Breast cancer: comparison of quantitative dual-layer spectral CT and axillary ultrasonography for preoperative diagnosis of metastatic axillary lymph nodes

Abstract

Abstract Background Our aim was to compare the diagnostic performance of quantitative dual-layer spectral computed tomography (DLSCT) and axillary ultrasound (US) for diagnosing lymph node metastases in breast cancer patients. Methods DLSCT and axillary US were prospectively performed in 70 needle biopsy-verified breast cancer patients. Histopathology and imaging data were available for evaluation in 36 axillae from 34 patients. In each patient, ipsilateral, contralateral, and inguinal lymph nodes (LNs) were semiautomatically segmented, and iodine density, spectral slope, Z effective, virtual non-contrast (VNC), conventional CT HU values, and Δ contrast enhancement (ΔCE, conventional CT HU minus VNC) were measured. Using histopathology as reference, the diagnostic performance of DLSCT and axillary US was compared. Results Of 36 axillae, 23 had metastatic lymph nodes. Compared with non-metastatic LNs, metastatic LNs had significantly different iodine density (p = 0.021), spectral slope (p < 0.001), Z effective (p < 0.001), conventional CT HU values (p < 0.01), and ΔCE (p < 0.01). All DLSCT parameters were significantly different between arterial phase and portal-venous phase (p < 0.001) except for VNC (p = 0.092). ΔCE had the highest diagnostic performance (sensitivity 0.79, specificity 0.92, positive predictive value 0.95, negative predictive value 0.69) with a significantly increased sensitivity compared with conventional CT HU (p = 0.027). There were no significant differences between ΔCE and axillary US for sensitivity (p = 1.000) or specificity (p = 0.320). Conclusions DLSCT is a promising quantitative technique for evaluating LN metastases and could potentially reduce the need for sentinel LN biopsy.