Evaluation of axillary lymph nodes by diffusion‐weighted MRI using ultrasmall superparamagnetic iron oxide in patients with breast cancer: Initial clinical experience

Abstract

Purpose: To investigate the diagnostic performance and clinical feasibility of diffusion-weighted magnetic resonance imaging (MRI) using ultrasmall superparamagnetic iron oxide (USPIO) in the evaluation of axillary lymph nodes (ALNs) in patients with breast cancer. Materials and Methods:Sixteen patients with known breast cancer underwent 1.5 T MRI. Axial diffusionweighted images (DWIs) and conventional T1-and T2*-weighted images (CIs) were acquired before and 24-36 hours after intravenous administration of USPIO. Detection of ALNs was evaluated on DWIs in comparison with CIs. The apparent diffusion coefficient values (ADCvs) of the nonmetastatic and metastatic nodes in precontrast DWIs were determined. The diagnostic performance of DWI using USPIO was compared with that of CIs using USPIO with pathological correlation.Results: Out of a total of 286 ALNs, 216/286 (76%) nodes were detected on DWIs and 238/286 (83%) on CIs. The differences in the ADCvs between metastatic and nonmetastatic nodes were not significant (P ¼ 0.06). Sensitivity of CIs and DWIs using USPIO were respectively 70% and 83%, specificity 98% and 98%, and overall accuracy 93% and 95%.Conclusion: Although the detection on DWIs of ALNs in patients with breast cancer was inferior compared to CIs, the sensitivity and accuracy of DWIs using USPIO were superior in the diagnosis of ALNs metastasis.

Development of nanotheranostics against metastatic breast cancer — A focus on the biology & mechanistic approaches

“…Sentinel Lymph Node (SLN) biopsy are invasive conventional imaging technique for lymph node metastasis with many side effects such as morbidity, infection and chronic pain in patients. On the contrary, use of SPION in SLN is less invasive and can differentiate the healthy and metastatic lymph nodes by decreasing the signal intensity (negative contrast) in the non-metastatic lymph nodes (Harada et al, 2007; A C C E P T E D M A N U S C R I P T Motomura et al, 2011;Nakai et al, 2011;Zhang F et al, 2013). USPIO based post contrast MR imaging has been found to be highly effective in detecting metastatic lymph nodes of axilla region even in stage II and III breast cancer patients when compared to conventional MR imaging (Harada et al, 2007).…”

“…Detection of lymph node metastasis is crucial in staging breast tumor and for determining adjuvant therapy for the cancer patients (Nakai et al, 2011;Zhang F et al, 2013). Sentinel Lymph Node (SLN) biopsy are invasive conventional imaging technique for lymph node metastasis with many side effects such as morbidity, infection and chronic pain in patients.…”

Nonmalignant Breast Lesions: ADCs of Benign and High-Risk Subtypes Assessed as False-Positive at Dynamic Enhanced MR Imaging

“…For a subset of 30 consecutive lesions, the average absolute difference between the analysis dataset (SP1) ADC measurements and a second measurement by the same reader (SP2) was 0.12 3 10 23 mm 2 / (19,40,41) suggest that papillomas and lymph nodes are two benign lesion types that frequently show restricted diffusion; this is attributed to their higher cellularity. This was confirmed by our findings, with the majority of papillomas and all lymph nodes in our study exhibiting ADCs below the ADC threshold.…”

Supine MRI for regional breast radiotherapy: imaging axillary lymph nodes before and after sentinel-node biopsy

“…The numbers in our study, ranging from 14 to 42 on MRI, fall within the expected range of 6-45 LNs, based on previous imaging (MRI, CT, and ultrasonography) and histological studies on LNs (Jiang et al 2007, Luciani et al 2009, MacDonald et al 2010, Korteweg et al 2011, Nakai et al 2011, Hong et al 2012. Histological information, after axillary dissection, is limited to axillary levels I and II, while our work aimed to image LNs in axillary levels I-IV.…”