<b>Simultaneous Bilateral Breast and High-Resolution Axillary MRI of Patients with Breast Cancer:</b> Preliminary Results

Magnetic resonance (MR) imaging after ultra-small super paramagnetic iron oxide (USPIO) injection and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) for preoperative axillary lymph node staging in patients with breast cancer were evaluated using histopathologic findings as the reference standard. USPIO-enhanced MR and FDG-PET were performed in ten patients with breast cancer who were scheduled for surgery and axillary node resection. T2-weighted fast spin echo, T1-weighted three-dimensional (3D) gradient echo, T2*-weighted gradient echo and gadolinium-enhanced T1-weighted 3D gradient echo with spectral fat saturation were evaluated. MR imaging before USPIO infusion was not performed. The results were correlated with FDG-PET (acquired with dedicated PET camera, visual analysis) and histological findings. The histopathologic axillary staging was negative for nodal malignancy in five patients and positive in the remaining five patients. There was one false positive finding for USPIO-enhanced MR and one false negative finding for FDG-PET. A sensitivity (true positive rate) of 100%, specificity (true negative rate) of 80%, positive predictive value of 80%, and negative predictive value of 100% were achieved for USPIO-enhanced MR and of 80%, 100%, 100%, 80% for FDG-PET, respectively. The most useful sequences in the detection of invaded lymph nodes were in the decreasing order: gadolinium-enhanced T1-weighted 3D gradient echo with fat saturation, T2*-weighted 2D gradient echo, T1-weighted 3D gradient echo and T2-weighted 2D spin echo. In our study, USPIO-enhanced T1 gradient echo after gadolinium injection and fat saturation emerged as a very useful sequence in the staging of lymph nodes. The combination of USPIO-enhanced MR and FDG-PET achieved 100% sensitivity, specificity, PPV and NPV. If these results are confirmed, the combination of USPIO MR with FDG-PET has the potential to identify the patient candidates for axillary dissection versus sentinel node lymphadenectomy.

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“…Moreover, Luciani et al [5] reported significantly higher enhancement in the invaded lymph nodes than in those with negative pathologic findings.…”

Section: Discussionmentioning

confidence: 97%

“…Luciani et al [5] found that the best discrimination between pathologic and negative findings were the presence of irregular contours, high signal intensity on T2 and marked gadolinium enhancement.…”

Section: Introductionmentioning

confidence: 99%

Breast imaging. Preoperative breast cancer staging: comparison of USPIO-enhanced MR imaging and 18F-fluorodeoxyglucose (FDC) positron emission tomography (PET) imaging for axillary lymph node staging—initial findings

et al. 2006

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“…The studies are mostly about enhancement and MRI characteristics of the lymph nodes (11-15). In a study by Luciani et al, (11) high-resolution MRI of the axilla and bilateral breast MRI was evaluated in order to identify nodal lymph node features and metastatic involvement.…”

Section: Discussionmentioning

confidence: 99%

Contribution of kinetic characteristics of axillary lymph nodes to the diagnosis in breast magnetic resonance imaging

Örgüç¹,

Başaran²,

Pekindil³

et al. 2012

Balkan Med J

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Objective: To assess the contribution of kinetic characteristics in the discrimination of malignant-benign axillary lymph nodes. Material and Methods:One hundred fifty-five female patients were included in the study. Following magnetic resonance imaging (MRI) examinations postprocessing applications were applied, dynamic curves were obtained from subtracted images. Types of dynamic curves were correlated with histopathological results in malignant cases or final clinical results in patients with no evidence of malignancy. Sensitivity, specificity, positive likehood ratio (+LHR), negative (-LHR) of dynamic curves characterizing the axillary lymph nodes were calculated.Results: A total of 178 lymph nodes greater than 8 mm were evaluated in 113 patients. Forty-six lymph nodes in 24 cases had malignant axillary involvement. 132 lymph nodes in 89 patients with benign diagnosis were included in the study. The sensitivity of type 3 curve as an indicator of malignancy was calculated as 89%. However the specificity, +LHR, -LHR were calculated as 14%, 1.04, 0.76 respectively. Conclusion:Since kinetic analysis of both benign and malignant axillary lymph nodes, rapid enhancement and washout (type 3) they cannot be used as a discriminator, unlike breast lesions. MRI, depending on the kinetic features of the axillary lymph nodes, is not high enough to be used in the clinical management of breast cancer patients.

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“…This is also well in correlation with our study. In study by Luciani et al [35] also eccentric or irregular cortical thickening and non visualization of hilum was seen as having a high positive predictive value for nodal metastasis. They also showed that irregular nodal margin was correlating well with extracapsular extension.…”

Section: Axillary Lymphadenopathymentioning

confidence: 83%

Reliability and Reproducibility of Breast MRI as A Roadmap in Treatment Planning of Breast Cancer –A Single Centre Experience

Bansal¹

2017

IJRRT

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Aim: To study the significance of MRI in the preoperative work up of patients with newly diagnosed breast cancer and its potential to create a road map for surgical and definitive treatment. To study and define those interpretation criteria of MRI that serve to increase its specificity in pre-treatment breast cancer assessment with emphasis on non mass enhancement (NME). To study its role in predicting the nodal status in diagnosed cases of breast cancer. Material and methods:MRI and pathological data of 156 patients spread over period from September 2011 to JUNE 2014 were studied retrospectively. Morphology and enhancement characteristics of breast lesions, both masses and NME and axillary lymph nodes were analysed on DCE MRI with subsequent histopathological correlation.Results: Our study showed Sensitivity (Sn): 79%, Specificity (Sp): 86%, Positive Predictive value (PPV): 76%, Negative predictive value (NPV): 88% for identification of extratumoral DCIS (Ductal carcinoma in situ) while Sn: 74%, Sp: 76, PPV: 52%, NPV: 89% for extensive intraductal component (EIC) on histopathology in patients having non mass enhancement (NME) on DCE-MR. When NME was correlated with extratumoral DCIS and EIC taken together, we obtained Sn: 89%, Sp: 78%, PPV: 50%, NPV: 97%. Multifocal/multicentric tumours with or without satellite nodules on MRI had Sn: 86%, Sp: 89%, PPV: 60%, NPV: 97% for multiple lesions on histopathology. For detection of axillary nodal metastasis, fatty hilum effacement showed Sn: 65%, Sp: 89%, PPV: 86%, NPV: 73% and cortical thickening with and without fatty hilum effacement showed Sn: 86%, Sp: 69%, PPV: 73%, NPV: 84%. Conclusion:MRI plays an important role in assessment of disease extent in breast cancer patients desirous of breast conservation surgery and has a potential to act as a road map in treatment planning. Following certain diagnostic criteria it helps in identifying the in situ cancers with a reasonable high specificity.

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Simultaneous Bilateral Breast and High-Resolution Axillary MRI of Patients with Breast Cancer: Preliminary Results

Abstract: Breast tissue and axillary lymph nodes both can be analyzed on MRI in a one-step process using a bilateral breast coil combined with a surface coil. Morphologic features observed on high-resolution MRI of the axilla can improve the identification of metastatic nodes.

Cited by 59 publications

References 29 publications

Breast imaging. Preoperative breast cancer staging: comparison of USPIO-enhanced MR imaging and 18F-fluorodeoxyglucose (FDC) positron emission tomography (PET) imaging for axillary lymph node staging—initial findings

Breast imaging. Preoperative breast cancer staging: comparison of USPIO-enhanced MR imaging and 18F-fluorodeoxyglucose (FDC) positron emission tomography (PET) imaging for axillary lymph node staging—initial findings

Contribution of kinetic characteristics of axillary lymph nodes to the diagnosis in breast magnetic resonance imaging

Reliability and Reproducibility of Breast MRI as A Roadmap in Treatment Planning of Breast Cancer –A Single Centre Experience

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