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Huang JX, Liu FT, Sun L, Ma C, Fu J, Wang XY, Huang GL, Zhang YT, Pei XQ. Comparing shear wave elastography of breast tumors and axillary nodes in the axillary assessment after neoadjuvant chemotherapy in patients with node-positive breast cancer. LA RADIOLOGIA MEDICA 2024; 129:1143-1155. [PMID: 39060887 PMCID: PMC11322251 DOI: 10.1007/s11547-024-01848-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Accurately identifying patients with axillary pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) in breast cancer patients remains challenging. PURPOSE To compare the feasibility of shear wave elastography (SWE) performed on breast tumors and axillary lymph nodes (LNs) in predicting the axillary status after NAC. MATERIALS AND METHODS This prospective study included a total of 319 breast cancer patients with biopsy-proven positive node who received NAC followed by axillary lymph node dissection from 2019 to 2022. The correlations between shear wave velocity (SWV) and pathologic characteristics were analyzed separately for both breast tumors and LNs after NAC. We compared the performance of SWV between breast tumors and LNs in predicting the axillary status after NAC. Additionally, we evaluated the performance of the most significantly correlated pathologic characteristic in breast tumors and LNs to investigate the pathologic evidence supporting the use of breast or axilla SWE. RESULTS Axillary pCR was achieved in 51.41% of patients with node-positive breast cancer. In breast tumors, there is a stronger correlation between SWV and collagen volume fraction (CVF) (r = 0.52, p < 0.001) compared to tumor cell density (TCD) (r = 0.37, p < 0.001). In axillary LNs, SWV was weakly correlated with CVF (r = 0.31, p = 0.177) and TCD (r = 0.29, p = 0.213). No significant correlation was found between SWV and necrosis proportion in breast tumors or axillary LNs. The predictive performances of both SWV and CVF for axillary pCR were found to be superior in breast tumors (AUC = 0.87 and 0.85, respectively) compared to axillary LNs (AUC = 0.70 and 0.74, respectively). CONCLUSION SWE has the ability to characterize the extracellular matrix, and serves as a promising modality for evaluating axillary LNs after NAC. Notably, breast SWE outperform axilla SWE in determining the axillary status in breast cancer patients after NAC.
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Affiliation(s)
- Jia-Xin Huang
- Department of Medical Ultrasound, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
- Department of Liver Surgery, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Feng-Tao Liu
- Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510000, China
| | - Lu Sun
- Department of Pathology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Chao Ma
- Department of Pathology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Jia Fu
- Department of Pathology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Xue-Yan Wang
- Department of Medical Ultrasound, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Gui-Ling Huang
- Department of Medical Ultrasound, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Yu-Ting Zhang
- Department of Medical Ultrasound, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Xiao-Qing Pei
- Department of Medical Ultrasound, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.
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Kim K, Ha M, Kim SJ. Comparative Study of Different Imaging Modalities for Diagnosis of Bone Metastases of Prostate Cancer: A Bayesian Network Meta-analysis. Clin Nucl Med 2024; 49:312-318. [PMID: 38350066 DOI: 10.1097/rlu.0000000000005078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
PURPOSE This study aimed to compare the diagnostic performances of 8 different imaging modalities for preoperative detection of bone metastases in prostate cancer patients by performing a network meta-analysis using direct comparison studies with 2 or more imaging techniques. PATIENTS AND METHODS We searched PubMed, Embase, and Cochrane Library for studies evaluating the performances of 8 different imaging modalities for the preoperative detection of bone metastases in prostate cancer patients. The network meta-analysis was performed in patient-based analysis. The consistency was evaluated by examining the agreement between direct and indirect treatment effects, and the surface under the cumulative ranking curve (SUCRA) values were obtained to calculate the probability of each imaging modality being the most effective diagnostic method. RESULTS A total of 999 patients from 13 direct comparison studies using 8 different imaging modalities for preoperative detection or follow-up of bone metastases in prostate cancer patients were included. For the detection of bone metastases of prostate cancer, 68 Ga-PSMA-11 PET/CT showed the highest SUCRA values of sensitivity, positive predictive value, accuracy, and diagnostic odds ratio. In addition, 18 F-NaF PET/CT and SPECT/CT showed high SUCRA values. CONCLUSIONS 68 Ga-PSMA-11 PET/CT showed the highest SUCRA values. Other imaging modalities showed complementary diagnostic roles for preoperative detection of bone metastases in patients with prostate cancer, except bone scintigraphy and MRI.
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Affiliation(s)
| | - Mihyang Ha
- From the Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan
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Pereslucha AM, Wenger DM, Morris MF, Aydi ZB. Invasive Lobular Carcinoma: A Review of Imaging Modalities with Special Focus on Pathology Concordance. Healthcare (Basel) 2023; 11:healthcare11050746. [PMID: 36900751 PMCID: PMC10000992 DOI: 10.3390/healthcare11050746] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
Invasive lobular cancer (ILC) is the second most common type of breast cancer. It is characterized by a unique growth pattern making it difficult to detect on conventional breast imaging. ILC can be multicentric, multifocal, and bilateral, with a high likelihood of incomplete excision after breast-conserving surgery. We reviewed the conventional as well as newly emerging imaging modalities for detecting and determining the extent of ILC- and compared the main advantages of MRI vs. contrast-enhanced mammogram (CEM). Our review of the literature finds that MRI and CEM clearly surpass conventional breast imaging in terms of sensitivity, specificity, ipsilateral and contralateral cancer detection, concordance, and estimation of tumor size for ILC. Both MRI and CEM have each been shown to enhance surgical outcomes in patients with newly diagnosed ILC that had one of these imaging modalities added to their preoperative workup.
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Affiliation(s)
- Alicia M Pereslucha
- Department of Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85006, USA
| | - Danielle M Wenger
- College of Medicine-Phoenix, University of Arizona, Phoenix, AZ 85004, USA
| | - Michael F Morris
- Division of Diagnostic Imaging, Banner MD Anderson Cancer Center, Phoenix, AZ 85006, USA
- Department of Radiology, Banner University Medical Center-Phoenix, Phoenix, AZ 85006, USA
| | - Zeynep Bostanci Aydi
- Department of Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85006, USA
- Department of Surgical Oncology, Banner MD Anderson Cancer Center, Phoenix, AZ 85006, USA
- Correspondence:
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Li Z, Gao Y, Gong H, Feng W, Ma Q, Li J, Lu X, Wang X, Lei J. Different Imaging Modalities for the Diagnosis of Axillary Lymph Node Metastases in Breast Cancer: A Systematic Review and Network Meta-Analysis of Diagnostic Test Accuracy. J Magn Reson Imaging 2022; 57:1392-1403. [PMID: 36054564 DOI: 10.1002/jmri.28399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Accurate diagnosis of axillary lymph node metastasis (ALNM) of breast cancer patients is important to guide local and systemic treatment. PURPOSE To evaluate the diagnostic performance of different imaging modalities for ALNM in patients with breast cancer. STUDY TYPE Systematic review and network meta-analysis (NMA). SUBJECTS Sixty-one original articles with 8011 participants. FIELD STRENGTH 1.5 T and 3.0 T. ASSESSMENT We used the QUADAS-2 and QUADAS-C tools to assess the risk of bias in eligible studies. The identified articles assessed ultrasonography (US), MRI, mammography, ultrasound elastography (UE), PET, CT, PET/CT, scintimammography, and PET/MRI. STATISTICAL ANALYSIS We used random-effects conventional meta-analyses and Bayesian network meta-analyses for data analyses. We used sensitivity and specificity, relative sensitivity and specificity, superiority index, and summary receiver operating characteristic curve (SROC) analysis to compare the diagnostic value of different imaging modalities. RESULTS Sixty-one studies evaluated nine imaging modalities. At patient level, sensitivities of the nine imaging modalities ranged from 0.27 to 0.84 and specificities ranged from 0.84 to 0.95. Patient-based NMA showed that UE had the highest superiority index (5.95) with the highest relative sensitivity of 1.13 (95% confidence interval [CI]: 0.93-1.29) among all imaging methods when compared to US. At lymph node level, MRI had the highest superiority index (6.91) with highest relative sensitivity of 1.13 (95% CI: 1.01-1.23) and highest relative specificity of 1.11 (95% CI: 0.95-1.23) among all imaging methods when compared to US. SROCs also showed that UE and MRI had the largest area under the curve (AUC) at patient level and lymph node level of 0.92 and 0.94, respectively. DATA CONCLUSION UE and MRI may be superior to other imaging modalities in the diagnosis of ALNM in breast cancer patients at the patient level and the lymph node level, respectively. Further studies are needed to provide high-quality evidence to validate our findings. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Zhifan Li
- The First Clinical Medical College of Lanzhou University, Lanzhou, China.,Department of Radiology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Ya Gao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Hengxin Gong
- The First Clinical Medical College of Lanzhou University, Lanzhou, China.,Department of Radiology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Wen Feng
- The First Clinical Medical College of Lanzhou University, Lanzhou, China.,Department of Radiology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Qinqin Ma
- The First Clinical Medical College of Lanzhou University, Lanzhou, China.,Department of Radiology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Jinkui Li
- The First Clinical Medical College of Lanzhou University, Lanzhou, China.,Department of Radiology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Xingru Lu
- The First Clinical Medical College of Lanzhou University, Lanzhou, China.,Department of Radiology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Xiaohui Wang
- Department of Obstetrics and Gynecology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Junqiang Lei
- Department of Radiology, the First Hospital of Lanzhou University, Lanzhou, China
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Abel F, Landsmann A, Hejduk P, Ruppert C, Borkowski K, Ciritsis A, Rossi C, Boss A. Detecting Abnormal Axillary Lymph Nodes on Mammograms Using a Deep Convolutional Neural Network. Diagnostics (Basel) 2022; 12:diagnostics12061347. [PMID: 35741157 PMCID: PMC9221636 DOI: 10.3390/diagnostics12061347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/26/2022] [Accepted: 05/26/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to determine the feasibility of a deep convolutional neural network (dCNN) to accurately detect abnormal axillary lymph nodes on mammograms. In this retrospective study, 107 mammographic images in mediolateral oblique projection from 74 patients were labeled to three classes: (1) “breast tissue”, (2) “benign lymph nodes”, and (3) “suspicious lymph nodes”. Following data preprocessing, a dCNN model was trained and validated with 5385 images. Subsequently, the trained dCNN was tested on a “real-world” dataset and the performance compared to human readers. For visualization, colored probability maps of the classification were calculated using a sliding window approach. The accuracy was 98% for the training and 99% for the validation set. Confusion matrices of the “real-world” dataset for the three classes with radiological reports as ground truth yielded an accuracy of 98.51% for breast tissue, 98.63% for benign lymph nodes, and 95.96% for suspicious lymph nodes. Intraclass correlation of the dCNN and the readers was excellent (0.98), and Kappa values were nearly perfect (0.93–0.97). The colormaps successfully detected abnormal lymph nodes with excellent image quality. In this proof-of-principle study in a small patient cohort from a single institution, we found that deep convolutional networks can be trained with high accuracy and reliability to detect abnormal axillary lymph nodes on mammograms.
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