JoVE - Journal of Visualized Experiments
JoVE Visualize
Contact Us

Predicting three or more metastatic nodes using contrast-enhanced lymphatic US findings in early breast cancer

  • 0Department of Ultrasound, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China.
Insights Into Imaging +

|

March 25, 2024

|

March 25, 2024

View abstract on PubMed

Summary

This summary is machine-generated.

A new nomogram accurately predicts axillary lymph node metastasis in early breast cancer using contrast-enhanced lymphatic ultrasound and grayscale findings of sentinel lymph nodes. This tool aids in preoperative assessment of axillary tumor burden for better treatment decisions.

Area Of Science

  • Oncology
  • Radiology
  • Surgical Oncology

Background

  • Accurate staging of axillary lymph nodes is crucial for early breast cancer treatment decisions.
  • Sentinel lymph node biopsy (SLNB) is standard, but predicting extensive nodal involvement preoperatively remains challenging.
  • Current methods may not sufficiently identify patients with significant axillary burden, potentially leading to overtreatment or undertreatment.

Purpose Of The Study

  • To develop and validate a predictive nomogram for ≥ 3 metastatic axillary lymph nodes (ALNs) in early breast cancer.
  • To integrate clinicopathologic data with contrast-enhanced (CE) lymphatic ultrasound and grayscale findings of sentinel lymph nodes (SLNs).
  • To improve preoperative assessment of axillary tumor burden in patients without palpable adenopathy.

Main Methods

  • A prospective cohort study involving women with T1-2N0 invasive breast cancer undergoing CE lymphatic ultrasound.
  • Development and validation cohorts established from two centers (Center 1: development/internal validation; Center 2: external validation).
  • Statistical analysis using logistic regression to identify predictors and assess nomogram performance via AUC and calibration curves.

Main Results

  • CE lymphatic ultrasound findings (no enhancement, diffuse/focal eccentric cortical thickening, absent hilum) were independently associated with ≥ 3 metastatic ALNs.
  • The developed nomogram achieved a high AUC of 0.88, outperforming grayscale or CE lymphatic US alone.
  • Excellent calibration (slope 1.0) was observed in validation cohorts, indicating reliable predictions.

Conclusions

  • A nomogram combining CE lymphatic and grayscale US findings of SLNs effectively identifies early breast cancer patients with high axillary tumor burden preoperatively.
  • This tool aids in multidisciplinary treatment decision-making, particularly relevant in the context of evolving axillary staging guidelines (e.g., Z0011 trial).
  • The nomogram demonstrates high diagnostic value and applicability for preoperative risk stratification.

Keywords: