Smolar Marek, Kudelova Eva, Danova Ivana, Lucansky Vincent, Dankova Zuzana, Musova Diana, Grendar Marian, Nosakova Lenka, Uhrik Peter, Samec Marek
Clinic of General, Visceral and Transplant Surgery, Jessenius Faculty of Medicine, Comenius University in Bratislava, University Hospital Martin, Martin, Slovakia.
Department of Pathological Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia.
Front Oncol. 2025 Mar 13;15:1478701. doi: 10.3389/fonc.2025.1478701. eCollection 2025.
The differential diagnosis of lymphadenopathy is an important determinant of prognosis in patients with breast cancer (BC). Invasive, fine needle aspiration (FNA) biopsy has been long considered as the gold standard for differentiating malignant lymph nodes (LN) from benign ones. Ultrasonography (USG) evaluation is a useful, rapid, and user-friendly imaging tool for LN assessment due to its high resolution. Compared to USG, ultrasound elastography is a relatively novel non-invasive method to differentiate benign and malignant lesions based on the stiffness heterogeneity of the tissue. The purpose of our study was to compare non-invasive imaging techniques, conventional USG, and strain elastography, to differentiate benign and malignant LNs lesions in a cohort of patients with early BC.
In total, 50 patients (48 women and 2 men) with histologically confirmed early BC were evaluated by conventional USG in B-mode followed by strain elastography (using parameters: pattern, strain ratio, hue histogram) for assessment of axillary LNs status. The surgical treatment included surgery of regional LNs (sentinel LN biopsy or axillary dissection), which served as the gold standard in statistical processing.
The USG B-mode was found to have a sensitivity of 68.75% and a specificity of 61.54%. Among strain elastography parameters, the elastographic pattern showed the highest specificity (66.67%) while the sensitivity was 83.3%. The strain ratio showed 100% sensitivity and 55.6% specificity, followed by a hue histogram with a sensitivity of 72.2%, but specificity was only 25.9%.
Despite promising data, monitored parameters currently cannot reliably replace sentinel LN biopsy. However, the monitored parameters represent an appropriate additional tool that can be used to refine preoperative staging, better targeting of FNA biopsy, and more accurate assessment of LNs in follow-up patients within the dispensary.
淋巴结病的鉴别诊断是乳腺癌（BC）患者预后的重要决定因素。有创细针穿刺（FNA）活检长期以来一直被视为区分恶性淋巴结（LN）与良性淋巴结的金标准。超声检查（USG）评估因其高分辨率，是一种用于LN评估的有用、快速且用户友好的成像工具。与USG相比，超声弹性成像基于组织硬度异质性来区分良性和恶性病变，是一种相对新颖的非侵入性方法。我们研究的目的是比较非侵入性成像技术、传统USG和应变弹性成像，以区分早期BC患者队列中的良性和恶性LN病变。
总共50例（48名女性和2名男性）经组织学确诊的早期BC患者先接受B模式传统USG评估，随后进行应变弹性成像（使用参数：模式、应变率、色调直方图）以评估腋窝LN状态。手术治疗包括区域LN手术（前哨LN活检或腋窝清扫），其在统计处理中作为金标准。
发现USG B模式的敏感性为68.75%，特异性为61.54%。在应变弹性成像参数中，弹性成像模式显示出最高的特异性（66.67%），而敏感性为83.3%。应变率显示敏感性为100%，特异性为55.6%，其次是色调直方图，敏感性为72.2%，但特异性仅为25.9%。
尽管有令人鼓舞的数据，但目前监测参数不能可靠地替代前哨LN活检。然而，监测参数是一种合适的辅助工具，可用于完善术前分期、更好地针对FNA活检以及更准确地评估药房随访患者的LN。
