Adding contrast-enhanced ultrasound markers to conventional axillary ultrasound improves specificity for predicting axillary lymph node metastasis in patients with breast cancer

Objective: To evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) combined with conventional ultrasound of axillary lymph nodes (ALNs) in predicting metastatic ALNs in patients with breast cancer. Methods: This retrospective study included 259 patients with breast cancer who underwent conventional ultrasound and CEUS. The parameters and patterns evaluated on conventional ultrasound included short axis diameter (S), long axis/short axis (L/S) ratio, cortical thickness, resistive index (RI), lymph node (LN) morphology of greyscale ultrasound, hilum and vascular pattern. Meanwhile, enhancement pattern, wash-in time, time to peak (TP), maximum signal intensity, and duration of contrast enhancement were evaluated on CEUS. Univariate and multiple logistic regression analyses were performed to identify independent factors of ALN status. Three models (conventional ultrasound, CEUS, and combined parameters) were established. Receiver operating characteristic (ROC) curves were applied to evaluate the accuracy of the three predictive models. Results: On conventional axillary ultrasound, LN morphology and vascular pattern were independent factors in predicting metastatic ALNs. On CEUS, maximum signal intensity, duration of contrast enhancement, and TP were independent factors in predicting metastatic ALNs. When combining conventional ultrasound and CEUS features, five independent factors obtained from the conventional ultrasound and CEUS were associated with ALN status. ROC curve analysis showed that the use of CEUS markers combined with conventional ultrasound features (AUC = 0.965) was superior to the use of CEUS markers (AUC = 0.936) and conventional ultrasound features alone (AUC = 0.851). Conclusion: Combining conventional ultrasound and CEUS features can enable discrimination of ALN status better than the use of CEUS and conventional ultrasound features alone. Advances in knowledge: The axillary lymph node status in breast cancer patients impacts the treatment decision. Our ultrasonic data demonstrated that CEUS features of ALNs in breast cancer patients could be image markers for predicting ALN status. Combining conventional ultrasound and CEUS features of ALNs can improve specificity discrimination of ALN status better than the use of CEUS and the conventional ultrasound features alone, which will help the treatment planning optimization.

SAT-621 Framingham Cardiovascular Disease 10-Year-Risk Score Is Associated with Myocardial Perfusion in Asymptomatic Diabetic Patients

Background: Even without atherosclerosis, diabetes increases the risk of death from coronary heart disease and heart failure. Myocardial perfusion dysfunction may occur in the early stage of diabetic cardiomyopathy, but its examination method is relatively complex. It is very important to carry out targeted cardiac screening to find the factors related to diabetic myocardial perfusion in the early stage. Methods: We enrolled 77 patients with diabetes and 30 controls, performed anthropometric and laboratory tests such as blood glucose and lipids, and calculated Framingham Cardiovascular Disease 10-year-risk Score (FRS). All participants underwent cardiac magnetic resonance examinations and recorded their cardiac structure, functional indicators (such as ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume(SV), peak filling rate (PFR),myocardial perfusion index (maximum upslope (Slope), half time to maximum signal intensity (Time50Max (s)), time to maximum signal intensity (TimeMax (s)), the maximum signal intensity (MaxSI),, basic signal intensity (Baseline),the ratio of MaxSI and Baseline ((MaxSI (BL) %), the difference value between MaxSI and Baseline (MaxSI (BL))). Results: Compared with normal group, no cardiovascular symptoms of left ventricular and right ventricular systolic function in patients with diabetes and end-diastolic and end systolic volume had no obvious difference, left ventricular PFR is lower than normal (279.65 + 57.62 vs. 322.57 + / - 78.29, p = 0.02), in the subgroup analysis we found that the FRS high-risk groups, ventricular septal thickening tend to, and Slope, MaxSI, MaxSI BL (%), MaxSI (BL) were significantly lower than the high risk group, Time50Max and TimeMax were significantly longer than the non-high-risk group, and FRS was negatively correlated with Slope, MaxSI(%BL) and positively correlated with TimeMax(s) and Time50Max(s), with statistical significance. Conclusion: Systolic function remains and diastolic function decreases in asymptomatic diabetic patients. Moreover, the patients with high risk of FRS had significant decreased perfusion function, and the quantitative indexes of perfusion function were closely related to FRS. It is of great value to pay attention to the changes of FRS score for early screening and diagnosis of diabetic heart disease.