Vorontsov , D. A., Krivorotko, P. V., Gladkova, N. D., Tabagua, T. T., Sovetsky, A. A., Bederina, E. L., Sirotkina, M. A., Vorontsov, A. Y., Gamayunov, S. V., Zaitsev , V. Y., & Gubarkova, E. V. (2023). Compression Optical Coherence Elastography for Assessing Lymph Node Status in Early Breast Cancer. Voprosy Onkologii, 69(5), 885–896. https://doi.org/10.37469/0507-3758-2023-69-5-885-896

Abstract

Introduction. Assessment of the state of the lymph nodes is an important factor in determining the stage of the disease and choosing the optimal treatment tactics for breast cancer. In traditional lymph node dissection, only a small proportion of lymph nodes are often found to be metastatic, and this fact must be weighed against potential complications of dissection, such as lymphedema. Biopsy of sentinel lymph nodes using radiopharmaceuticals is currently an important step in surgical treatment and the standard method of regional staging in patients with early stages of breast cancer throughout the world. However, the main limitations of this method are the administration of exogenous agents, postoperative histological analysis, and the possibility of false negative results. There remains a need for the development and application of new intraoperative high-resolution and label-free imaging that can detect lymph nodes, which removal will reliably determine the extent of the tumor process in regional lymphatic collectors without lymphadenectomy. Optical coherence tomography (OCT) with its new modality, compression OCT elastography (C-OCE), can become such a method, capable of quantitatively assessing the elastic properties of biological tissues, which can significantly change with metastatic lesions of the lymph nodes, with a spatial resolution of about 40-50 µm.

The aim of the study was to study linear (stiffness) and nonlinear elastic properties of lymph nodes in the presence and absence of breast cancer metastases with the histological verification of the main structural components of the lymph nodes using the C-OCE method.

Materials and methods. A total of 27 postoperative sentinel and axillary lymph nodes were examined in 24 patients. Patients aged 54-73 years included in this study had previously histologically confirmed breast cancer with clinical stage T1-2N0M0 stage IA-IIA, and they were scheduled for breast-conserving surgery or amputation of the breast with sentinel lymph node biopsy. All patients underwent intraoperative lymphoscintigraphy after injection of a radiopharmaceutical (technetium-99m).

The study was carried out using a high-speed spectral-domain multimodal OCT device (Institute of Applied Physics of the RAS, Russia), which provides C-OCE for visualization of linear and nonlinear elastic properties of the tissue, with the calculation of the absolute values of the stiffness (Young's modulus in kPa) and the elastic non-linearity parameter of the tissue. Verification of the obtained OCT data was carried out using a standard histological study, according to the results of which all lymph nodes were divided into: normal (inactive) (n=6), reactive with follicular hyperplasia (n=7), reactive with sinus histiocytosis (n=8) and metastatic (n=6) lymph nodes.

Results. It was found that normal lymph nodes on C-OCE images are characterized by the lowest stiffness values in the cortical area with preserved lymphoid follicles (<200 kPa). Reactive lymph nodes with follicular hyperplasia show moderately elevated stiffness values (200-300 kPa) in the cortical region and more pronounced stiffness values (400-600 kPa) in areas of sinus histiocytosis. Lymph nodes with total metastasis show the highest stiffness values (> 600 kPa). Concerning the Young's modulus, which defines the linear elastic properties of tissue, there remains a noticeable overlap in stiffness values between these types of lymph nodes. Therefore, we also estimated the parameters of their elastic nonlinearity. The complementary use of both linear and nonlinear elastic parameters made it possible to differentiate all four main conditions of the lymph nodes with high statistical significance (p<0.0001).

Conclusions. C-OCE allows differentiation of normal, reactive and metastatic lymph nodes with higher contrast compared to conventional structural OCT imaging. C-OCE imaging shows a high potential for future intraoperative use to determine the status of lymph nodes in real time and assess the extent of breast cancer in regional lymphatic collectors to preserve intact lymph nodes.

https://doi.org/10.37469/0507-3758-2023-69-5-885-896

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