OBJECTIVE: Breast cancer starts as a local tumor but can become metastatic and spread via the lymph nodes. When the pre-operative assessment of the axillary lymph nodes is negative patients generally undergo sentinel node biopsy (SNB), followed by a secondary surgical axillary lymph node dissection (ALND) if the SNB is positive. The extemporaneous anatomo-pathological analysis of the sentinel lymph node enables metastases to be detected and an ALND at the same time of the SNB. The goal of this study was to evaluate the added value of ShearWave Elastography (SWE), compared with the conventional pre-operative assessment, in the screening of sentinel lymph nodes with a high metastatic risk, which could then benefit from an extemporaneous anatomo-pathological analysis. PATIENTS AND METHODS: Women undergoing breast surgery with SNB were prospectively enrolled. Before surgery, they underwent ultrasound and elastography imaging of axillary lymph nodes using the SuperSonic Imagine device and its ShearWave™ elastography mode (SWE™). The results obtained were compared to the immunohistochemical results for the removed lymph nodes. RESULTS: 65 patients were enrolled. From the 103 lymph nodes examined by elastography and the 185 lymph nodes removed we were able to pair 81; 70 were healthy and 11 were malignant. The stiffness measurements (mean and maximal values) were significantly different between the healthy and metastatic lymph nodes, (p<0.05). The areas under the ROC curves were 0.76 (95% confidence interval (CI): 0.58-0.94) and 0.75 (95%CI: 0.55-0.95) for the mean and the maximal stiffness, respectively. CONCLUSION: These encouraging results show a correlation between the metastatic risk of lymph nodes and their increased mean stiffness. Elasticity variables and potential thresholds that seem to predict the metastatic status of axillary lymph nodes were identified. If confirmed by further larger studies, these results could be useful in clinical practice for the identification of lymph nodes at high metastatic risk that could benefit from a intra-operative analysis to reduce the number of secondary surgical procedures.
OBJECTIVE:Breast cancer starts as a local tumor but can become metastatic and spread via the lymph nodes. When the pre-operative assessment of the axillary lymph nodes is negative patients generally undergo sentinel node biopsy (SNB), followed by a secondary surgical axillary lymph node dissection (ALND) if the SNB is positive. The extemporaneous anatomo-pathological analysis of the sentinel lymph node enables metastases to be detected and an ALND at the same time of the SNB. The goal of this study was to evaluate the added value of ShearWave Elastography (SWE), compared with the conventional pre-operative assessment, in the screening of sentinel lymph nodes with a high metastatic risk, which could then benefit from an extemporaneous anatomo-pathological analysis. PATIENTS AND METHODS: Women undergoing breast surgery with SNB were prospectively enrolled. Before surgery, they underwent ultrasound and elastography imaging of axillary lymph nodes using the SuperSonic Imagine device and its ShearWave™ elastography mode (SWE™). The results obtained were compared to the immunohistochemical results for the removed lymph nodes. RESULTS: 65 patients were enrolled. From the 103 lymph nodes examined by elastography and the 185 lymph nodes removed we were able to pair 81; 70 were healthy and 11 were malignant. The stiffness measurements (mean and maximal values) were significantly different between the healthy and metastatic lymph nodes, (p<0.05). The areas under the ROC curves were 0.76 (95% confidence interval (CI): 0.58-0.94) and 0.75 (95%CI: 0.55-0.95) for the mean and the maximal stiffness, respectively. CONCLUSION: These encouraging results show a correlation between the metastatic risk of lymph nodes and their increased mean stiffness. Elasticity variables and potential thresholds that seem to predict the metastatic status of axillary lymph nodes were identified. If confirmed by further larger studies, these results could be useful in clinical practice for the identification of lymph nodes at high metastatic risk that could benefit from a intra-operative analysis to reduce the number of secondary surgical procedures.
Authors: Heechul Yoon; Steven K Yarmoska; Alexander S Hannah; Changhan Yoon; Kristina A Hallam; Stanislav Y Emelianov Journal: Med Phys Date: 2017-05-16 Impact factor: 4.071
Authors: Adriana Gregory; Max Denis; Mahdi Bayat; Viksit Kumar; Bae Hyung Kim; Jeremy Webb; Rohit Nayak; Saba Adabi; Duane D Meixner; Eric C Polley; Robert T Fazzio; Mostafa Fatemi; Azra Alizad Journal: PLoS One Date: 2020-01-13 Impact factor: 3.240
Authors: Soong June Bae; Jong Tae Park; Ah Young Park; Ji Hyun Youk; Jong Won Lim; Hak Woo Lee; Hak Min Lee; Sung Gwe Ahn; Eun Ju Son; Joon Jeong Journal: J Breast Cancer Date: 2018-06-20 Impact factor: 3.588