Pre- and post-magnetic resonance imaging features of suspicious internal mammary lymph nodes in breast cancer patients receiving neo-adjuvant therapy: Are any imaging features predictive of malignancy?

Patel, Shalin; Delikat, Amber; Liao, Jason; Chetlen, Alison L.

doi:10.1111/tbj.13102

Cited by 8 publications

(11 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Many studies (5,7) show that the size of the IMLN is an important indicator for diagnosing metastasis. Compared with ALN, the threshold of IMLN for diagnosing L/S ratio = long axis length/short axis length ratio.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple IMLNs contribute to the diagnosis of IMLN metastasis, and the difference between the metastatic group and a non-metastatic group is significant. Patel et al (7) reported that metastasis could be diagnosed when two or more IMLNs appeared on MRI and the short diameter was ≥6 mm. This also demonstrated the significance of the number of IMLNs for the diagnosis of IMLN metastasis.…”

Section: Discussionmentioning

confidence: 99%

“…However, the low spatial resolution of PET/ CT limits the diagnosis of small nodal metastases (6). Patel et al reported that metastatic IMLNs should be considered when more than two ipsilateral IMLNs measuring 6 mm or greater are seen on diagnostic MRI in a patient with newly diagnosed BC (7). Meanwhile, another study by Segaert et al compared the sensitivity of PET-CT with that of contrast-enhanced CT (8), reporting a 100% sensitivity and 85% specificity for PET-CT and a sensitivity of 67% for contrast-enhanced CT.…”

Section: Original Articlementioning

confidence: 99%

See 2 more Smart Citations

The value of ultrasound in diagnosing metastatic internal mammary lymph nodes in preoperative breast cancer

Shi

et al. 2020

Gland Surg

View full text Add to dashboard Cite

Background: Internal mammary lymph nodes (IMLNs) metastasis is of great significance for patients with breast cancer (BC), but the diagnosis of metastasis is difficult. The purpose of this study was to explore the characteristics of metastatic internal mammary lymph nodes visualized on breast ultrasound (US) in preoperative breast cancer.Methods: Between March 2014 and May 2020, a total of 278 patients with primary BC were enrolled in a retrospective study and were divided into a metastatic group (n=224) and a non-metastatic group (n=54) according to IMLN status. Medical records, US findings, and especially IMLN status (long and short diameter, cortical thickness, blood flow) were reviewed, analyzed, and correlated with pathologic results.Results: There were significant differences in long diameter, short diameter, numbers, intercostal space (ICS) distribution, and structure type of IMLN between the two groups (P<0.05), but no statistical difference in the ratio of long to short diameter and blood flow (P>0.05). The best cutoff values of size for differentiating IMLN metastasis from benign LNs were 10.5 mm (long diameter), 4.5 mm (short diameter), and 1.9 mm (cortical thickness), with sensitivities of 62.9%, 71.4%, and 91.4%, respectively and specificities of 90.7%, 77.8%, and 86.7%, respectively. The sensitivity and specificity of long and short diameter combined with structure type of IMLN were 74.1% and 83.3%, respectively. Conclusions:US is an important tool to evaluate the status of IMLN in patients with BC. US features of metastatic IMLNs include thickened cortex (≥1.9 mm), absent fatty hilum, multiple (n≥2). The size (long or short diameter) combined with structural types of IMLN had good efficacy for diagnosing IMLN metastasis.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Original Articlementioning

confidence: 99%

See 1 more Smart Citation

The value of ultrasound in diagnosing metastatic internal mammary lymph nodes in preoperative breast cancer

Shi

et al. 2020

Gland Surg

View full text Add to dashboard Cite

show abstract

“…If applicable, morphologic features for the diagnosis of axillary and supraclavicular lymph node metastases were as follows: (a) short-axis diameter > 10 mm, (b) irregular margin, (c) inhomogeneous cortex, (d) perifocal edema, (e) absent fatty hilum, (f) asymmetry in comparison to contralateral site, (g) contrast media enhancement in comparison to surrounding and to contralateral lymph nodes, and (h) blurred nodal border. Lymph nodes in internal mammary chain were rated suspicious, when 2 or more lymph nodes were > 6 mm [ 21 ] or when increased tracer uptake was observed. In PET/MRI, in addition to the previously mentioned morphologic criteria, a tracer uptake above the direct background and the surrounding lymph nodes was considered a sign of malignancy.…”

Section: Methodsmentioning

confidence: 99%

Comparison of nodal staging between CT, MRI, and [18F]-FDG PET/MRI in patients with newly diagnosed breast cancer

Morawitz

Bruckmann

Dietzel

et al. 2021

Eur J Nucl Med Mol Imaging

View full text Add to dashboard Cite

Purpose To compare CT, MRI, and [18F]-fluorodeoxyglucose positron emission tomography ([18F]-FDG PET/MRI) for nodal status, regarding quantity and location of metastatic locoregional lymph nodes in patients with newly diagnosed breast cancer. Materials and methods One hundred eighty-two patients (mean age 52.7 ± 11.9 years) were included in this prospective double-center study. Patients underwent dedicated contrast-enhanced chest/abdomen/pelvis computed tomography (CT) and whole-body ([18F]-FDG PET/) magnet resonance imaging (MRI). Thoracal datasets were evaluated separately regarding quantity, lymph node station (axillary levels I–III, supraclavicular, internal mammary chain), and lesion character (benign vs. malign). Histopathology served as reference standard for patient-based analysis. Patient-based and lesion-based analyses were compared by a McNemar test. Sensitivity, specificity, positive and negative predictive values, and accuracy were assessed for all three imaging modalities. Results On a patient-based analysis, PET/MRI correctly detected significantly more nodal positive patients than MRI (p < 0.0001) and CT (p < 0.0001). No statistically significant difference was seen between CT and MRI. PET/MRI detected 193 lesions in 75 patients (41.2%), while MRI detected 123 lesions in 56 patients (30.8%) and CT detected 104 lesions in 50 patients, respectively. Differences were statistically significant on a lesion-based analysis (PET/MRI vs. MRI, p < 0.0001; PET/MRI vs. CT, p < 0.0001; MRI vs. CT, p = 0.015). Subgroup analysis for different lymph node stations showed that PET/MRI detected significantly more lymph node metastases than MRI and CT in each location (axillary levels I–III, supraclavicular, mammary internal chain). MRI was superior to CT only in axillary level I (p = 0.0291). Conclusion [18F]-FDG PET/MRI outperforms CT or MRI in detecting nodal involvement on a patient-based analysis and on a lesion-based analysis. Furthermore, PET/MRI was superior to CT or MRI in detecting lymph node metastases in all lymph node stations. Of all the tested imaging modalities, PET/MRI showed the highest sensitivity, whereas CT showed the lowest sensitivity, but was most specific.

show abstract

“…Then, the center points of IM-SLNs were transferred from the SPECT/CT fusion images onto corresponding anatomical positions of the representative CT images. Previous studies have indicated that the average size of the IM-SLNs was 5 mm (17)(18)(19). All imaging IM-SLNs were plotted with a diameter of 5 mm, and named IM-SLN 5mm.…”

Section: Im-sln Delineationmentioning

confidence: 99%

Definition of Internal Mammary Node Target Volume Based on the Position of the Internal Mammary Sentinel Lymph Nodes Presented on SPECT/CT Fusion Images

Wang

et al. 2020

Front. Oncol.

View full text Add to dashboard Cite

Purpose: Mapping the distribution of internal mammary sentinel lymph nodes (IM-SLNs) presented on single photon emission computed tomography in conjunction with computed tomography (SPECT/CT) images to explore the value of IM-SLN to guide tailored clinical target volume (CTV) delineation of postoperative prophylactic IMNI. Materials and methods: Ninety-seven patients who underwent preoperative lymphoscintigraphy by SPECT/CT and had imaging of IM-SLN were selected in this study. The imaging IM-SLNs on SPECT/CT of eligible patients were projected onto corresponding anatomical positions of a representative axial CT image. The IMN CTVs were delineated on the representative axial CT images according to the Radiation Therapy Oncology Group (RTOG) and Danish Breast Cancer Cooperative Group (DBCG) guideline, and defined as CTV RTOG and CTV DBCG. The location of the IM-SLNs was compared with the RTOG and DBCG guidelines of IMN target volume delineations, respectively. The intercostal space distribution of IM-SLNs was recorded. The distances from the CTV RTOG and CTV DBCG to the IM-SLNs were measured, respectively. Results: The total number of imaging IM-SLNs was 136. IM-SLNs were mostly found in the first intercostal space (40.4%), with 30.2, 24.3, 4.4, and 0.7% of IM-SLNs in the second, third, fourth, and fifth intercostal space, respectively. The average distance from the edge of the CTV RTOG and the edge of CTV DBCG to the central points of the IM-SLNs was 4.10 mm (SD, 3.3 mm) and 1.60 mm (SD, 2.6 mm), respectively (t = 16.640, P = 0.000). The average distance from the edge of CTV RTOG and the edge of CTV DBCG to the lateral border IM-SLN was 6.40 mm (SD, 3.5 mm) and 3.34 mm (SD, 3.3 mm), respectively (t = 19.815, P = 0.000). Only 18.4% of IM-SLN central points were included in the CTV RTOG , and 60.3% of IM-SLN central points were included in the CTV DBCG. When covering 90 and 100% of the IM-SLN center points, the CTV RTOG needs to expand 8 and 15 mm, respectively, and the CTV DBCG needs to expand 5 and 13 mm, respectively.

show abstract

Pre- and post-magnetic resonance imaging features of suspicious internal mammary lymph nodes in breast cancer patients receiving neo-adjuvant therapy: Are any imaging features predictive of malignancy?

Cited by 8 publications

References 10 publications

The value of ultrasound in diagnosing metastatic internal mammary lymph nodes in preoperative breast cancer

The value of ultrasound in diagnosing metastatic internal mammary lymph nodes in preoperative breast cancer

Comparison of nodal staging between CT, MRI, and [18F]-FDG PET/MRI in patients with newly diagnosed breast cancer

Definition of Internal Mammary Node Target Volume Based on the Position of the Internal Mammary Sentinel Lymph Nodes Presented on SPECT/CT Fusion Images

Contact Info

Product

Resources

About