Tüm lenf nodları aynı değildir: meme kanserinde metastatik ve non-metastatik aksiller lenf nodlarının ayırt edilmesinde shear wave elastografinin rolü

Abstract

Amaç: Meme kanserinde aksiller lenf nodu (ALN) durumunun doğru değerlendirilmesi, evreleme ve cerrahi planlama açısından kritik öneme sahiptir. Konvansiyonel ultrasonografinin (USG) sınırlılıkları nedeniyle, dokuların sertliğini nicel olarak ölçebilen shear wave elastografinin (SWE) tanısal doğruluğu araştırılmıştır. Yöntem: Retrospektif olarak planlanan çalışmaya, histopatolojik olarak doğrulanmış primer meme kanseri tanılı 150 hasta dahil edildi. Toplam 210 ALN, preoperatif dönemde USG ve SWE ile incelendi. SWE ölçümleri kayma dalgası hızı (SWV) ve elastisite modülü parametreleri üzerinden yapıldı. Histopatolojik sonuçlar altın standart olarak kabul edildi. ROC analizi ile duyarlılık, özgüllük ve AUC değerleri hesaplandı. Bulgular: Metastatik nodlarda SWV (4.12 ± 0.88 m/s) ve elastisite modülü (50.4 ± 8.9 kPa), non-metastatiklere göre (2.58 ± 0.75 m/s; 24.7 ± 6.3 kPa) anlamlı derecede yüksek bulundu (p<0.001). SWV için 3.30 m/s eşik değeri, %87.2 duyarlılık, %81.5 özgüllük ve 0.89 AUC sağladı. USG’nin duyarlılığı (%72.3) ve özgüllüğü (%68.1), SWE ile kombine edildiğinde sırasıyla %91.0 ve %84.7’ye yükseldi. Yanlış negatifler çoğunlukla mikrometastazlarda, yanlış pozitifler ise fibrotik reaktif nodlarda görüldü. Sonuç: SWE, meme kanserinde metastatik ve benign ALN’leri ayırt etmede yüksek tanısal doğruluk sunmaktadır. USG’ye eklenmesiyle tanısal performans belirgin şekilde artmakta, gereksiz biyopsiler azaltılabilmekte ve preoperatif cerrahi planlama daha güvenilir hale gelmektedir. SWE, klinik pratikte aksiller evreleme sürecine katkı sağlayabilecek güvenilir ve non-invaziv bir yöntemdir.

Keywords

• meme kanseri
• aksiller lenf nodu
• shear wave elastografi
• ultrasonografi
• metastaz

Supporting Institution

Bu çalışma için herhangi bir fon veya kurumsal destek alınmamıştır.”

Ethical Statement

Bu çalışma için Elazığ Fethi Sekin Şehir Hastanesi Girişimsel Olmayan Araştırmalar Etik Kurulu’ndan etik onay alınmıştır (Tarih: 06/03/2025, Karar No: 2025/5-18). Tüm araştırma süreçleri Helsinki Bildirgesi ilkelerine uygun olarak yürütülmüştür.

Not all nodes are alike: shear wave elastography in differentiating metastatic and non-metastatic axillary lymph nodes in breast cancer

Abstract

Aims: Accurate assessment of axillary lymph node (ALN) status in breast cancer is critical for staging and surgical planning. Owing to the limitations of conventional ultrasound (US), the diagnostic accuracy of shear wave elastography (SWE), which can quantitatively measure tissue stiffness, was investigated. Methods: This retrospective study included 150 patients with histopathologically confirmed primary breast cancer. A total of 210 ALNs were examined preoperatively using US and SWE. SWE measurements were performed using shear wave velocity (SWV) and elasticity modulus parameters. Histopathological results were considered to be the gold standard. The sensitivity, specificity, and AUC (area under the curve) values were calculated using ROC (receiver operating characteristic) analysis. Results: SWV (4.12±0.88 m/s) and elasticity modulus (50.4±8.9 kPa) were significantly higher in metastatic nodes (p<0.001) compared to non-metastatic nodes (2.58±0.75 m/s; 24.7±6.3 kPa). A threshold value of 3.30 m/s for SWV yielded an 87.2% sensitivity, 81.5% specificity, and an AUC of 0.89. When combined with SWE, the sensitivity (72.3%) and specificity (68.1%) of US increased to 91.0% and 84.7%, respectively. False negatives were mostly seen in micrometastases, whereas false positives were seen in fibrotic reactive nodules. Conclusion: SWE offers high diagnostic accuracy for distinguishing between metastatic and benign ALNs in breast cancer. Adding it to US significantly improves the diagnostic performance, reduces unnecessary biopsies, and makes preoperative surgical planning more reliable. SWE is a reliable and noninvasive method that can contribute to the axillary staging process in clinical practice.

Keywords

• Breast cancer
• axillary lymph node
• shear wave elastography
• ultrasonography
• metastasis

Supporting Institution

This research did not receive any specific grant or financial support from funding agencies or institutions

Ethical Statement

Ethical approval for this study was obtained from the Elazig Fethi Sekin City Hospital Non-Interventional Research Ethics Committee (Date: March 6, 2025, Decision No: 2025/5-18). All procedures in this study were conducted in accordance with the principles of the Declaration of Helsinki.

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