J Breast Cancer.  2018 Jun;21(2):190-196. 10.4048/jbc.2018.21.2.190.

Ex Vivo Shear-Wave Elastography of Axillary Lymph Nodes to Predict Nodal Metastasis in Patients with Primary Breast Cancer

Affiliations
  • 1Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. gsjjoon@yuhs.ac
  • 2Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
  • 3Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 4Department of Surgery, International St. Mary' Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea.

Abstract

PURPOSE
There is still a clinical need to easily evaluate the metastatic status of lymph nodes during breast cancer surgery. We hypothesized that ex vivo shear-wave elastography (SWE) would predict precisely the presence of metastasis in the excised lymph nodes.
METHODS
A total of 63 patients who underwent breast cancer surgery were prospectively enrolled in this study from May 2014 to April 2015. The excised axillary lymph nodes were examined using ex vivo SWE. Metastatic status was confirmed based on the final histopathological diagnosis of the permanent section. Lymph node characteristics and elasticity values measured by ex vivo SWE were assessed for possible association with nodal metastasis.
RESULTS
A total of 274 lymph nodes, harvested from 63 patients, were examined using ex vivo SWE. The data obtained from 228 of these nodes from 55 patients were included in the analysis. Results showed that 187 lymph nodes (82.0%) were nonmetastatic and 41 lymph nodes (18.0%) were metastatic. There was significant difference between metastatic and nonmetastatic nodes with respect to the mean (45.4 kPa and 17.7 kPa, p<0.001) and maximum (55.3 kPa and 23.2 kPa, p<0.001) stiffness. The elasticity ratio was higher in the metastatic nodes (4.36 and 1.57, p<0.001). Metastatic nodes were significantly larger than nonmetastatic nodes (mean size, 10.5 mm and 7.5 mm, p<0.001). The size of metastatic nodes and nodal stiffness were correlated (correlation coefficient of mean stiffness, r=0.553). The area under curve of mean stiffness, maximum stiffness, and elasticity ratio were 0.794, 0.802, and 0.831, respectively.
CONCLUSION
Ex vivo SWE may be a feasible method to predict axillary lymph node metastasis intraoperatively in patients undergoing breast cancer surgery.

Keyword

Axilla; Breast neoplasms; Elasticity imaging techniques; Lymphatic metastasis

MeSH Terms

Area Under Curve
Axilla
Breast Neoplasms*
Breast*
Diagnosis
Elasticity
Elasticity Imaging Techniques*
Humans
Lymph Nodes*
Lymphatic Metastasis
Methods
Neoplasm Metastasis*
Prospective Studies

Figure

  • Figure 1 Characteristics of metastatic and nonmetastatic lymph node. Box plot showing size (A), mean stiffness (B), max stiffness (C), and the elasticity ratio (D) between nonmetastatic and metastatic lymph nodes.

  • Figure 2 Correlation coefficients for metastatic node size and ex vivo shear-wave elastic values. (A) Mean stiffness, (B) max stiffness.

  • Figure 3 Receiver operating characteristic (ROC) curve analysis of size, mean stiffness, max stiffness, and elasticity ratio. (A) Lymph nodes with micro-metastasis were regarded as nonmetastatic nodes, (B) lymph nodes with micro-metastasis were regarded as metastatic nodes.


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