TY - JOUR
T1 - Establishment of a Diagnostic Method for Pelvic Sentinel Lymph Node Metastasis by Contrast-Enhanced Ultrasound in Uterine Cancer
AU - Toki, Asami
AU - Niikura, Hitoshi
AU - Mori, Naoko
AU - Shigeta, Shogo
AU - Nagai, Tomoyuki
AU - Tokunaga, Hideki
AU - Shimada, Muneaki
AU - Yaegashi, Nobuo
N1 - Funding Information:
This work was supported by JSPS KAKENHI Grant JP18K45678 and in part by The National Cancer Center Research and Development Fund (2020-J-3). We thank Editage ( www.editage.com ) for English language editing.
Publisher Copyright:
© 2021 World Federation for Ultrasound in Medicine & Biology
PY - 2021/8
Y1 - 2021/8
N2 - This study investigated the usefulness of conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) in distinguishing metastasis of pelvic sentinel lymph nodes (SLNs) in patients with gynecological cancer. We examined 74 SLNs of patients with endometrial cancer (n = 26) and cervical cancer (n = 11). Patients underwent US and CEUS followed by SLN biopsy; US and CEUS results were evaluated visually and quantitatively and compared between pathological metastasis-negative and -positive groups. To support CEUS results, the microvessel density of SLNs was evaluated immunohistochemically. Seventeen positive and 40 negative SLNs were evaluable. Margin and enhancement patterns by visual assessment revealed significant differences (p = 0.046 and 0.022, respectively). In quantitative time–intensity curve analyses, the weakest peak intensities (PImin), PI ratio and PI difference indicated significant differences (p = 0.045, p < 0.001 and p < 0.001, respectively). The areas under the receiver operating characteristic curves (AUCs) were 0.64, 0.82 and 0.83, respectively. The most effective PI ratio from the AUC was 1.3 (sensitivity = 82%, specificity = 70%), and the PI difference from the AUC was 20 (sensitivity = 88%, specificity = 70%). Microvessel density was significantly lower in metastatic lesions than in other areas. The quantitative analysis of CEUS seemed to be a reasonable method for distinguishing lymph node metastasis in patients with gynecological cancer.
AB - This study investigated the usefulness of conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) in distinguishing metastasis of pelvic sentinel lymph nodes (SLNs) in patients with gynecological cancer. We examined 74 SLNs of patients with endometrial cancer (n = 26) and cervical cancer (n = 11). Patients underwent US and CEUS followed by SLN biopsy; US and CEUS results were evaluated visually and quantitatively and compared between pathological metastasis-negative and -positive groups. To support CEUS results, the microvessel density of SLNs was evaluated immunohistochemically. Seventeen positive and 40 negative SLNs were evaluable. Margin and enhancement patterns by visual assessment revealed significant differences (p = 0.046 and 0.022, respectively). In quantitative time–intensity curve analyses, the weakest peak intensities (PImin), PI ratio and PI difference indicated significant differences (p = 0.045, p < 0.001 and p < 0.001, respectively). The areas under the receiver operating characteristic curves (AUCs) were 0.64, 0.82 and 0.83, respectively. The most effective PI ratio from the AUC was 1.3 (sensitivity = 82%, specificity = 70%), and the PI difference from the AUC was 20 (sensitivity = 88%, specificity = 70%). Microvessel density was significantly lower in metastatic lesions than in other areas. The quantitative analysis of CEUS seemed to be a reasonable method for distinguishing lymph node metastasis in patients with gynecological cancer.
KW - Contrast-enhanced ultrasound
KW - Diagnosis
KW - Gynecological cancer
KW - Microvessel density
KW - Sentinel lymph node
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U2 - 10.1016/j.ultrasmedbio.2021.03.040
DO - 10.1016/j.ultrasmedbio.2021.03.040
M3 - Article
C2 - 34052062
AN - SCOPUS:85106892937
VL - 47
SP - 2107
EP - 2116
JO - Ultrasound in Medicine and Biology
JF - Ultrasound in Medicine and Biology
SN - 0301-5629
IS - 8
ER -