In the relentless quest to improve breast cancer prognosis and tailor therapeutic strategies, an innovative study has illuminated the clinical significance of tumor size discrepancies observed between two prevalent imaging modalities: conventional ultrasonography (cUS) and contrast-enhanced ultrasonography (CEUS). This retrospective cohort analysis, recently published in BMC Cancer, explores how variations in tumor measurements between these methods may correlate with axillary lymph node (ALN) metastasis, a pivotal determinant of breast cancer progression and patient outcomes.
Ultrasonography remains a cornerstone in breast cancer evaluation due to its noninvasiveness, accessibility, and ability to assess both tumor morphology and lymph node involvement. Conventional ultrasonography, utilizing high-frequency sound waves, provides detailed grayscale images delineating tumor boundaries. However, CEUS, a more advanced technique, introduces microbubble contrast agents to accentuate vascularization within breast lesions, potentially offering a more dynamic assessment of tumor biology. The study focused on the discrepancies encountered in tumor size measurements between these two modalities, hypothesizing that such differences might reflect underlying metastatic potential.
The investigation included a sizable cohort of 259 breast cancer patients who had undergone preoperative evaluation with both cUS and CEUS followed by surgical intervention. Researchers quantified the tumor size discrepancy as the absolute difference in measurement between CEUS and cUS. Patients exhibiting a size difference of 4.0 mm or greater were classified into the “DISCR” group, while those with less discrepancy formed the “non-DISCR” group. This stratification allowed for a detailed comparison regarding ALN metastasis prevalence and long-term recurrence-free survival.
Intriguingly, despite similar tumor sizes reported by conventional ultrasonography in both groups, the DISCR group showed a significantly elevated rate of axillary lymph node metastasis. This finding underscores that the apparent increase in tumor size observed on CEUS is not merely an imaging artifact but may signify more aggressive tumor behavior with enhanced angiogenesis or infiltrative growth. Multivariate logistic regression analysis reinforced this association, revealing that a discrepancy of 4.0 mm or more between CEUS and cUS measurements independently predicted lymph node metastasis with an odds ratio of approximately 5.8.
The prognostic implications extended beyond immediate staging. Patients classified within the DISCR group experienced substantially poorer 5-year recurrence-free survival rates compared to those without significant measurement differences, with survival probabilities of 75% versus over 92% respectively. This stark contrast highlights the potential utility of CEUS-derived tumor size augmentation as a biomarker for disease aggressiveness and recurrence risk. Such information is invaluable for oncologists in refining therapeutic decisions, identifying candidates for more intensive systemic treatment or vigilant surveillance.
Fundamentally, the physiological basis for these findings lies in the enhanced visualization of tumor neoangiogenesis provided by CEUS. The contrast agent selectively highlights microvasculature, often revealing tumor extensions or satellite lesions that conventional ultrasonography may underestimate or miss. This vascular map not only augments tumor delineation but also reflects dynamic tumor biology linked with metastatic dissemination propensity to regional lymph nodes.
This study also addresses a critical uncertainty in breast ultrasonography: why frequent measurement discrepancies exist between cUS and CEUS. By correlating these differences with pathological outcomes, the research bridges a crucial knowledge gap, suggesting that CEUS could surpass conventional methods in predictive accuracy for nodal involvement. This advancement holds promise for more personalized breast cancer management protocols, where imaging biomarkers can tailor surgical and adjuvant therapy strategies.
However, while the retrospective design brings inherent limitations, the rigorous pathological confirmation of axillary lymph node status lends robust clinical relevance to these observations. Future prospective studies and integration with other molecular markers could further validate CEUS-based tumor size discrepancy as a prognostic indicator, potentially incorporating it into standardized breast cancer staging frameworks.
Moreover, the technical nuances of ultrasonography are pivotal in interpreting these findings. Factors such as operator expertise, ultrasound equipment quality, and contrast agent characteristics contribute to measurement variability. Nonetheless, the consistent association between significant size discrepancies and worse clinical outcomes observed across this cohort highlights the reliability of this imaging biomarker when standardized protocols are applied.
In clinical practice, the implications of this study are profound. Incorporating CEUS as a routine adjunct to conventional ultrasonography may enhance the preoperative evaluation of breast tumors, enabling a more accurate risk stratification for axillary metastasis. This could lead to more tailored surgical planning, such as choosing sentinel lymph node biopsy over axillary dissection or vice versa, reducing morbidity without compromising oncological safety.
Beyond the scope of axillary staging, these insights may stimulate further research into the vascular characteristics of breast tumors and their role in metastatic pathways. CEUS could potentially guide targeted therapies aimed at angiogenesis inhibition or vascular modulation, opening novel therapeutic avenues.
Overall, this work marks a significant step forward in breast cancer imaging, coupling sophisticated ultrasonographic techniques with clinical prognostication. The demonstrated link between CEUS tumor size discrepancy and axillary node metastasis paves the way for refined diagnostic and therapeutic strategies, ultimately aspiring to improve outcomes for patients navigating breast cancer’s complex landscape.
As breast cancer treatment increasingly embraces precision medicine, imaging innovations like CEUS stand alongside molecular profiling as critical components for crafting individualized care plans. The meticulous work of Oshino et al. exemplifies how re-examining established diagnostic tools through a novel lens can yield impactful clinical insights with potential to alter standard care paradigms globally.
It is anticipated that future guidelines may incorporate CEUS-generated data to better inform prognosis and treatment pathways. Embracing such advancements ensures that breast cancer management continues evolving, driven by multidisciplinary research and technology integration, to deliver maximal benefit to patients worldwide.
Subject of Research: Breast tumor size discrepancy between contrast-enhanced ultrasonography and conventional ultrasonography as a predictor of axillary lymph node metastasis in breast cancer.
Article Title: Impact of breast tumor size discrepancy between contrast-enhanced and conventional ultrasonography on axillary node metastasis: a retrospective cohort study.
Article References:
Oshino, T., Shimizu, H., Sato, M. et al. Impact of breast tumor size discrepancy between contrast-enhanced and conventional ultrasonography on axillary node metastasis: a retrospective cohort study. BMC Cancer 25, 1718 (2025). https://doi.org/10.1186/s12885-025-15167-9
Image Credits: Scienmag.com
DOI: 05 November 2025
