic regression was used to develop a radiomics nomogram incorporating radiomics signature and clinical factors. The performance of the radiomics nomogram was evaluated by its discrimination, calibration, and clinical usefulness and was compared with BI-RADS classification evaluated by a senior breast radiologist. RESULTS The All-Combination radiomics signature derived from the combination of DCE-MRI, BMUS and SE images showed better diagnostic performance than signatures derived from single modality alone, with area under the curves (AUCs) of 0.953 and 0.941 in training and testing datasets, respectively. The multi-modality radiomics nomogram incorporating the All-Combination radiomics signature and age showed excellent discrimination with the highest AUCs of 0.964 and 0.951 in two datasets, respectively, which outperformed all single modality radiomics signatures and BI-RADS classification. Furthermore, the specificity of radiomics nomogram was significantly higher than BI-RADS classification (both p < 0.04) with the same sensitivity in both datasets. CONCLUSION The proposed multi-modality radiomics nomogram based on DCE-MRI and ultrasound images has the potential to serve as a non-invasive tool for classifying benign and malignant breast lesions and reduce unnecessary biopsy.
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Affiliation(s)
- Xinmiao Liu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Ji Zhang
- Radiotherapy Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jiejie Zhou
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yun He
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yunyu Xu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhenhua Zhang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guoquan Cao
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haiwei Miao
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhongwei Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Youfan Zhao
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiance Jin
- Radiotherapy Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- School of Basic Medical Science, Wenzhou Medical University, Wenzhou, China
| | - Meihao Wang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
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Lin X, Zhuang S, Yang S, Lai D, Chen M, Zhang J. Development and internal validation of a conventional ultrasound-based nomogram for predicting malignant nonmasslike breast lesions. Quant Imaging Med Surg 2022; 12:5452-5461. [PMID: 36465828 PMCID: PMC9703106 DOI: 10.21037/qims-22-378] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/25/2022] [Indexed: 11/09/2023]
Abstract
BACKGROUND The aim of this study was to develop a conventional ultrasound (US) features-based nomogram for the prediction of malignant nonmasslike (NML) breast lesions. METHODS Consecutive cases of adult females diagnosed with NML breast lesions via US screening in our center from June 1st, 2017, to April 17th, 2020, were retrospectively enrolled. Candidate variables included age, clinical symptoms, and the image features obtained from the conventional US. Nomograms were developed based on the results of the multiple logistic regression analysis via R language. One thousand bootstraps were used for internal validation. The area under the curve (AUC) and the bias-corrected concordance index (C-index) were calculated. Decision curve analysis (DCA) was also performed for further comparison between the nomogram and the Breast Imaging Reporting and Data System (BI-RADS). The study has not yet been registered. RESULTS A total of 229 patients were included in the study after exclusion and follow-up. The overall malignant rate of NML breast lesions was 31.0%. Age, clinical symptoms, echo pattern, calcification, orientation, and Adler's classification were selected to generate the nomogram according to the results of the multivariable logistic regression analysis. The bias-corrected C-index and the AUC of our nomogram were 0.790 and 0.828, respectively. The DCA showed that our model had larger net benefits in a range from 0.2 to 0.7 when compared with the BI-RADS. CONCLUSIONS We developed a prediction model using a combination of age, clinical symptoms, echo pattern, calcification, orientation, and Adler's classification for malignant NML breast lesion prediction that yielded adequate discrimination and calibration.
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Affiliation(s)
- Xian Lin
- Department of Ultrasound, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shulian Zhuang
- Department of Ultrasound, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shuang Yang
- Department of Ultrasound, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Danhui Lai
- Department of Ultrasound, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Miao Chen
- Department of Ultrasound, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jianxing Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Togawa R, Binder LL, Feisst M, Barr RG, Fastner S, Gomez C, Hennigs A, Nees J, Pfob A, Schäfgen B, Stieber A, Riedel F, Heil J, Golatta M. Shear wave elastography as a supplemental tool in the assessment of unsuspicious axillary lymph nodes in patients undergoing breast ultrasound examination. Br J Radiol 2022; 95:20220372. [DOI: 10.1259/bjr.20220372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives: To define reference values for shear wave elastography (SWE) in unsuspicious axillary lymph nodes in patients undergoing breast ultrasound examination. Methods: In total, 177 clinically and sonographically unsuspicious axillary lymph nodes were prospectively evaluated with SWE using Virtual Touch Tissue Imaging Quantification (VTIQ) in 175 women. Mean values of tissue stiffness for axillary fatty tissue, lymph node cortex, and lymph node hilus were measured. Additionally, test-retest reliability of SWE in the assessment of axillary lymph node stiffness was evaluated by repeating each measurement three times. Results: In 177 axillary lymph nodes, the mean stiffness of lymph node cortex, hilus, and surrounding fatty tissue as quantified by SWE was 1.90 m/s (SD: 0.34 m/s), 2.02 m/s (SD: 0.37 m/s), and 1.75 m/s (SD: 0.38 m/s), respectively. The mean stiffness of cortex and hilus was significantly higher compared to fatty tissue (p < 0.0001). SWE demonstrated good test–retest reliability in the assessment of stiffness of the lymph node hilus, cortex, and the surrounding fatty tissue with an intraclass correlation of 0.79 (95% CI: 0.75; 0.83), 0.75 (95% CI: 0.70; 0.79), and 0.78 (95% CI: 0.74; 0.82), respectively, (p < 0.0001). Conclusions: Reference values for SWE in unsuspicious axillary lymph nodes are determined. These results may help to better identify axillary lymph node metastasis for breast cancer patients when combined with other lymph node features. SWE is a reliable method for the objective quantification of tissue stiffness of axillary lymph nodes. Advances in knowledge: This study presents physiological reference values for tissue stiffness by examining the axillary lymph nodes with SWE in 175 women with sonomorphologically unsuspicious lymph nodes.
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Affiliation(s)
- Riku Togawa
- Breast Unit,Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Leah-Larissa Binder
- Breast Unit,Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Manuel Feisst
- Institute of Medical Biometry (IMBI), Heidelberg University, Heidelberg, Germany
| | - Richard G. Barr
- Department of Radiology, Northeastern Ohio Medical University, OH, United States
| | - Sarah Fastner
- Breast Unit, Sankt Elisabeth Hospital, Heidelberg, Germany
| | - Christina Gomez
- Breast Unit,Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - André Hennigs
- Breast Unit,Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Juliane Nees
- Breast Unit,Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - André Pfob
- Breast Unit,Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Benedikt Schäfgen
- Breast Unit,Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Anne Stieber
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Fabian Riedel
- Breast Unit,Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jörg Heil
- Breast Unit,Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
- Breast Unit, Sankt Elisabeth Hospital, Heidelberg, Germany
| | - Michael Golatta
- Breast Unit,Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Germany
- Breast Unit, Sankt Elisabeth Hospital, Heidelberg, Germany
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Yan C, Luo Z, Lin Z, He H, Luo Y, Chen J. Shear Wave Elastography-Assisted Ultrasound Breast Image Analysis and Identification of Abnormal Data. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:5499354. [PMID: 35035845 PMCID: PMC8759893 DOI: 10.1155/2022/5499354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/22/2021] [Accepted: 12/02/2021] [Indexed: 01/26/2023]
Abstract
In this paper, shear wave elastography was used to study and analyze the images of the breast in-depth and identify the abnormal image data. Sixty breast lesions were evaluated, and quantitative metrics were reproducible in the static and dynamic modes of shear wave elastography with a higher interobserver agreement in dynamic qualitative metrics than in the static mode. There were no statistically significant differences between the two modes of imaging in quantitative metrics, and quantitative metrics were more effective than qualitative metrics. Postoperative immunohistochemical expression of ER, PR, HER-2, Ki-67, molecular typing, pathological type, histological grading, and axillary lymph node status of breast cancer was obtained based on pathological results. The correlation between mass size, patient age, and WiMAX values of breast cancer masses was analyzed using Pearson correlation, and the differences in SWVmax values of breast cancer masses between different expressions of immunohistochemical parameters ER, PR, HER-2, Ki-67, and axillary lymph node status were compared using tests. The variables with correlations and differences were included in the multiple linear regression analysis to assess the factors influencing the SWVmax values. The performance of TDPM, SPM, and TSPM was compared using PVA body models with different freeze-thaw cycles. The results showed that TSPM performed better than SPM in general, and TDPM showed excellent performance because of high temporal resolution and low random error, especially when the number of freeze-thaw cycles increased and the hardness of the PVA body mold increased. Measurements at different depths of inhomogeneous body models also showed that the TDPM method was less affected by depth, and the results were more stable. Finally, the reliability of the shear wave velocity (SWS) measured by the TDPM and SPM methods was investigated using porcine ligament tissue, and the results showed that the mean values of SWS goodness of fit for TDPM and SPM were 0.94 and 0.87, respectively, and the estimated elastic modulus of TDPM was very close to the mechanical test results.
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Affiliation(s)
- Caoxin Yan
- Department of Ultrasound in Medicine, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, Zhejiang 322000, China
| | - Zhiyan Luo
- Department of Ultrasound in Medicine, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Zimei Lin
- Department of Ultrasound in Medicine, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, China
| | - Huilin He
- Department of Ultrasound in Medicine, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, Zhejiang 322000, China
| | - Yunkai Luo
- Department of Ultrasound in Medicine, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, Zhejiang 322000, China
| | - Jian Chen
- Department of Ultrasound in Medicine, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, Zhejiang 322000, China
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Elmesidy DS, Eissa MAGAM, Hamed ST, Youssef OZ, Nada OM, Hashem LMB. Axillary lymph node status in BIRADS 4-5 female patients: can shear wave and strain ultrasound elastography help? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00560-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
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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Jiang M, Li CL, Chen RX, Tang SC, Lv WZ, Luo XM, Chuan ZR, Jin CY, Liao JT, Cui XW, Dietrich CF. Management of breast lesions seen on US images: dual-model radiomics including shear-wave elastography may match performance of expert radiologists. Eur J Radiol 2021; 141:109781. [PMID: 34029933 DOI: 10.1016/j.ejrad.2021.109781] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/28/2021] [Accepted: 05/17/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To develop a nomogram incorporating B-mode ultrasound (BMUS) and shear-wave elastography (SWE) radiomics to predict malignant status of breast lesions seen on US non-invasively. METHODS Data on 278 consecutive patients from Hospital #1 (training cohort) and 123 cases from Hospital #2 (external validation cohort) referred for breast US with subsequent histopathologic analysis between May 2017 and October 2019 were retrospectively collected. Using their BMUS and SWE images, we built a radiomics nomogram to improve radiology workflow for management of breast lesions. The performance of the algorithm was compared with a consensus of three ACR BI-RADS committee experts and four individual radiologists, all of whom interpreted breast US images in clinical practice. RESULTS Twelve features from BMUS and three from SWE were selected finally to construct the respective radiomic signature. The nomogram based on the dual-modal US radiomics achieved good diagnostic performance in the training (AUC 0.96; 95% confidence intervals [CI], 0.94-0.98) and the validation set (AUC 0.92; 95% CI, 0.87-0.97). For the 123 test lesions, the algorithm achieved 105 of 123 (85%) accuracy, comparable to the expert consensus (104 of 123 [85%], P = 0.86) and four individual radiologists (93, 99, 95 and 97 of 123, with P value of 0.05, 0.31, 0.10 and 0.18 respectively). Furthermore, the model also performed well in the BI-RADS 4 and 5 categories. CONCLUSIONS Performance of a dual-model US radiomics nomogram based on SWE for breast lesion classification may comparable to that of expert radiologists who used ACR BI-RADS guideline.
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Affiliation(s)
- Meng Jiang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Chang-Li Li
- Department of Geratology, Hubei Provincial Hospital of Integrated Chinese and Western medicine, 11 Lingjiaohu Avenue, Wuhan, 430015, China
| | - Rui-Xue Chen
- Department of Medical Ultrasound, Wuchang Hospital, Wuhan, 430030, China
| | - Shi-Chu Tang
- Department of Medical Ultrasound, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, 410013, China
| | - Wen-Zhi Lv
- Department of Artificial Intelligence, Julei Technology Company, Wuhan, 430030, China
| | - Xiao-Mao Luo
- Deaprtment of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, 650118, China
| | - Zhi-Rui Chuan
- Deaprtment of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, 650118, China
| | - Chao-Ying Jin
- Department of Medical Ultrasound, Taizhou Hospital of Zhejiang Province, Taizhou, 317000, China
| | - Jin-Tang Liao
- Department of Ultrasound Imaging, Xiangya Hospital, Central South University, Changsha, 410013, China.
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Christoph F Dietrich
- Department of Internal Medicine, Hirslanden Clinic, Schänzlihalde 11, 3013, Bern, Switzerland
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Chen MY, Gillanders WE. Staging of the Axilla in Breast Cancer and the Evolving Role of Axillary Ultrasound. BREAST CANCER (DOVE MEDICAL PRESS) 2021; 13:311-323. [PMID: 34040436 PMCID: PMC8139849 DOI: 10.2147/bctt.s273039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/23/2021] [Indexed: 12/15/2022]
Abstract
Axillary lymph nodes have long been recognized as a route for breast cancer to spread systemically. As a result, staging of the axilla has always played a central role in the treatment of breast cancer. Anatomic staging was believed to be important for two reasons: 1) it predicts prognosis and guides medical therapy, and 2) it is a potential therapy for removal of disease in the axilla. This paradigm has now been called into question. Prognostic information is driven increasingly by tumor biology, and trials such as the ACOSOG Z0011 demonstrates removal of axillary disease is not therapeutic. Staging of the axilla has undergone a dramatic de-escalation; however, sentinel lymph node biopsy (SLNB) is still an invasive surgery and represents a large economic burden on the healthcare system. In this review, we outline the changing paradigms of axillary staging in breast cancer from emphasis on anatomic staging to tumor biology, and the evolving role of axillary ultrasound, bringing patients less invasive and more personalized therapy.
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Affiliation(s)
- Michael Y Chen
- Department of Surgery, Washington University, St Louis, MS, USA
| | - William E Gillanders
- Department of Surgery, Washington University, St Louis, MS, USA
- Siteman Cancer Center in St. Louis, St Louis, MS, USA
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Feasibility of T 2WI-MRI-based radiomics nomogram for predicting normal-sized pelvic lymph node metastasis in cervical cancer patients. Eur Radiol 2021; 31:6938-6948. [PMID: 33585992 DOI: 10.1007/s00330-021-07735-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/22/2020] [Accepted: 02/01/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the feasibility of T2WI-based radiomics nomogram analysis to non-invasively predict normal-sized pelvic lymph node (LN) metastasis (LNM) in cervical cancer patients. METHODS Preoperative images of 219 normal-sized pathologically confirmed LNs from 132 cervical cancer patients admitted to our hospital between January 2013 and March 2020 were retrospectively reviewed. Regions of interests (ROIs) were separately delineated on whole LNs and tumors. The maximum-relevance and minimum-redundancy (mRMR) and least absolute shrinkage and selection operator (LASSO) methods were used for the construction of radiomics signature. Logistic regression modeling was employed to build models based on clinical features on LN T2WI (model 1), model 1 combined with LN radiomics features (model 2), and model 2 combined with tumor score (model 3). Diagnostic performance was assessed and compared. RESULTS Both model 2 and model 3 showed higher diagnostic accuracy (training: model 2 0.75, model 3 0.78, model 1 0.72; validation: model 2 0.77, model 3 0.69, model 1 0.66) and AUC (training: model 2 0.77, model 3 0.82, model 1 0.74; validation: model 2 0.75, model 3 0.74, model 1 0.70) than clinical model 1. Diagnostic performance of model 3 was improved compared with model 2 in primary cohort, but reduced in validation cohort. However, the differences did not show obvious statistical difference (p = 0.05 and p = 0.15). CONCLUSIONS T2WI-based radiomics nomogram incorporating the LN radiomics signature with the clinical morphological LN features is promising for predicting the normal-sized pelvic LNM in cervical cancer patients. The original tumor radiomics analysis did not significantly improve the differential diagnosis of LNM. KEY POINTS • The combination of LN radiomics signature with LN clinical morphological features on T2WI could discriminate LNM relatively well. • The tumor radiomics analysis did not significantly improve the differential diagnosis of LNM.
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