Ultrasonographic Algorithm for the Assessment of Sentinel Lymph Nodes That Drain the Mammary Carcinomas in Female Dogs
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Gray Scale Examination
2.2. Doppler US Examination
2.3. CEUS Examination
2.4. Real-Time Elastography (RTE)
2.5. Statistical Analysis
3. Results
3.1. B-Mode Ultrasonography
3.2. Color Doppler Ultrasonography
3.3. Contrast-Enhanced Ultrasonography
3.4. Real-Time Elastography
3.5. Lymphatic Mapping
4. Discussion
4.1. B-Mode Ultrasonography
4.2. Color Doppler Ultrasonography
4.3. Contrast-Enhanced Ultrasonography
4.4. Real Time Elastography
4.5. Lymphatic Mapping
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Elasticity Score | Description | Interpretation |
---|---|---|
1 | Total green or yellow, absent blue areas or very small blue area/s | Soft |
2 | Small scattered blue areas or total blue area <45% | Moderately soft |
3 | Large blue area/s, total blue area ≥45% | Moderately stiff |
4 | Peripheral large hard area and central small green areas suggesting central necrosis | Predominantly stiff |
5 | Hard area occupying the entire lymph node, with or without green rim | Stiff |
Type of Neoplasms | Number of Neoplasms |
---|---|
Carcinoma in a mixed tumor | 25 |
Carcinoma—simple tubular | 19 |
Carcinoma—simple tubulopapillary | 17 |
Carcinoma—solid | 5 |
Carcinoma—complex type | 3 |
Carcinoma—anaplastic | 2 |
Total subjects | 71 |
Ultrasound Parameter n (%) | Unaffected Nodes (N = 42) | Metastatic/Affected Nodes (N = 54) | p Value |
---|---|---|---|
B-MODE ULTRASONOGRAPHY OF SENTINEL LYMPH NODES | |||
SA/LA ratio < 0.55 | 33 (78.57) | 9(16.66) | <0.001 |
Short axis (mean ± SD) cm | 0.67 ± 0.26 | 1.17 ± 0.53 | |
Long axis (mean ± SD) cm | 1.33 ± 0.46 | 1.83 ± 0.79 | |
Internal structure (Echostructure) | |||
Homogeneous | 36(85.71) | 10(18.51) | <0.001 |
Inhomogeneous | 6(14.28) | 44(81.48) | |
Echogenicity | |||
Hypoechoic | 28(66.66) | 37(68.51) | =0.81 |
Isoechoic | 10(23.80) | 14(25.92) | |
Hyperechoic | 4(9.52) | 3(5.55) | |
Hillum tissue definition | |||
Present | 30(71.48) | 29(53.70) | =0.07 |
Absent/invisible | 12(28.57) | 25(46.29) | |
Capsule (Borders) | |||
Well-defined | 37(88.09) | 39(72.22) | 0.057 |
Ill-defined | 5 (11.90) | 15(27.77) | |
COLOR DOPPLER ULTRASONOGRAPHY—VASCULAR PATTERN | |||
Localization | |||
Absence of vascular signal | 2(4.76) | 1(1.85) | <0.001 |
Hilar pattern | 36(85.71) | 12(22.22) | |
Peripheral pattern | 1(2.38) | 30(55.55) | |
Mixed | 3(7.14) | 11(20.37) | |
Type and distribution | |||
Ordered | 36(85.71) | 5(9.25) | <0.001 |
Chaotic | 4(9.52) | 48(88.88) | |
NA | 2(4.76) | 1(1.85) | |
Intranodal vascular resistance (expressed by mean ± SD) | |||
RI | 0.5060 ± 0.147 | 0.7011 ± 0.138 | <0.001 |
PI | 0.9828 ± 0.223 | 1.2426 ± 0.259 | |
CONTRAST-ENHANCED ULTRASONOGRAPHY (CEUS) | |||
Enhancement patterns | |||
Intense homogeneouss | 32(76.19) | 6(11.11) | <0.001 |
Inhomogeneous | 8(19.04) | 44(81.48) | |
No enhancement | 2(4.76) | 4(7.40) | |
Perfusion times (expressed by mean ± SD) | |||
Wash in time/s | 18.12 ± 7.15 | 15.34 ± 7.23 | =0.07 |
Wash out time/s | 151.48 ± 34.62 | 104.26 ± 39.67 | <0.001 |
REAL-TIME ELASTOGRAPHY—LYMPH NODE STIFFNESS ASSESSED BY ELASTICITY STIFFNESS SCORES | |||
Soft (scores 1 and 2) | 38(90.47) | 6(11.11) | <0.001 |
Hard (scores 3, 4 and 5) | 6(14.28) | 48(88.88) |
Lymph Nodes | 1 | 2 | 3 | 4 | 5 |
---|---|---|---|---|---|
Unaffected (N = 42) | 25 (59.5) | 13 (31.0) | 3 (7.1) | - | 1 (2.4) |
Metastatic (N = 54) | 2 (3.7) | 4 (7.4) | 14 (25.9) | 19 (35.2) | 15 (27.8) |
p value | <0.001 |
Criterion | AUC | SE (%) | SP (%) | Statistical Sig. | Cutoff Value | CI 95% | PPV (%) | NPV (%) | Acc (%) |
---|---|---|---|---|---|---|---|---|---|
S/L Ratio | 0.812 | 83.3 | 78.6 | Good | 0.550 | 0.724–0.899 | 83.33 | 78.57 | 81.25 |
L axis | 0.689 | 50.0 | 92.9 | Poor | 1.860 | 0.583–0.794 | 90.00 | 59.09 | 68.75 |
S axis | 0.798 | 64.8 | 85.7 | Fair | 0.854 | 0.711–0.885 | 85.37 | 65.45 | 73.96 |
RI | 0.837 | 83.0 | 75.0 | Good | 0.565 | 0.753–0.921 | 81.02 | 77.45 | 80.00 |
PI | 0.798 | 83.0 | 65.0 | Fair | 1.025 | 0.705–0.891 | 75.31 | 74.86 | 75.14 |
WOT (s) | 0.818 | 84.0 | 74.4 | Good | 133.0 | 0.727–0.910 | 80.81 | 78.33 | 79.78 |
ES | 0.928 | 88.9 | 90.5 | Excellent | 2.5 | 0.871–0.986 | 89.69 | 86.36 | 89.71 |
US Parameter | Pattern | Score | |
---|---|---|---|
Gray scale ultrasound | |||
1. | S/L ratio | <0.55 | 0 |
≥0.55 | 1 | ||
2. | Echostructure | Homogeneous | 0 |
Inhomogeneous | 1 | ||
Doppler ultrasound | |||
3. | Localization | Hilar | 0 |
Peripheral | 1 | ||
4. | Type and distribution | Ordered | 0 |
Chaotic | 1 | ||
5. | RI | <0.54 | 0 |
≥0.54 | 1 | ||
6. | PI | <0.83 | 0 |
≥0.83 | 1 | ||
Score < 3—unaffected lymph node; Score = 3 CEUS and elastography should be performed; Score ≥ 3 metastatic lymph node should be taken into account | |||
CEUS | |||
1. | Enhancement pattern | Intense, homogeneous | 0 |
Inhomogeneous ± no enhanced areas | 1 | ||
2. | Wash-out time (s) peritumoral ad. | >133 | 0 |
≤133 | 1 | ||
Strain elastography | |||
3. | Stiffness | Soft or moderately soft (scores 1 and 2) | 0 |
Predominantly/moderately stiff or stiff (scores 3,4,5) | 1 |
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Stan, F.; Gudea, A.; Damian, A.; Gal, A.F.; Papuc, I.; Pop, A.R.; Martonos, C. Ultrasonographic Algorithm for the Assessment of Sentinel Lymph Nodes That Drain the Mammary Carcinomas in Female Dogs. Animals 2020, 10, 2366. https://doi.org/10.3390/ani10122366
Stan F, Gudea A, Damian A, Gal AF, Papuc I, Pop AR, Martonos C. Ultrasonographic Algorithm for the Assessment of Sentinel Lymph Nodes That Drain the Mammary Carcinomas in Female Dogs. Animals. 2020; 10(12):2366. https://doi.org/10.3390/ani10122366
Chicago/Turabian StyleStan, Florin, Alexandru Gudea, Aurel Damian, Adrian Florin Gal, Ionel Papuc, Alexandru Raul Pop, and Cristian Martonos. 2020. "Ultrasonographic Algorithm for the Assessment of Sentinel Lymph Nodes That Drain the Mammary Carcinomas in Female Dogs" Animals 10, no. 12: 2366. https://doi.org/10.3390/ani10122366