SavedAdd your journal

Journals / Uludağ Üniversitesi Tıp Fakültesi Dergisi / 2026 / Cilt: 52

Multiparametric Ultrasound Evaluation of Axillary Lymph Nodes in Breast Cancer Patients

Meme Kanserli Hastalarda Aksiller Lenf Nodlarının Çok Parametreli Ultrason İle Değerlendirmesi

Başak Erdemli Gürsel(Bursa Uludağ University Faculty of Medicine, Department of Radiology, Bursa, Türkiye.)0000-0002-0047-1780
Rifat Özpar(Bursa Uludağ University Faculty of Medicine, Department of Radiology, Bursa, Türkiye.)0000-0001-6649-9287
İlker Ercan(Bursa Uludağ University Faculty of Medicine, Department of Biostatistics, Bursa, Türkiye.)0000-0002-2382-290X
Gökhan Gökalp(Bursa Uludağ University Faculty of Medicine, Department of Radiology, Bursa, Türkiye.)0000-0001-9169-5087
Pages
—
Publication Date
2026-07-08
🏛️Bibliographic metadata and full text access for this article are provided via DergiPark.
DergiPark Record ↗
✨

AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Since multiparametric ultrasound provides valuable information for detecting metastatic lymph nodes, we recommend multiparametric assessment rather than B-mode ultrasound alone.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:This study aims to evaluate benign and malignant axillary lymph nodes (LN) in breast cancer using multiparametric ultrasound (US).
📊
Key Findings & Data:The morphological characteristics, stiffness, and VI differences between 52 benign and malignant LNs were statistically evaluated using B-mode US, shear wave elastography (SWE), and superb microvascular imaging (SMI) before biopsy.
💡
Conclusion & Impact:Since multiparametric ultrasound provides valuable information for detecting metastatic lymph nodes, we recommend multiparametric assessment rather than B-mode ultrasound alone.
🔬Design:Araştırma Makalesi
📍Scope:Comprehensive Sample
⚙️Variables:meme kanseri · çok parametreli ultrason · shear wave elastografi (SWE)

Abstract

This study aims to evaluate benign and malignant axillary lymph nodes (LN) in breast cancer using multiparametric ultrasound (US). The morphological characteristics, stiffness, and VI differences between 52 benign and malignant LNs were statistically evaluated using B-mode US, shear wave elastography (SWE), and superb microvascular imaging (SMI) before biopsy. Significant cutoff values were determined using receiver operating characteristic (ROC) curve analysis. Malignant lymph nodes had higher short-axis diameters (SD), lower long-axis diameter/short axis diameter ratios (LD/SD), and increased cortical thickness (p=0.026, p=0.044, p=0.004, p=0.000, respectively). A cortical thickness above 3.1 mm (AUC: 0.751, sensitivity: 94.1%, specificity: 51.4%, p=0.0003), SD greater than 8.4 mm (AUC: 0.692, sensitivity: 41.1%, specificity: 91.4%, p= 0.0141), LD/SD ≤2 (AUC: 0.664, sensitivity: 76.5%, specificity: 48.6%, p=0.0355) and, a mean elasticity value above 26.2 kPa (AUC: 0.861, sensitivity: 70.6%, specificity: 91.4%, p<0.0001) were identified as the best cutoff values for detecting metastasis. Since multiparametric ultrasound provides valuable information for detecting metastatic lymph nodes, we recommend multiparametric assessment rather than B-mode ultrasound alone.

Özet

Bu çalışma, meme kanserli hastalarda çok parametreli Ultrason (US) ile benign ve malign aksiller lenf nodlarını (LN) değerlendirmeyi amaçlamaktadır. Elli iki lenf nodunun morfolojik özellikleri, sertlik ve vasküler indeks (VI) değerleri, biyopsi öncesinde B-mod US, shear wave elastografi (SWE) ve superb microvascular imaging (SMI) teknikleri ile istatistiksel olarak değerlendirildi. Anlamlı cutoff değerler, receiver operating characteristic (ROC) eğri analizi kullanılarak tespit edildi. Malign LN'ları benign LN'larına kıyasla, daha yüksek kısa-aks değerine (KD), daha düşük uzun/kısa-aks oranlarına (UD/KD) ve artmış kortikal kalınlığa sahipti (sırasıyla p=0,026, p=0,044, p=0,004, p=0,000). 3,1 mm'nin üzerindeki kortikal kalınlık (AUC: 0,751, duyarlılık: %94,1, özgüllük: %51,4, p=0,0003), 8,4 mm'nin üzerindeki KD (AUC: 0,692, duyarlılık: %41,1, özgüllük: %91,4, p= 0,0141), ≤2 UD/KD (AUC: 0,664, duyarlılık: %76,5, özgüllük: 48,6%, p=0,0355) ve 26,2 kPa'nın üzerinde ortalama elastikiyet değeri (AUC: 0,861, duyarlılık: 70,6%, özgüllük: 91,4%, p<0,0001) metastazı tespit etmek için en iyi cutoff değerler olarak belirlendi. Multiparametrik US ile lenf nodlarının değerlendirilmesi tanı ve tedavinin belirlenmesinde değerli bilgiler sağlamaktadır. Bu nedenle tek başına B-mod US inceleme yerine multiparametrik US değerlendirmeyi önermekteyiz.

🔖

Cite This Article

Gürsel, B. E., Özpar, R., Ercan, İ., Gökalp, G., *, B. E. G. (2026). Multiparametric Ultrasound Evaluation of Axillary Lymph Nodes in Breast Cancer Patients. Uludağ Üniversitesi Tıp Fakültesi Dergisi, Cilt: 52. https://doi.org/10.32708/uutfd.1906063

📄 Full Text PDF Viewer

📄

PDF görüntüleyici hazırlanıyor...

References (38)

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin 2019;69(1):7.
  2. Fisher B, Bauer M, Wickerham DL, et al. Relation of number of positive axillary nodes to the prognosis of patients with primary breast cancer: an NSABP update. Cancer 1983; 52:1551–1557.
  3. Carter CL, Allen C, Henson DE. Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases. Cancer1989; 63:181–187.
  4. Kim T, Giuliano AE, Lyman GH. Lymphatic mapping and sentinel lymph node biopsy in early-stage breast carcinoma: a metaanalysis. Cancer2006; 106:4–16.
  5. Balasubramanian I, Fleming CA, Corrigan MA, et al. Meta-analysis of the diagnostic accuracy of ultrasound-guided fine-needle aspiration and core needle biopsy in diagnosing axillary lymph node metastasis. Br J Surg 2018;105(10):1244.
  6. Lyman GH, Giuliano AE, Somerfield MR, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol 2005; 23:7703–7720
  7. Gipponi M, Fregatti P, Garlaschi A, et al. Axillary ultrasound and fineneedle aspiration cytology in the preoperative staging of axillary node metastasis in breast cancer patients. Breast 2016;30:146
  8. Choi YJ, Ko EY, Han BK, Shin JH, Kang SS, Hahn SY. High-resolution ultrasonographic features of axillary lymph node metastasis in patients with breast cancer. Breast 2009; 18:119–122.
  9. Bedi DG, Krishnamurthy R, Krishnamurthy S, et al. Cortical morphologic features of axillary lymph nodes as a predictor of metastasis in breast cancer: in vitro sonographic study. AJR Am J Roentgenol 2008; 191:646– 652.
  10. Moore A, Hester M, Nam MW, et al. Distinct lymph nodal sonographic characteristics in breast cancer patients at high risk for axillary metastases correlate with the final axillary stage. Br J Radiol 2008; 81:630–636.
  11. Alvarez S, Añorbe E, Alcorta P, López F, Alonso I, Cortés J. Role of sonography in the diagnosis of axillary lymph node metastases in breast cancer: a systematic review. AJR Am J Roentgenol 2006; 186:1342–1348
  12. Seo M, Sohn Y. Differentiation of benign and metastatic axillary lymph nodes in breast cancer: additive value of shear wave elastography to Bmode ultrasound. Clin Imaging 2018;50:258
  13. Luo S, Yao G, Hong Z, et al. Qualitative classification of shear wave elastography for differential diagnosis between benign and metastatic axillary lymph nodes in breast cancer. Front Oncol 2019 Jul 2;9:533.
  14. Choi JJ, Kang BJ, Kim SH, et al. Role of sonographic elastography in the differential diagnosis of axillary lymph nodes in breast cancer. J Ultrasound Med 2011;30(4):429.
  15. Chang W, Jia W, Shi J, Yuan C, Zhang Y, Chen M. Role of Elastography in Axillary Examination of Patients With Breast Cancer. J Ultrasound Med. 2018 Mar;37(3):699-707.
  16. Luo H, Yin L. Diagnostic value of superb microvascular imaging and color doppler for thyroid nodules: A meta-analysis. Front Oncol. 2023 Apr 5;13:1029936.
  17. Hu, B., Zhao, Y., & Wang, L. Superb Microvascular Imaging for the Differentiation of Benign and Malignant Breast Lesions:A System Review and Meta-Analysis. Journal of Ultrasound in Medicine, 2023;42(7), 1385-1399.
  18. . Clinical Applications of Superb Microvascular Imaging in the Liver, Breast, Thyroid, Skeletal Muscle, and Carotid Plaques. Journal of Ultrasound in Medicine, 38(11), 2811-2820.
  19. Dubinsky TJ, Revels J, Wang S, et al. Comparison of superbmicrovascular imaging with color flow and power Dopplerimaging of small hepatocellular carcinomas. J Ultrasound Med. 2018; 37(12): 2915-2924.
  20. Nori J, Vanzi E, Bazzocchi M, et al. Role of axillary ultrasound examination in the selection of breast cancer patients for sentinel node biopsy. Am J Surg 2007; 193:16-20.
  21. Chae BJ, Bae JS, Kang BJ, Kim SH, Jung SS, Song BJ.Positron emission tomography-computed tomography in the detection of axillary lymph node metastasis in patients with early stage breast cancer. Jpn J Clin Oncol 2009;39:284–289.
  22. Abe H, Schmidt RA, Kulkarni K, Sennett CA, Mueller JS,Newstead GM. Axillary lymph nodes suspicious for breastcancer metastasis: sampling with US-guided 14-gauge core-needle biopsy—clinical experience in 100 patients. Radiology2009; 250:41–49.
  23. Xiao XY, Chen X, Guan XF, et al. Superb microvascular imaging in diagnosis of breast lesions: a comparative study with contrast-enhanced ultrasonographic microvascular imaging. Br J Radiol. 2016;89:20160546.
  24. Kurt SA, Eryurekli AE, Kayadibi Y, Samanci C, VelidedeogluM, Onur I, Arslan S, Taskin F. Diagnostic Performance ofSuperb Microvascular Imaging in Differentiating Benign andMalignant Axillary Lymph Nodes. Ultrasound Q. 2023 Jun 1;39(2):74-80.
  25. Esen G, Gurses B, Yilmaz MH, et al. Gray scale and powerDoppler US in the preoperative evaluation of axillary metastases in breast cancer patients with no palpable lymph nodes. Eur Radiol 2005; 15:1215–1223.
  26. Saffar B, Bennett M, Metcalf C, Burrows S. Retrospective preoperative assessment of the axillary lymph nodes in patients with breast cancer and literature review. Clin Radiol. 2015 Sep;70(9):954-9.
  27. Xu Y, Bai X, Chen Y, Jiang L, Hu B, Hu B, Yu L. Applicationof Real-time Elastography Ultrasound in the Diagnosis ofAxillary Lymph Node Metastasis in Breast Cancer Patients. Sci Rep. 2018 Jul 6;8(1):10234.
  28. Uslu H, Tosun M. The benefit of superb microvascular imaging and shear wave elastography in differentiating metastatic axillary lymphadenopathy from lymphadenitis. Clin Breast Cancer. 2022 Aug;22(6):515-520.
  29. Zhao, Q.-L. et al. Elastosonography and two-dimensional ultrasonography in diagnosis of axillary lymph node metastasis in breast cancer. Clinical Radiology, Volume 73, Issue 3, 312–318.
  30. Amonkar SJ, Oates E, McLean L, et al. Pre-operative staging of the axilla in primary breast cancer. By redefining the abnormal appearing node can we reduce investigations without affecting overall treatment? Breast 2013;22:1114e8.
  31. Carmeliet P, Jain RK. Angiogenesis in cancer and other diseases. Nature. 2000;407:249–257.
  32. Nathanson SD. Insights into the mechanisms of lymph node metastasis. Cancer. 2003;98:413–423.
  33. Ryoo I, Suh S, You SH, Seol HY. Usefulness of MicrovascularUltrasonography in Differentiating Metastatic Lymphadenopathy from Tuberculous Lymphadenitis. Ultrasound Med Biol. 2016 Sep;42(9):2189-95.
  34. Tokur O, Aydin S, Kilinc F, Degirmenci T, Oztekin PS.Diagnostic value of super microvascular imaging in differentiating axillary lymph nodes: semi-quantitative and qualitative approach in primary breast cancer and suspicious axillary nodes. BMC Cancer. 2025 Nov 4;25(1):1705.
  35. Bulut, Iclal Nur MD∗; Kayadibi, Yasemin MD∗; Deger, Enes∗;Kurt, Seda Aladag∗; Velidedeoglu, Mehmet†; Onur, Irem‡; Ozturk, Tulin‡; Adaletli, Ibrahim∗. Preoperative Role ofSuperb Microvascular Imaging and Shear-Wave Elastography for Prediction of Axillary Lymph Node Metastasis in Patients With Breast Cancer. Ultrasound Quarterly 40(2), June 2024:p111-118.
  36. Ji Hyun Youk, Eun Ju Son, Jeong-Ah Kim, Hye Mi Gweon.Pre-Operative Evaluation of Axillary Lymph Node Status in Patients with Suspected Breast Cancer Using Shear Wave Elastography, Ultrasound in Medicine & Biology, Volume 43, Issue 8, 2017, Pages 1581-1586.
  37. Wang RY, Zhang YW, Gao ZM, Wang XM. Role ofsonoelastography in assessment of axillary lymph nodes inbreast cancer: a systematic review and meta-analysis. Clin Radiol. 2020 Apr;75(4):320.e1-320.e7.
  38. Kritcharoen W, Pradaranon V, Rohitopakarn P, Kaewpiboon W.Accuracy of shear wave elastography in diagnosing axillary lymph node metastasis in patients with suspicious axillary lymph nodes: development of a predictive nomogram. J Ultrasound. 2025 Sep;28(3):627-633.