{"title":"加强对结节受累的乳腺癌患者进行新辅助治疗后高位腋窝淋巴结转移的检测：腋窝超声和乳腺弹性成像的联合方法。","authors":"Jia-Xin Huang, Feng-Tao Liu, Yu-Ting Tan, Xue-Yan Wang, Jia-Hui Huang, Shi-Yang Lin, Gui-Ling Huang, Yu-Ting Zhang, Xiao-Qing Pei","doi":"10.1007/s11547-024-01936-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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<sup>2</sup> = 13.90, p = 0.085, HL test), with an improved sensitivity of 93.94% and a comparable specificity of 75.64%%.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":20817,"journal":{"name":"Radiologia Medica","volume":" ","pages":""},"PeriodicalIF":9.7000,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Enhancing detection of high-level axillary lymph node metastasis after neoadjuvant therapy in breast cancer patients with nodal involvement: a combined approach of axilla ultrasound and breast elastography.\",\"authors\":\"Jia-Xin Huang, Feng-Tao Liu, Yu-Ting Tan, Xue-Yan Wang, Jia-Hui Huang, Shi-Yang Lin, Gui-Ling Huang, Yu-Ting Zhang, Xiao-Qing Pei\",\"doi\":\"10.1007/s11547-024-01936-2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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<sup>2</sup> = 13.90, p = 0.085, HL test), with an improved sensitivity of 93.94% and a comparable specificity of 75.64%%.</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":20817,\"journal\":{\"name\":\"Radiologia Medica\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":9.7000,\"publicationDate\":\"2024-11-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Radiologia Medica\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s11547-024-01936-2\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Radiologia Medica","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11547-024-01936-2","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
引用次数: 0
摘要
目的：开发一种剪切波弹性成像（SWE）和传统超声（US）相结合的方法，用于确定结节受累的乳腺癌患者接受新辅助治疗（NAT）后腋窝淋巴结（LN）阳性的范围：这项前瞻性多中心研究在中国临床试验注册中心注册（ChiCTR2400085035）。自2018年10月至2024年2月，共入组303例经活检证实LN阳性的乳腺癌患者。分析了腋窝LN的常规US特征和NAT后乳腺病变的SWE特征。评估了腋窝 US、乳腺 SWE 及其组合在检测 NAT 后腋窝 III 级残余转移方面的诊断性能：结果：13.75%的病例在 NAT 后检测到腋窝 III 层病理阳性 LN。经手术病理证实并由 US 检测出 LN 阳性的腋窝水平的 kappa 值为 0.39（P 2 = 13.90，P = 0.085，HL 检验），敏感性提高了 93.94%，特异性为 75.64%%：对于初步诊断为腋窝阳性的患者，SWE 在确定 NAT 后有结节转移的腋窝水平方面优于传统 US。此外，将乳腺SWE与腋窝X线检查相结合，在检测NAT后腋窝III度残余转移方面显示出良好的诊断性能。
Enhancing detection of high-level axillary lymph node metastasis after neoadjuvant therapy in breast cancer patients with nodal involvement: a combined approach of axilla ultrasound and breast elastography.
Purpose: 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.
Methods: 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.
Results: 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 (X2 = 13.90, p = 0.085, HL test), with an improved sensitivity of 93.94% and a comparable specificity of 75.64%%.
Conclusions: 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.
期刊介绍：
Felice Perussia founded La radiologia medica in 1914. It is a peer-reviewed journal and serves as the official journal of the Italian Society of Medical and Interventional Radiology (SIRM). The primary purpose of the journal is to disseminate information related to Radiology, especially advancements in diagnostic imaging and related disciplines. La radiologia medica welcomes original research on both fundamental and clinical aspects of modern radiology, with a particular focus on diagnostic and interventional imaging techniques. It also covers topics such as radiotherapy, nuclear medicine, radiobiology, health physics, and artificial intelligence in the context of clinical implications. The journal includes various types of contributions such as original articles, review articles, editorials, short reports, and letters to the editor. With an esteemed Editorial Board and a selection of insightful reports, the journal is an indispensable resource for radiologists and professionals in related fields. Ultimately, La radiologia medica aims to serve as a platform for international collaboration and knowledge sharing within the radiological community.
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