Huang Jia-Xin, Liu Feng-Tao, Tan Yu-Ting, Wang Xue-Yan, Huang Jia-Hui, Lin Shi-Yang, Huang Gui-Ling, Zhang Yu-Ting, Pei Xiao-Qing
Department of Liver Surgery, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.
Department of Medical Ultrasound, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.
Radiol Med. 2025 Jan;130(1):121-131. doi: 10.1007/s11547-024-01936-2. Epub 2024 Nov 20.
To develop a combined approach using shear wave elastography (SWE) and conventional ultrasound (US) to determine the extent of positive axillary lymph nodes (LNs) following neoadjuvant therapy (NAT) in breast cancer patients with nodal involvement.
This prospective, multicenter study was registered on the Chinese Clinical Trial Registry (ChiCTR2400085035). From October 2018 to February 2024, a total of 303 breast cancer patients with biopsy-proven positive LN were enrolled. The conventional US features of axillary LNs and SWE characteristics of breast lesions after NAT were analyzed. The diagnostic performances of axilla US, breast SWE, and their combination in detecting residual metastasis in axillary level III after NAT were assessed.
Pathologically positive LN(s) in axilla level III were detected in 13.75% of cases following NAT. The kappa value for the axilla level with positive LN confirmed by surgical pathology and detected by US is 0.39 (p < 0.001). The AUC of conventional axilla US to determine the status of axilla level III LNs after NAT was 0.67, with a sensitivity of 51.52%, a specificity of 74.36%. The breast SWE displayed moderate performance for detecting residual metastasis in axilla level III following NAT, with an AUC of 0.79, sensitivity of 84.85%, and specificity of 74.36%. Compared to axilla US and breast SWE alone, the combination of axilla US with breast SWE achieved a stronger discriminatory ability (AUC, 0.86 vs 0.67 vs 0.79, p < 0.05, Delong's test) and precise calibration (X = 13.90, p = 0.085, HL test), with an improved sensitivity of 93.94% and a comparable specificity of 75.64%%.
SWE outperformed conventional US in identifying the axilla levels with nodal metastasis following NAT in patients with initially diagnosed positive axilla. Furthermore, combining breast SWE with axilla US showed good diagnostic performance for detecting residual metastasis in axilla level III after NAT.
开发一种结合剪切波弹性成像（SWE）和传统超声（US）的方法，以确定新辅助治疗（NAT）后腋窝淋巴结（LNs）阳性的乳腺癌患者腋窝阳性淋巴结的范围。
本前瞻性、多中心研究已在中国临床试验注册中心注册（ChiCTR2400085035）。2018年10月至2024年2月，共纳入303例经活检证实腋窝淋巴结阳性的乳腺癌患者。分析了NAT后腋窝淋巴结的传统超声特征和乳腺病变的SWE特征。评估了腋窝超声、乳腺SWE及其联合检测NAT后腋窝Ⅲ级残留转移的诊断性能。
NAT后13.75%的病例在腋窝Ⅲ级检测到病理阳性淋巴结。手术病理证实并经超声检测的腋窝淋巴结阳性水平的kappa值为0.39（p<0.001）。传统腋窝超声确定NAT后腋窝Ⅲ级淋巴结状态的AUC为0.67，灵敏度为51.52%，特异度为74.36%。乳腺SWE在检测NAT后腋窝Ⅲ级残留转移方面表现中等，AUC为0.79，灵敏度为84.85%，特异度为74.36%。与单独的腋窝超声和乳腺SWE相比，腋窝超声与乳腺SWE联合具有更强的鉴别能力（AUC分别为0.86、0.67和0.79，p<0.05，德龙检验）和精确校准（X=13.90，p=0.085，HL检验），灵敏度提高到93.94%，特异度为75.64%，与之相当。
在最初诊断腋窝阳性的患者中，SWE在识别NAT后有淋巴结转移的腋窝水平方面优于传统超声。此外，乳腺SWE与腋窝超声联合在检测NAT后腋窝Ⅲ级残留转移方面具有良好的诊断性能。
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