1
|
Yan Y, Jiang T, Sui L, Ou D, Qu Y, Chen C, Lai M, Ni C, Liu Y, Wang Y, Xu D. Combined conventional ultrasonography with clinicopathological features to predict axillary status after neoadjuvant therapy for breast cancer: A case-control study. Br J Radiol 2023; 96:20230370. [PMID: 37750854 PMCID: PMC10646660 DOI: 10.1259/bjr.20230370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/15/2023] [Accepted: 08/24/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate the value of a model combining conventional ultrasonography and clinicopathologic features for predicting axillary status after neoadjuvant therapy in breast cancer. METHODS This retrospective study included 329 patients with lymph node-positive who underwent neoadjuvant systemic treatment (NST) from June 2019 to March 2022. Ultrasound and clinicopathological characteristics of breast lesions and axillary lymph nodes were analyzed before and after NST. The diagnostic efficacy of ultrasound, clinicopathological characteristics, and combined model were evaluated using multivariate logistic regression and receiver operator characteristic curve (ROC) analyses. RESULTS The area under ROC (AUC) for the ability of the combined model to predict the axillary pathological complete response (pCR) after NST was 0.882, that diagnostic effectiveness was significantly better than that of the clinicopathological model (AUC of 0.807) and the ultrasound feature model (AUC of 0.795). In addition, eight features were screened as independent predictors of axillary pCR, including clinical N stage, ERBB2 status, Ki-67, and after NST the maximum diameter reduction rate and margins of breast lesions, the short diameter, cortical thickness, and fatty hilum of lymph nodes. CONCLUSIONS The combined model constructed from ultrasound and clinicopathological features for predicting axillary pCR has favorable diagnostic results, which allowed more accurate identification of BC patients who had received axillary pCR after NST. ADVANCES IN KNOWLEDGE A combined model incorporated ultrasound and clinicopathological characteristics of breast lesions and axillary lymph nodes demonstrated favorable performance in evaluating axillary pCR preoperatively and non-invasively.
Collapse
Affiliation(s)
| | | | | | | | - Yiyuan Qu
- The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | | | | | | | | | | | | |
Collapse
|
2
|
Ferroni G, Sabeti S, Abdus-Shakur T, Scalise L, Carter JM, Fazzio RT, Larson NB, Fatemi M, Alizad A. Noninvasive prediction of axillary lymph node breast cancer metastasis using morphometric analysis of nodal tumor microvessels in a contrast-free ultrasound approach. Breast Cancer Res 2023; 25:65. [PMID: 37296471 PMCID: PMC10257266 DOI: 10.1186/s13058-023-01670-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSE Changes in microcirculation of axillary lymph nodes (ALNs) may indicate metastasis. Reliable noninvasive imaging technique to quantify such variations is lacking. We aim to develop and investigate a contrast-free ultrasound quantitative microvasculature imaging technique for detection of metastatic ALN in vivo. EXPERIMENTAL DESIGN The proposed ultrasound-based technique, high-definition microvasculature imaging (HDMI) provides superb images of tumor microvasculature at sub-millimeter size scales and enables quantitative analysis of microvessels structures. We evaluated the new HDMI technique on 68 breast cancer patients with ultrasound-identified suspicious ipsilateral axillary lymph nodes recommended for fine needle aspiration biopsy (FNAB). HDMI was conducted before the FNAB and vessel morphological features were extracted, analyzed, and the results were correlated with the histopathology. RESULTS Out of 15 evaluated quantitative HDMI biomarkers, 11 were significantly different in metastatic and reactive ALNs (10 with P << 0.01 and one with 0.01 < P < 0.05). We further showed that through analysis of these biomarkers, a predictive model trained on HDMI biomarkers combined with clinical information (i.e., age, node size, cortical thickness, and BI-RADS score) could identify metastatic lymph nodes with an area under the curve of 0.9 (95% CI [0.82,0.98]), sensitivity of 90%, and specificity of 88%. CONCLUSIONS The promising results of our morphometric analysis of HDMI on ALNs offer a new means of detecting lymph node metastasis when used as a complementary imaging tool to conventional ultrasound. The fact that it does not require injection of contrast agents simplifies its use in routine clinical practice.
Collapse
Affiliation(s)
- Giulia Ferroni
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN, 55905, USA
| | - Soroosh Sabeti
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN, 55905, USA
| | - Tasneem Abdus-Shakur
- Department of Radiology, Mayo Clinic College of Medicine and Science, 200 1st. St. SW, Rochester, MN, 55905, USA
| | - Lorenzo Scalise
- Department of Industrial Engineering and Mathematical Science, Marche Polytechnic University, 60131, Ancona, Italy
| | - Jodi M Carter
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Robert T Fazzio
- Department of Radiology, Mayo Clinic College of Medicine and Science, 200 1st. St. SW, Rochester, MN, 55905, USA
| | - Nicholas B Larson
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, MN, 55905, USA
| | - Mostafa Fatemi
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN, 55905, USA
| | - Azra Alizad
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN, 55905, USA.
- Department of Radiology, Mayo Clinic College of Medicine and Science, 200 1st. St. SW, Rochester, MN, 55905, USA.
| |
Collapse
|
3
|
Zhang H, Cao W, Liu L, Meng Z, Sun N, Meng Y, Fei J. Noninvasive prediction of node-positive breast cancer response to presurgical neoadjuvant chemotherapy therapy based on machine learning of axillary lymph node ultrasound. J Transl Med 2023; 21:337. [PMID: 37211604 DOI: 10.1186/s12967-023-04201-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/14/2023] [Indexed: 05/23/2023] Open
Abstract
OBJECTIVES To explore an optimal model to predict the response of patients with axillary lymph node (ALN) positive breast cancer to neoadjuvant chemotherapy (NAC) with machine learning using clinical and ultrasound-based radiomic features. METHODS In this study, 1014 patients with ALN-positive breast cancer confirmed by histological examination and received preoperative NAC in the Affiliated Hospital of Qingdao University (QUH) and Qingdao Municipal Hospital (QMH) were included. Finally, 444 participants from QUH were divided into the training cohort (n = 310) and validation cohort (n = 134) based on the date of ultrasound examination. 81 participants from QMH were used to evaluate the external generalizability of our prediction models. A total of 1032 radiomic features of each ALN ultrasound image were extracted and used to establish the prediction models. The clinical model, radiomics model, and radiomics nomogram with clinical factors (RNWCF) were built. The performance of the models was assessed with respect to discrimination and clinical usefulness. RESULTS Although the radiomics model did not show better predictive efficacy than the clinical model, the RNWCF showed favorable predictive efficacy in the training cohort (AUC, 0.855; 95% CI 0.817-0.893), the validation cohort (AUC, 0.882; 95% CI 0.834-0.928), and the external test cohort (AUC, 0.858; 95% CI 0.782-0.921) compared with the clinical factor model and radiomics model. CONCLUSIONS The RNWCF, a noninvasive, preoperative prediction tool that incorporates a combination of clinical and radiomics features, showed favorable predictive efficacy for the response of node-positive breast cancer to NAC. Therefore, the RNWCF could serve as a potential noninvasive approach to assist personalized treatment strategies, guide ALN management, avoiding unnecessary ALND.
Collapse
Affiliation(s)
- Hao Zhang
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Wen Cao
- Department of Medical Record Management, The Affiliated Hospital of Qingdao University, Pingdu District, Qingdao, Shandong, China
| | - Lianjuan Liu
- Department of Ultrasound, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong, China
| | - Zifan Meng
- Department of Blood Transfusion, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Ningning Sun
- Department of Breast Disease Center, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yuanyuan Meng
- Department of Cardiac Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jie Fei
- Department of Breast Imaging, The Affiliated Hospital of Qingdao University, No. 59 Haier Road, Qingdao, 266000, Shandong, China.
| |
Collapse
|
4
|
Pulappadi VP, Paul S, Hari S, Dhamija E, Manchanda S, Kataria K, Mathur S, Mani K, Gogia A, Deo S. Role of shear wave elastography as an adjunct to axillary ultrasonography in predicting nodal metastasis in breast cancer patients with suspicious nodes. Br J Radiol 2022; 95:20220055. [PMID: 35290097 DOI: 10.1259/bjr.20220055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To evaluate the role of shear wave elastography (SWE) of suspicious axillary lymph nodes and its combination with B-mode USG in predicting nodal metastasis in breast cancer patients. METHODS Prospective observational study was performed from June 2018 to August 2020 on breast cancer patients with suspicious axillary nodes on USG. B-mode features (cortical thickness, effacement of fatty hilum, non-hilar blood flow and round shape) and SWE parameters (Emax, Emin, Emean and ESD) of the node with the thickest cortex were evaluated. Diagnostic performances of USG, SWE and their combination were estimated using pathological status of the node on biopsy as the gold standard. RESULTS Of the 54 patients evaluated, optimal elasticity maps were obtained in 49 nodes of 49 patients (mean age, 46.3 ± 12.1 years; 48/49 (98%) females). On biopsy, 38 nodes (77.6%) had metastasis, while 11 (22.4%) had reactive hyperplasia. Emax, Emin, Emean and ESD of both cortex and hilum were significantly higher in metastatic than reactive nodes. Emax (cortex) ≥14.9 kPa had the best diagnostic performance (sensitivity, 73.7%; specificity, 81.8%). Cortical thickness ≥6.7 mm had the best diagnostic performance among B-mode features (sensitivity, 89.5%; specificity, 72.7%). Combining cortical thickness with effacement of fatty hilum and/or non-hilar blood flow yielded sensitivity of 89.5% and specificity of 90.9%. Addition of Emax (cortex) to cortical thickness and combination of ≥2 B-mode features increased their specificities to 90.9 and 100%, respectively. CONCLUSIONS Metastatic axillary nodes are stiffer than reactive nodes on SWE in breast cancer patients. Emax (cortex) has the best diagnostic performance in differentiating between reactive hyperplasia and nodal metastasis. Combination of Emax (cortex) and cortical thickness increases the specificity for diagnosing metastasis, especially in nodes showing only cortical thickening. ADVANCES IN KNOWLEDGE Combination of SWE and B-mode USG is highly specific for differentiating metastasis from reactive hyperplasia in suspicious nodes of breast carcinoma patients, especially in nodes with only cortical thickening.
Collapse
Affiliation(s)
- Vishnu Prasad Pulappadi
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shashi Paul
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Smriti Hari
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ekta Dhamija
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Smita Manchanda
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kamal Kataria
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Kalaivani Mani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Gogia
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Svs Deo
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
5
|
Huang JX, Lin SY, Ou Y, Shi CG, Zhong Y, Wei MJ, Pei XQ. Combining conventional ultrasound and sonoelastography to predict axillary status after neoadjuvant chemotherapy for breast cancer. Eur Radiol 2022; 32:5986-5996. [PMID: 35364714 DOI: 10.1007/s00330-022-08751-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/05/2022] [Accepted: 03/16/2022] [Indexed: 11/29/2022]
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.
Collapse
Affiliation(s)
- Jia-Xin Huang
- 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
| | - Shi-Yang Lin
- Department of Medical Ultrasound, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510000, China
| | - Yan Ou
- Department of Medical Ultrasound, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, 518000, China
| | - Cai-Gou Shi
- Department of Medical Ultrasound, Liuzhou People's Hospital, Liuzhou, 545000, China
| | - Yuan Zhong
- 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
| | - Ming-Jie Wei
- 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
| | - Xiao-Qing Pei
- 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.
| |
Collapse
|
6
|
Pulappadi VP, Paul S, Hari S, Dhamija E, Manchanda S, Kataria K, Mathur S, Mani K, Gogia A, Deo S. Axillary ultrasonography combined with pre-operative wire localisation of clipped node in nodal restaging after neoadjuvant chemotherapy in node positive breast cancer patients: a pilot study. Br J Radiol 2021; 94:20210788. [PMID: 34491822 DOI: 10.1259/bjr.20210788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To evaluate the role of axillary ultrasonography (axUS) and ultrasound-guided pre-operative wire localisation of pre-treatment positive clipped node (CN) for prediction of nodal response to neoadjuvant chemotherapy (NACT) in node positive breast carcinoma patients. METHODS AND MATERIALS A prospective study was conducted between June 2018 and August 2020 after Ethics Committee approval. Breast carcinoma patients (cT1-cT4b) with palpable axillary nodes (cN1-cN3) and suitable for NACT were recruited after written informed consent. Single, most suspicious node was biopsied and clipped. Nodal response to NACT was assessed on axUS. Wire localisation of CN was performed prior to axillary lymph node dissection (ALND). Diagnostic performances of axUS and CN excision were assessed. RESULTS Of the 69 patients evaluated, 32 patients (mean age, 43.5 ± 11.8 years; females, 31/32 [97%]; pre-menopausal, 18/32 [56.3%]) with metastatic nodes who received NACT were included. Nodal pathological complete response rate was 34.4% (11/32) overall and 70% (7/10) in patients with ≤2 suspicious nodes on pre-NACT axUS. False-negative rates (FNRs) of axUS and CN excision were 4.8% and 28.6% respectively. Combination of post-NACT axUS and CN excision had an FNR of 4.8% overall and 0% in patients with ≤2 suspicious nodes on pre-NACT axUS. CONCLUSION Combination of AxUS and ultrasound-guided wire localisation of pre-treatment positive CN has high diagnostic accuracy for nodal restaging after NACT in node positive breast cancer patients. ADVANCES IN KNOWLEDGE Addition of axUS assessment to wire localisation of CN reduces its FNR for detecting residual metastasis after NACT.
Collapse
Affiliation(s)
- Vishnu Prasad Pulappadi
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shashi Paul
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Smriti Hari
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ekta Dhamija
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Smita Manchanda
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kamal Kataria
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Kalaivani Mani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Gogia
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Svs Deo
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
7
|
Vijayaraghavan GR, Kona M, Maheswaran A, Kandil DH, Toke MK, Vedantham S. Ultrasound Imaging Morphology is Associated with Biological Behavior in Invasive Ductal Carcinoma of the Breast. J Clin Imaging Sci 2021; 11:48. [PMID: 34513212 PMCID: PMC8422408 DOI: 10.25259/jcis_60_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/11/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Ultrasound (US) is commonly used for diagnostic evaluation of breast lesions. The objective of this study was to investigate the association between US imaging morphology from routine radiologists’ interpretation and biological behavior such as receptor status and tumor grade determined from histopathology in invasive ductal carcinoma (IDC). Material and Methods: This retrospective study included 453 patients with pathology-verified diagnosis of IDC who had undergone US imaging and had surgery over a 5-year period. US and surgical pathology reports were reviewed and compiled. Correlation analyses and age-adjusted multivariable models were used to determine the association between US imaging morphology and receptor status, tumor grade, and germ line mutation of the breast cancer genes (BRCA1 and BRCA2). The odds ratio (OR), area under receiver operating characteristic curve (AUC), and 95% confidence intervals (CI) were obtained. Results: The likelihood for high-grade cancer increased with size (OR: 1.066; CI: 1.042–1.091) and hypo-echogenicity (OR: 2.044; CI: 1.337–3.126), and decreased with angular or spiculated margins (OR: 0.605; CI: 0.393–0.931) and posterior acoustic shadowing (OR: 0.352; CI: 0.238–0.523). These features achieved an AUC of 0.799 (CI: 0.752–0.845) for predicting high-grade tumors. The likelihood for Estrogen Receptor-positive tumors increased with posterior acoustic shadowing (OR: 3.818; CI: 2.206–6.607), angulated or spiculated margins (OR: 2.596; CI: 1.159–5.815) and decreased with US measured tumor size (OR: 0.959; CI: 0.933–0.986) and hypoechoic features (OR: 0.399; CI: 0.198– 0.801), and achieved an AUC of 0.787 (CI: 0.733–0.841). The likelihood for Progesterone Receptor-positive tumors increased with posterior acoustic shadowing (OR: 2.732; CI: 1.744–4.28) and angulated or spiculated margins (OR: 2.618; CI: 1.412–4.852), and decreased with US measured tumor size (OR: 0.961; CI: 0.937–0.985) and hypoechoic features (OR: 0.571; CI: 0.335–0.975), and achieved an AUC of 0.739 (CI: 0.689–0.790). The likelihood for Human epidermal growth factor receptor 2-positive tumors increased with heterogeneous echo texture (OR: 2.141; CI: 1.17– 3.919) and decreased with angulated or spiculated margins (OR: 0.408; CI: 0.177–0.944), and was marginally associated with hypoechoic features (OR: 2.101; CI: 0.98–4.505) and circumscribed margins (OR: 4.225; CI: 0.919–19.4). The model with the aforementioned four US morphological features and achieved an AUC of 0.686 (CI: 0.614–0.758). The likelihood for triple-negative breast cancers increased with hypo-echogenicity (OR: 2.671; CI: 1.249–5.712) and decreased with posterior acoustic shadowing (OR: 0.287; CI: 0.161–0.513), and achieved an AUC of 0.739 (CI: 0.671– 0.806). No statistical association was observed between US imaging morphology and BRCA mutation. Conclusion: In this study of over 450 IDCs, significant statistical associations between tumor grade and receptor status with US imaging morphology were observed and could serve as a surrogate imaging marker for the biological behavior of the tumor.
Collapse
Affiliation(s)
- Gopal R Vijayaraghavan
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, United States
| | - Matthew Kona
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, United States
| | - Abiramy Maheswaran
- Department of Medical Oncology, University of Massachusetts Medical School, Worcester, Massachusetts, United States
| | - Dina H Kandil
- Department of Pathology, University of Massachusetts Medical School, Worcester, Massachusetts, United States
| | - Madhavi K Toke
- Department of Medical Oncology, University of Massachusetts Medical School, Worcester, Massachusetts, United States
| | - Srinivasan Vedantham
- Department of Medical Imaging, University of Arizona, Tucson, Arizona, United States
| |
Collapse
|
8
|
Līcīte B, Irmejs A, Maksimenko J, Loža P, Trofimovičs G, Miklaševičs E, Nazarovs J, Romanovska M, Deičmane J, Irmejs R, Purkalne G, Gardovskis J. Ultrasound guided needle biopsy of axilla to evaluate nodal metastasis after preoperative systemic therapy in cohort of 106 breast cancers enriched with BRCA1/2 pathogenic variant carriers. Hered Cancer Clin Pract 2021; 19:30. [PMID: 34233740 PMCID: PMC8262039 DOI: 10.1186/s13053-021-00187-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/18/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Aim of the study is to evaluate the role of ultrasound guided fine needle aspiration cytology (FNAC) in the restaging of node positive breast cancer after preoperative systemic therapy (PST). METHODS From January 2016 - October 2020 106 node positive stage IIA-IIIC breast cancer cases undergoing PST were included in the study. 18 (17 %) were carriers of pathogenic variant in BRCA1/2. After PST restaging of axilla was performed with ultrasound and FNAC of the marked and/or the most suspicious axillary node. In 72/106 cases axilla conserving surgery and in 34/106 cases axillary lymph node dissection (ALND) was performed. RESULTS False Positive Rate (FPR) of FNAC after PST in whole cohort and BRCA1/2 positive subgroup is 8 and 0 % and False Negative Rate (FNR) - 43 and 18 % respectively. Overall Sensitivity - 55 %, specificity- 93 %, accuracy 70 %. CONCLUSION FNAC after PST has low FPR and is useful to predict residual axillary disease and to streamline surgical decision making regarding ALND both in BRCA1/2 positive and negative subgroups. FNR is high in overall cohort and FNAC alone are not able to predict ypCR and omission of further axillary surgery. However, FNAC performance in BRCA1/2 positive subgroup is more promising and further research with larger number of cases is necessary to confirm the results.
Collapse
Affiliation(s)
- Baiba Līcīte
- Department of Surgery, Riga Stradiņš University, Pilsoņu iela 13, LV-1002, Riga, Latvia.
- Department of Surgery, (Affiliated Partner of the European Reference Network on Genetic Tumour Risk Syndromes (ERN GENTURIS)), Pauls Stradiņš Clinical University Hospital, Pilsoņu iela 13, LV-1002, Riga, Latvia.
| | - Arvīds Irmejs
- Department of Surgery, Riga Stradiņš University, Pilsoņu iela 13, LV-1002, Riga, Latvia
- Department of Surgery, (Affiliated Partner of the European Reference Network on Genetic Tumour Risk Syndromes (ERN GENTURIS)), Pauls Stradiņš Clinical University Hospital, Pilsoņu iela 13, LV-1002, Riga, Latvia
- Institute of Oncology, Riga Stradiņš University, Pilsoņu iela 13, LV-1002, Riga, Latvia
| | - Jeļena Maksimenko
- Department of Surgery, Riga Stradiņš University, Pilsoņu iela 13, LV-1002, Riga, Latvia
- Department of Surgery, (Affiliated Partner of the European Reference Network on Genetic Tumour Risk Syndromes (ERN GENTURIS)), Pauls Stradiņš Clinical University Hospital, Pilsoņu iela 13, LV-1002, Riga, Latvia
- Institute of Oncology, Riga Stradiņš University, Pilsoņu iela 13, LV-1002, Riga, Latvia
| | - Pēteris Loža
- Department of Surgery, Riga Stradiņš University, Pilsoņu iela 13, LV-1002, Riga, Latvia
- Department of Surgery, (Affiliated Partner of the European Reference Network on Genetic Tumour Risk Syndromes (ERN GENTURIS)), Pauls Stradiņš Clinical University Hospital, Pilsoņu iela 13, LV-1002, Riga, Latvia
| | - Genādijs Trofimovičs
- Department of Surgery, Riga Stradiņš University, Pilsoņu iela 13, LV-1002, Riga, Latvia
- Department of Surgery, (Affiliated Partner of the European Reference Network on Genetic Tumour Risk Syndromes (ERN GENTURIS)), Pauls Stradiņš Clinical University Hospital, Pilsoņu iela 13, LV-1002, Riga, Latvia
| | - Edvīns Miklaševičs
- Institute of Oncology, Riga Stradiņš University, Pilsoņu iela 13, LV-1002, Riga, Latvia
| | - Jurijs Nazarovs
- Department of Pathology, Pauls Stradiņš Clinical University Hospital, Pilsoņu iela 13, LV-1002, Riga, Latvia
| | - Māra Romanovska
- Department of Pathology, Pauls Stradiņš Clinical University Hospital, Pilsoņu iela 13, LV-1002, Riga, Latvia
| | - Justīne Deičmane
- Department of Radiology, Pauls Stradiņš Clinical University Hospital, Pilsoņu iela 13, LV-1002, Riga, Latvia
| | - Reinis Irmejs
- St John's College, University of Cambridge, Cambridge, England
| | - Gunta Purkalne
- Department of Surgery, Riga Stradiņš University, Pilsoņu iela 13, LV-1002, Riga, Latvia
- Department of Oncology, Pauls Stradiņš Clinical University Hospital, Pilsoņu iela 13, LV-1002, Riga, Latvia
| | - Jānis Gardovskis
- Department of Surgery, Riga Stradiņš University, Pilsoņu iela 13, LV-1002, Riga, Latvia
- Department of Surgery, (Affiliated Partner of the European Reference Network on Genetic Tumour Risk Syndromes (ERN GENTURIS)), Pauls Stradiņš Clinical University Hospital, Pilsoņu iela 13, LV-1002, Riga, Latvia
- Institute of Oncology, Riga Stradiņš University, Pilsoņu iela 13, LV-1002, Riga, Latvia
| |
Collapse
|
9
|
Zhu Y, Zhou JQ, Jia XH, Zhou W, Zhan WW. Interobserver variability between experienced radiologists in evaluating the number of abnormal lymph nodes seen on preoperative axillary ultrasound. Clin Radiol 2020; 76:60-66. [PMID: 33077155 DOI: 10.1016/j.crad.2020.03.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/31/2020] [Indexed: 10/23/2022]
Abstract
AIM To determine the interobserver variability of experienced radiologists in evaluating the number of suspicious lymph nodes (LNs) seen on axillary ultrasound (AUS) examination, and to evaluate the effects of clinicopathological features on the discordance. MATERIAL AND METHODS A prospective non-randomised triple-blind study was conducted from July 2016 to December 2017 at Shanghai Ruijin Hospital. Three experienced radiologists performed AUS on 462 patients (469 axillae) with invasive breast cancer independently and assessed the number of abnormal LNs during the real-time AUS examination. Interobserver agreement was determined according to the kappa statistic. RESULTS The mean numbers of metastatic LNs on final histology study were 0.35, 0.98, 3.05 and 4.70 for patients with 0, 1, 2 and >2 abnormal nodes on preoperative AUS. When the cut-off (the number of abnormal LNs seen on AUS was >1) at which the maximal sum of sensitivity and specificity for diagnosis of ≥3 tumour-involved LNs was achieved was applied, the Az values ranged from 0.776 to 0.811. When the number of abnormal LNs was grouped into two-category classification (0-1 versus ≥2 abnormal LNs detected by AUS), good interobserver agreement (kappa: 0.601-0.687) was found, and disagreement between the radiologists was more frequently found in patients with T2-stage tumour and in those with one or two tumour-involved nodes. CONCLUSION Abnormal LN count according to two-category classification (0-1 versus ≥2 abnormal LNs detected by AUS) was a feasible method with good accuracy and high repeatability to select patients with heavy nodal disease in the post-Z0011 trial era.
Collapse
Affiliation(s)
- Y Zhu
- Department of Ultrasound, Shanghai Ruijin Hospital affiliated to Medical School of Shanghai Jiaotong University, Shanghai, China
| | - J Q Zhou
- Department of Ultrasound, Shanghai Ruijin Hospital affiliated to Medical School of Shanghai Jiaotong University, Shanghai, China
| | - X H Jia
- Department of Ultrasound, Shanghai Ruijin Hospital affiliated to Medical School of Shanghai Jiaotong University, Shanghai, China
| | - W Zhou
- Department of Ultrasound, Shanghai Ruijin Hospital affiliated to Medical School of Shanghai Jiaotong University, Shanghai, China
| | - W W Zhan
- Department of Ultrasound, Shanghai Ruijin Hospital affiliated to Medical School of Shanghai Jiaotong University, Shanghai, China.
| |
Collapse
|
10
|
Horváth Z, Paszt A, Simonka Z, Látos M, Kaizer L, Hamar S, Vörös A, Ormándi K, Fejes Z, Lázár G. Is axillary lymph node dissection necessary for positive preoperative aspiration cytology lymph node results? Eur J Surg Oncol 2019; 46:504-510. [PMID: 31708307 DOI: 10.1016/j.ejso.2019.10.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/17/2019] [Accepted: 10/31/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Based on international guidelines, axillary lymph node dissection (ALND) is recommended in cases of breast cancer if preoperative examinations confirm axillary metastasis. We examined which set of preoperative parameters might render ALND unnecessary. PATIENTS AND METHODS Preoperative examinations (axillary ultrasound and aspiration cytology) confirmed axillary metastasis in 190 cases out of 2671 patients with breast cancer; primary ALN dissection was performed on these patients with or without prior neoadjuvant therapy. The clinicopathological results were analysed to determine which parameter might predict the presence of no more than 2 or 3 metastatic ALNs. RESULTS The final histological examination confirmed 1-3 metastatic lymph nodes in ALND samples in 116 cases and over 3 metastatic lymph nodes in 74 cases. For patients receiving neoadjuvant therapy (59 out of the 190 cases), if the size of the primary tumour was 2 cm or smaller and/or the metastatic ALN was 15 mm or smaller, then the patient was likely to have no more than 3 positive ALNs (stage N0-1 disease) (p < 0.001). If the patient did not receive neoadjuvant therapy, stage N2 or N3 disease was very likely. No correlation was found between other clinicopathological characteristics of the tumour and involvement of the ALNs. CONCLUSION Axillary lymph node dissection is not necessary for selected breast cancer patients with axillary metastasis receiving neoadjuvant therapy. In these cases, sentinel lymph node biopsy with or without radiation therapy and close follow-up may serve as adequate therapy.
Collapse
Affiliation(s)
- Z Horváth
- Department of Surgery, University of Szeged, Albert Szent-Györgyi Clinical Centre, H-6725, Szeged, Semmelweis u. 8, Hungary.
| | - A Paszt
- Department of Surgery, University of Szeged, Albert Szent-Györgyi Clinical Centre, H-6725, Szeged, Semmelweis u. 8, Hungary.
| | - Z Simonka
- Department of Surgery, University of Szeged, Albert Szent-Györgyi Clinical Centre, H-6725, Szeged, Semmelweis u. 8, Hungary.
| | - M Látos
- Department of Surgery, University of Szeged, Albert Szent-Györgyi Clinical Centre, H-6725, Szeged, Semmelweis u. 8, Hungary.
| | - L Kaizer
- Department of Pathology, University of Szeged, Albert Szent-Györgyi Clinical Centre, H-6725, Szeged, Állomás u. 2, Hungary.
| | - S Hamar
- Department of Pathology, University of Szeged, Albert Szent-Györgyi Clinical Centre, H-6725, Szeged, Állomás u. 2, Hungary.
| | - A Vörös
- Department of Pathology, University of Szeged, Albert Szent-Györgyi Clinical Centre, H-6725, Szeged, Állomás u. 2, Hungary.
| | - K Ormándi
- Affidea Hungary - Szeged, University of Szeged, Albert Szent-Györgyi Clinical Centre, H-6725, Szeged, Semmelweis u. 6/A, Hungary.
| | - Z Fejes
- Affidea Hungary - Szeged, University of Szeged, Albert Szent-Györgyi Clinical Centre, H-6725, Szeged, Semmelweis u. 6/A, Hungary.
| | - G Lázár
- Department of Surgery, University of Szeged, Albert Szent-Györgyi Clinical Centre, H-6725, Szeged, Semmelweis u. 8, Hungary.
| |
Collapse
|
11
|
Morency D, Dumitra S, Parvez E, Martel K, Basik M, Robidoux A, Poirier B, Holloway CMB, Gaboury L, Sideris L, Meterissian S, Boileau JF. Axillary Lymph Node Ultrasound Following Neoadjuvant Chemotherapy in Biopsy-Proven Node-Positive Breast Cancer: Results from the SN FNAC Study. Ann Surg Oncol 2019; 26:4337-4345. [PMID: 31605348 DOI: 10.1245/s10434-019-07809-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The sentinel node biopsy following neoadjuvant chemotherapy (SN FNAC) study has shown that in node-positive (N+) breast cancer, sentinel node biopsy (SNB) can be performed following neoadjuvant chemotherapy (NAC), with a low false negative rate (FNR = 8.4%). A secondary endpoint of the SN FNAC study was to determine whether axillary ultrasound (AxUS) could predict axillary pathological complete response (ypN0) and increase the accuracy of SNB. METHODS The SN FNAC trial is a study of patients with biopsy-proven N+ breast cancer who underwent SNB followed by completion node dissection. All patients had AxUS following NAC and the axillary nodes were classified as either positive (AxUS+) or negative (AxUS-). AxUS was compared with the final axillary pathology results. RESULTS There was no statistical difference in the baseline characteristics of patients with AxUS+ versus those with AxUS-. Overall, 82.5% (47/57) of AxUS+ patients had residual positive lymph nodes (ypN+) at surgery and 53.8% (42/78) of AxUS- patients had ypN+. Post NAC AxUS sensitivity was 52.8%, specificity 78.3%, and negative predictive value 46.2%. AxUS FNR was 47.2%, versus 8.4% for SNB. If post-NAC AxUS- was used to select patients for SNB, FNR would decrease from 8.4 to 2.7%. However, using post-NAC AxUS in addition to SNB as an indication for ALND would have led to unnecessary ALND in 7.8% of all patients. CONCLUSION AxUS is not appropriate as a standalone staging procedure, and SNB itself is sufficient to assess the axilla post NAC in patients who present with N+ breast cancer.
Collapse
Affiliation(s)
- Dominique Morency
- Jewish General Hospital Segal Cancer Centre, McGill University, Montreal, QC, Canada
| | - Sinziana Dumitra
- Jewish General Hospital Segal Cancer Centre, McGill University, Montreal, QC, Canada
| | - Elena Parvez
- Jewish General Hospital Segal Cancer Centre, McGill University, Montreal, QC, Canada
| | - Karyne Martel
- Hopital de Saint-Jerome CISSS St-Jerome, Saint-Jerome, QC, Canada
| | - Mark Basik
- Jewish General Hospital Segal Cancer Centre, McGill University, Montreal, QC, Canada
| | - André Robidoux
- Centre Hospitalier de l'Universite de Montreal, Montreal, QC, Canada
| | - Brigitte Poirier
- Centre des maladies du sein HSS CHU de Quebec, Universite Laval, Quebec, QC, Canada
| | - Claire M B Holloway
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Louis Gaboury
- Centre Hospitalier de l'Universite de Montreal, Montreal, QC, Canada
| | - Lucas Sideris
- Hopital Maisonneuve-Rosemont, Universite de Montreal, Montreal, QC, Canada
| | | | - Jean-François Boileau
- Jewish General Hospital Segal Cancer Centre, McGill University, Montreal, QC, Canada.
| |
Collapse
|
12
|
Vijayaraghavan GR, Vedantham S, Santos-Nunez G, Hultman R. Unifocal Invasive Lobular Carcinoma: Tumor Size Concordance Between Preoperative Ultrasound Imaging and Postoperative Pathology. Clin Breast Cancer 2018; 18:e1367-e1372. [PMID: 30131246 DOI: 10.1016/j.clbc.2018.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/17/2018] [Accepted: 07/20/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND We systematically analyzed the extent of disease in unifocal invasive lobular carcinoma (ILC) using ultrasonography, with the histopathologic findings as the reference standard. PATIENTS AND METHODS In the present single-institution retrospective study, 128 cases of ILC were identified during a 5-year period. After exclusions, the analyzed cohort included 66 cases. Ultrasound measurements of the tumor extent along 3 axes were obtained. The tumor size was determined as the largest extent among the 3 axes and the tumor volume by ellipsoidal approximation. Pathology review provided the tumor size and volume. Correlation and regression analyses of tumor size and volume from the ultrasound and pathologic examinations were performed. The tumor stage from the ultrasound and pathologic examinations were used for the concordance analyses. RESULTS The median and quartiles (Q1, Q3) of tumor size from ultrasonography and pathology were 12.5 mm (Q1, 9 mm; Q3, 19 mm) and 17 mm (Q1, 12 mm; Q3, 25 mm), respectively. The corresponding data for tumor volume were 0.52 cm3 (Q1, 0.18 cm3; Q3, 1.92 cm3) and 1.04 cm3 (Q1, 0.45 cm3; Q3, 2.49 cm3). The ultrasound measurements correlated with the pathology-reported tumor size (Spearman ρ = 0.678; P < .0001) and volume (Spearman ρ = 0.699; P < .0001). The ultrasound-measured size and volume differed from the pathology-reported size and volume (P < .0001; Wilcoxon signed ranks test). Concordance between the clinical tumor size stage from ultrasound (cT) and pathology tumor size stage (pT) varied with the pT stage (P = .0003, Fisher's exact test), with the greatest concordance rate of 95.7% (95% confidence limit, 85.2%-99.5%) observed for pT1 tumors. CONCLUSION Ultrasonography underestimates the tumor size and volume, with the underestimation increasing for larger tumors. Hence, the concordance rate in tumor size stage between ultrasonography and pathology is tumor size dependent, with the greatest concordance rate observed for pT1 tumors.
Collapse
|
13
|
Grimm LJ, Viradia NK, Johnson KS. Normal Axillary Lymph Node Variability Between White and Black Women on Breast MRI. Acad Radiol 2018; 25:305-308. [PMID: 29195786 DOI: 10.1016/j.acra.2017.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/01/2017] [Accepted: 10/03/2017] [Indexed: 11/15/2022]
Abstract
RATIONALE AND OBJECTIVES This study aimed to determine if there were differences in the imaging features of normal lymph nodes between white and black women using magnetic resonance imaging. MATERIALS AND METHODS Following institutional review board approval, we identified white and black women who underwent breast magnetic resonance imaging from November 1, 2008 to December 31, 2013 at our institution. To identify normal lymph nodes for measurement, patients with any benign or malignant causes for lymph node enlargement and patients with any subsequent breast cancer in the following 2 years were excluded. Black and white women were age matched at a 1:2 ratio. The largest lymph node in each axilla was measured for the long-axis length and maximal cortical thickness. Comparisons were made between white and black women using a conditional logistic regression to control for matching. RESULTS There were 55 black women and 110 white women for analysis. The mean lymph node long-axis length was 14.7 ± 5.3 mm for black women and 14.4 ± 6.4 mm for white women (P = .678). The mean maximum cortical thickness was 3.3 ± 1.6 mm for black women and 2.6 ± 1.4 mm for Caucasian women (P < .001). A significantly higher percentage of black than white women had cortical thicknesses greater than threshold values of 3, 4, 5, 6, and 7 mm (P < .01 for all). CONCLUSIONS The normal lymph node cortical thickness in black women is significantly greater than in white women, which should be considered when deciding to recommend a lymph node biopsy.
Collapse
Affiliation(s)
- Lars J Grimm
- Duke University Medical Center, Department of Radiology, Box 3808, Durham, NC 27710.
| | - Neal K Viradia
- Duke University Medical Center, Department of Radiology, Box 3808, Durham, NC 27710
| | - Karen S Johnson
- Duke University Medical Center, Department of Radiology, Box 3808, Durham, NC 27710
| |
Collapse
|
14
|
Vedantham S, Karellas A. Emerging Breast Imaging Technologies on the Horizon. Semin Ultrasound CT MR 2018; 39:114-121. [PMID: 29317033 DOI: 10.1053/j.sult.2017.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Early detection of breast cancers by mammography in conjunction with adjuvant therapy has contributed to reduction in breast cancer mortality. Mammography remains the "gold-standard" for breast cancer screening but is limited by tissue superposition. Digital breast tomosynthesis and more recently, dedicated breast computed tomography have been developed to alleviate the tissue superposition problem. However, all of these modalities rely upon x-ray attenuation contrast to provide anatomical images, and there are ongoing efforts to develop and clinically translate alternative modalities. These emerging modalities could provide for new contrast mechanisms and may potentially improve lesion detection and diagnosis. In this article, several of these emerging modalities are discussed with a focus on technologies that have advanced to the stage of in vivo clinical evaluation.
Collapse
Affiliation(s)
- Srinivasan Vedantham
- Department of Medical Imaging, University of Arizona College of Medicine, Banner University Medical Center, Tucson, AZ.
| | - Andrew Karellas
- Department of Medical Imaging, University of Arizona College of Medicine, Banner University Medical Center, Tucson, AZ
| |
Collapse
|