Noninvasive prediction of axillary lymph node breast cancer metastasis using morphometric analysis of nodal tumor microvessels in a contrast-free ultrasound approach.

Giulia Ferroni, Soroosh Sabeti, Tasneem Abdus-Shakur, Lorenzo Scalise, Jodi M Carter, Robert T Fazzio, Nicholas B Larson, Mostafa Fatemi, Azra Alizad
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引用次数: 2

Abstract

Purpose: Changes in microcirculation of axillary lymph nodes (ALNs) may indicate metastasis. Reliable noninvasive imaging technique to quantify such variations is lacking. We aim to develop and investigate a contrast-free ultrasound quantitative microvasculature imaging technique for detection of metastatic ALN in vivo.

Experimental design: The proposed ultrasound-based technique, high-definition microvasculature imaging (HDMI) provides superb images of tumor microvasculature at sub-millimeter size scales and enables quantitative analysis of microvessels structures. We evaluated the new HDMI technique on 68 breast cancer patients with ultrasound-identified suspicious ipsilateral axillary lymph nodes recommended for fine needle aspiration biopsy (FNAB). HDMI was conducted before the FNAB and vessel morphological features were extracted, analyzed, and the results were correlated with the histopathology.

Results: Out of 15 evaluated quantitative HDMI biomarkers, 11 were significantly different in metastatic and reactive ALNs (10 with P << 0.01 and one with 0.01 < P < 0.05). We further showed that through analysis of these biomarkers, a predictive model trained on HDMI biomarkers combined with clinical information (i.e., age, node size, cortical thickness, and BI-RADS score) could identify metastatic lymph nodes with an area under the curve of 0.9 (95% CI [0.82,0.98]), sensitivity of 90%, and specificity of 88%.

Conclusions: The promising results of our morphometric analysis of HDMI on ALNs offer a new means of detecting lymph node metastasis when used as a complementary imaging tool to conventional ultrasound. The fact that it does not require injection of contrast agents simplifies its use in routine clinical practice.

Abstract Image

Abstract Image

Abstract Image

无造影剂超声方法下淋巴结肿瘤微血管形态学分析无创预测腋窝淋巴结乳腺癌转移。
目的:腋窝淋巴结(ALNs)微循环变化可能提示转移。目前还缺乏可靠的无创成像技术来量化这些变化。我们的目标是开发和研究一种无造影剂的超声定量微血管成像技术,用于体内转移性ALN的检测。实验设计:提出的基于超声的技术,高清微血管成像(HDMI)提供了亚毫米尺度的肿瘤微血管图像,并使微血管结构的定量分析成为可能。我们评估了新的HDMI技术对68例超声发现可疑同侧腋窝淋巴结的乳腺癌患者进行细针穿刺活检(FNAB)。在FNAB和血管形态学特征提取、分析之前进行HDMI,并将结果与组织病理学相关联。结果:在15个评估的定量HDMI生物标志物中,11个在转移性和反应性aln中有显著差异(10个有P)。结论:我们对aln上HDMI的形态计量学分析提供了一种新的检测淋巴结转移的方法,可作为常规超声的补充成像工具。它不需要注射造影剂的事实简化了它在常规临床实践中的使用。
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