Detection of lymph node metastases with ultrasmall superparamagnetic iron oxide (USPIO)-enhanced magnetic resonance imaging in oesophageal cancer: a feasibility study

Abstract

Aim: In this feasibility study we investigated whether magnetic resonance imaging (MRI) with ultrasmall superparamagnetic iron oxide (USPIO) can be used to identify regional and distant lymph nodes, including mediastinal and celiac lymph node metastases in patients with oesophageal cancer.Patients and methods: Ten patients with a potentially curative resectable cancer of the oesophagus were eligible for this study. All patients included in the study had positive lymph nodes on conventional staging (including endoscopic ultrasound, computed tomography and fluorodeoxyglucose-positron emission tomography). Nine patients underwent MRI + USPIO before surgery. Results were restricted to those patients who had both MRI + USPIO and histological examination. Results were compared with conventional staging and histopathologic findings.Results: One patient was excluded due to expired study time. Five out of 9 patients underwent an exploration; in 1 patient prior to surgery MRI + USPIO diagnosed liver metastases and in 3 patients an oesophageal resection was performed. USPIO uptake in mediastinal lymph nodes was seen in 6 out of 9 patients; in 3 patients non-malignant nodes were not visible. In total, 9 lymph node stations (of 6 patients) were separately analysed; 7 lymph node stations were assessed as positive (N1) on MRI+USPIO compared with 9 by conventional staging. According to histology findings, there was one false-positive and one false-negative result in MRI + USPIO. Also, conventional staging modalities had one false-positive and one false-negative result. MRI + USPIO had surplus value in one patient. Not all lymph node stations could be compared due to unforeseen explorations. No adverse effects occurred after USPIO infusion.Conclusion: MRI+USPIO identified the majority of mediastinal and celiac (suspect) lymph nodes in 9 patients with oesophageal cancer. MRI+USPIO could have an additional value in loco-regional staging; however, more supplementary research is needed.

The number of pathologic lymph nodes involved is still a significant prognostic factor even after neoadjuvant chemoradiotherapy in esophageal squamous cell carcinoma

“…The recent TNM system includes the number of involved LNs, which is in line with our findings and those of many others. However, despite the recent advances in diagnostic tools, such as PET‐CT and MRI systems 29, 30, even in the cases without adjuvant therapy, it is often difficult to determine the correct number of positive LNs by only clinical evaluation, and this fact may cause a large discrepancy between the clinical and pathologic LN status. Since the importance of the metastatic LNs has been demonstrated, it is now necessary to develop another useful modality to precisely detect involved LNs as early as possible in order to more accurately predict a patient's prognosis, and provide more aggressive treatments for those considered to have a poorer prognosis.…”

Detecting Metastasis of Lymph Nodes and Predicting Aggressiveness in Patients With Breast Carcinomas

“…Computed tomography, MRI, and positron emission tomography are currently available for evaluation of axillary LN involvement. 17 However, even with multidetector row computed tomography and contrast-enhanced MRI, depiction of LNs smaller than 1 cm remains nearly impossible. 18 Positron emission tomography appears to be an important modality for assessing tumor viability, evaluating axillary staging, and detecting distant Values are mean ± SD.…”

Superparamagnetic Iron Oxide Nanoparticles in Biomedicine: Applications and Developments in Diagnostics and Therapy

“…Due to the longer circulation time of dextran-coated USPIO as a result of the lower accumulation in the RES of the liver and spleen and the small size of USPIO compared to SSPIO, these can exit the vascular system after intravenous application (extravasation), are transported lymphogenically, and are absorbed physiologically in the lymph nodes by macrophages, resulting in a signal loss of the lymph nodes in T2w and in particular T2*w gradient echo sequences. Depending on the extent of the lymph node invasion, metastatic lymph nodes exhibit this signal loss only partially or not at all as could be shown in clinical studies in carcinomas of the head-neck [73], breast [74], bronchus [75], esophagus [76], stomach [77], rectum [78], and in pelvic/urological carcinomas [79], and can therefore result in an improvement of the lymph node staging. However, USPIO are currently not approved for clinical application.…”