Dynamic contrast‐enhanced and diffusion‐weighted MRI of invasive breast cancer for the prediction of sentinel lymph node status

Abstract

Background Although sentinel lymph node biopsy (SLNB) is the current standard for identifying lymph metastasis in breast cancer patients, there are complications of SLNB. Purpose To evaluate preoperative dynamic contrast‐enhanced magnetic resonance imaging (DCE‐MRI) and diffusion‐weighted imaging (DWI) of invasive breast cancer for predicting sentinel lymph node metastasis. Study Type Retrospective. Population In all, 309 patients who underwent clinically node‐negative invasive breast cancer surgery Field Strength/Sequence 3.0T, DCE‐MRI, DWI. Assessment We collected clinicopathologic variables (age, histologic and nuclear grade, extensive intraductal carcinoma component, lymphovascular invasion, and immunohistochemical profiles) and preoperative MRI features (tumor size, background parenchymal enhancement, internal enhancement, adjacent vessel sign, whole‐breast vascularity, initial enhancement pattern, kinetic curve types, quantitative kinetic parameters, tumoral apparent diffusion coefficient [ADC], peritumoral maximal ADC, and peritumoral‐tumoral ADC ratio). Statistical Tests Multivariate logistic regressions were performed to determine independent variables associated with SLN metastasis, and the area under the receiver operating characteristic curve (AUC) was analyzed for those variables. Results 41 (13.3%) of the patients showed SLN metastasis. With MRI, tumor size (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.06–1.17), heterogeneous (OR, 5.33; 95% CI, 1.71–16.58), and rim (OR, 15.54; 95% CI, 2.12–113.72) enhancement and peritumoral–tumoral ADC ratio (OR, 72.79; 95% CI, 7.15–740.82) were independently associated with SLN metastasis. Clinicopathologic variables independently associated with SLN metastasis included age (OR, 0.96; 95% CI, 0.92–0.99) and CD31 (OR, 2.90; 95% CI, 1.04–8.92). The area under the curve (AUC) of MRI features (0.80; 95% CI, 0.73–0.87) was significantly higher than for clinicopathologic variables (0.68; 95% CI, 0.60–0.77; P = 0.048) and was barely below statistical significance for combined MRI features with clinicopathologic variables (0.84; 95% CI 0.78–0.90, P = 0.057). Data Conclusion Preoperative internal enhancement on DCE‐MRI and peritumoral‐tumoral ADC ratio on DWI might be useful for predicting SLN metastasis in patients with invasive breast cancer. Level of Evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:615–626.

Radiomics Based on T2-Weighted Imaging and Apparent Diffusion Coefficient Images for Preoperative Evaluation of Lymph Node Metastasis in Rectal Cancer Patients

“…It can provide more metabolic and biological information than conventional imaging methods (17). Previous studies have shown that radiomic features derived from MRI or computed tomography (CT) data have the potential to predict LN metastasis in such malignancies as breast cancer, cervical cancer, and bladder cancer (18)(19)(20). For the rectal cancer, some previous studies demonstrated that the histogram features from T2-weighted imaging (T2WI) and the texture features from apparent diffusion coefficient (ADC) maps can help predict lymph node metastasis (21,22).…”

Recent Radiomics Advancements in Breast Cancer: Lessons and Pitfalls for the Next Future

“…In the published literature to date [ 6 , 76 , 77 , 78 , 80 , 81 , 82 , 83 , 84 , 85 ] radiomics has been found to have moderate to good diagnostic accuracy for the determining the nodal status (AUC 0.60–0.90) in patients with BC.…”

“…In some studies [ 6 , 81 , 82 , 83 ], the prediction using a combination of radiomics features and clinical risk factors led to further improvement in the identification of nodal status. Particularly, Dong et al [ 82 ] showed how radiomics features extracted from DWI sequences were highly correlated with ALN metastases than those extracted from ADC.…”

Quantitative Three-Dimensional Assessment of the Pharmacokinetic Parameters of Intra- and Peri-tumoural Tissues on Breast Dynamic Contrast-Enhanced Magnetic Resonance Imaging

“…In addition to the tissue concentrations over time, the quantitative kinetic parameters were also extracted from the TICs. The initial percentage enhancement (E 1 ), peak percentage enhancement (E peak ), and signal enhancement ratio (SER) were calculated as follows [27]:…”

“…Most DCE-MRI studies have focused on measuring the intra-tumoural and background parenchymal features in individual two-dimensional (2D) slices with manually drawn ROIs [12][13][14]. More recently, it has been suggested that features extracted from peri-tumoural tissues could offer additional markers by reflecting angiogenic activity [15].…”