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Breast Cancer Research
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Open Access 01-12-2023 | Ultrasound | Research

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

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

Published in: Breast Cancer Research | Issue 1/2023

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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.
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Metadata
Title
Noninvasive prediction of axillary lymph node breast cancer metastasis using morphometric analysis of nodal tumor microvessels in a contrast-free ultrasound approach
Authors
Giulia Ferroni
Soroosh Sabeti
Tasneem Abdus-Shakur
Lorenzo Scalise
Jodi M. Carter
Robert T. Fazzio
Nicholas B. Larson
Mostafa Fatemi
Azra Alizad
Publication date
01-12-2023
Publisher
BioMed Central
Published in
Breast Cancer Research / Issue 1/2023
Electronic ISSN: 1465-542X
DOI
https://doi.org/10.1186/s13058-023-01670-z

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