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A nomogram constructed using intraoperative ex vivo shear-wave elastography precisely predicts metastasis of sentinel lymph nodes in breast cancer

 Soong June Bae  ;  Ji Hyun Youk  ;  Chang Ik Yoon  ;  Soeun Park  ;  Chi Hwan Cha  ;  Hak Woo Lee  ;  Sung Gwe Ahn  ;  Seung Ah Lee  ;  Eun Ju Son  ;  Joon Jeong 
 EUROPEAN RADIOLOGY, Vol.30(2) : 789-797, 2020 
Journal Title
Issue Date
Breast neoplasm ; Elasticity imaging techniques ; Lymphatic metastasis ; Nomogram
OBJECTIVE: To develop a nomogram and validate its use for the intraoperative evaluation of nodal metastasis using shear-wave elastography (SWE) elasticity values and nodal size METHODS: We constructed a nomogram to predict metastasis using ex vivo SWE values and ultrasound features of 228 axillary LNs from fifty-five patients. We validated its use in an independent cohort comprising 80 patients. In the validation cohort, a total of 217 sentinel LNs were included. RESULTS: We developed the nomogram using the nodal size and elasticity values of the development cohort to predict LN metastasis; the area under the curve (AUC) was 0.856 (95% confidence interval (CI), 0.783-0.929). In the validation cohort, 15 (7%) LNs were metastatic, and 202 (93%) were non-metastatic. The mean stiffness (23.54 and 10.41 kPa, p = 0.005) and elasticity ratio (3.24 and 1.49, p = 0.028) were significantly higher in the metastatic LNs than those in the non-metastatic LNs. However, the mean size of the metastatic LNs was not significantly larger than that of the non-metastatic LNs (8.70 mm vs 7.20 mm, respectively; p = 0.123). The AUC was 0.791 (95% CI, 0.668-0.915) in the validation cohort, and the calibration plots of the nomogram showed good agreement. CONCLUSIONS: We developed a well-validated nomogram to predict LN metastasis. This nomogram, mainly based on ex vivo SWE values, can help evaluate nodal metastasis during surgery. KEY POINTS: • A nomogram was developed based on axillary LN size and ex vivo SWE values such as mean stiffness and elasticity ratio to easily predict axillary LN metastasis during breast cancer surgery. • The constructed nomogram presented high predictive performance of sentinel LN metastasis with an independent cohort. • This nomogram can reduce unnecessary intraoperative frozen section which increases the surgical time and costs in breast cancer patients.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Park, So Eun(박소은)
Bae, Soong June(배숭준) ORCID logo https://orcid.org/0000-0002-0012-9694
Son, Eun Ju(손은주) ORCID logo https://orcid.org/0000-0002-7895-0335
Ahn, Sung Gwe(안성귀) ORCID logo https://orcid.org/0000-0002-8778-9686
Youk, Ji Hyun(육지현) ORCID logo https://orcid.org/0000-0002-7787-780X
Lee, Hak Woo(이학우)
Jeong, Joon(정준) ORCID logo https://orcid.org/0000-0003-0397-0005
Cha, Chi Hwan(차치환)
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