Department of Ultrasound, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, No. 651 Dongfeng East Road, Yuexiu District, Guangzhou City, Guangdong Province, China.
Department of Breast Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China.
BMC Med Imaging. 2024 Aug 30;24(1):229. doi: 10.1186/s12880-024-01407-0.
To investigate the value of conventional ultrasonography (US) combined with quantitative shear wave elastography (SWE) in evaluating and identifying target axillary lymph node (TALN) for fine needle aspiration biopsy (FNAB) of patients with early breast cancer.
A total of 222 patients with 223 ALNs were prospectively recruited from January 2018 to December 2021. All TALNs were evaluated by US, SWE and subsequently underwent FNAB. The diagnostic performances of US, SWE, UE (either US or SWE was positive) and UE (both US and SWE were positive), and FNAB guided by the above four methods for evaluating ALN status were assessed using receiver operator characteristic curve (ROC) analyses. Univariate and multivariate logistic regression analyses used to determine the independent predictors of axillary burden.
The area under the ROC curve (AUC) for diagnosing ALNs using conventional US and SWE were 0.69 and 0.66, respectively, with sensitivities of 78.00% and 65.00% and specificities of 60.98% and 66.67%. The combined method, UE, demonstrated significantly improved sensitivity of 86.00% (p < 0.001 when compared with US and SWE alone). The AUC of the UE-guided FNAB [0.85 (95% CI, 0.80-0.90)] was significantly higher than that of US-guided FNAB [0.83 (95% CI, 0.78-0.88), p = 0.042], SWE-guided FNAB [0.79 (95% CI, 0.72-0.84), p = 0.001], and UE-guided FNAB [0.77 (95% CI, 0.71-0.82), p < 0.001]. Multivariate logistic regression showed that FNAB and number of suspicious ALNs were found independent predictors of axillary burden in patients with early breast cancer.
The UE had superior sensitivity compared to US or SWE alone in ALN diagnosis. The UE-guided FNAB achieved a lower false-negative rate compared to FNAB guided solely by US or SWE, which may be a promising tool for the preoperative diagnosis of ALNs in early breast cancer, and had the potential implication for the selection of axillary surgical modality.
探讨常规超声（US）联合定量剪切波弹性成像（SWE）在评估和识别早期乳腺癌患者细针穿刺活检（FNAB）目标腋窝淋巴结（TALN）中的价值。
前瞻性纳入 2018 年 1 月至 2021 年 12 月的 222 例 223 个腋窝淋巴结转移患者。所有 TALN 均行 US、SWE 检查，随后行 FNAB。采用受试者工作特征曲线（ROC）分析评估 US、SWE、UE（US 或 SWE 阳性）和 UE（US 和 SWE 均阳性）四种方法评估腋窝淋巴结状态的诊断效能。单因素和多因素 logistic 回归分析确定腋窝受累的独立预测因素。
常规 US 和 SWE 诊断腋窝淋巴结的 ROC 曲线下面积（AUC）分别为 0.69 和 0.66，敏感度分别为 78.00%和 65.00%，特异度分别为 60.98%和 66.67%。联合方法 UE 的敏感度显著提高，为 86.00%（与 US 和 SWE 单独比较，p<0.001）。UE 引导 FNAB 的 AUC[0.85（95%CI，0.80-0.90）]显著高于 US 引导 FNAB[0.83（95%CI，0.78-0.88），p=0.042]、SWE 引导 FNAB[0.79（95%CI，0.72-0.84），p=0.001]和 UE 引导 FNAB[0.77（95%CI，0.71-0.82），p<0.001]。多因素 logistic 回归显示，FNAB 和可疑腋窝淋巴结数量是早期乳腺癌患者腋窝受累的独立预测因素。
UE 在 ALN 诊断中比 US 或 SWE 单独检查具有更高的敏感度。UE 引导 FNAB 与单纯 US 或 SWE 引导 FNAB 相比，假阴性率更低，可能是早期乳腺癌腋窝淋巴结术前诊断的一种有前途的工具，并有可能为腋窝手术方式的选择提供指导。
