A new, preoperative, MRI-based scoring system for diagnosing malignant axillary lymph nodes in women evaluated for breast cancer

He, Ningning; Xie, Conghua; Wei-dong, Wang; Pan, Ci; Wang, Wenyan; Lv, Ning; Wu, Peihong

doi:10.1016/j.ejrad.2012.03.019

Cited by 60 publications

(54 citation statements)

References 17 publications

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“…While new approaches for evaluating the axilla directly on MRI may hold promise to assess presence of nodal metastases (25–27), our results show MRI imaging of the axilla is currently of limited value for predicting extensive nodal disease in patients who are candidates for sentinel lymph node biopsy. However, enhancement data from the primary tumor appear to hold predictive value for the presence of additional nodal disease beyond the sentinel lymph node.…”

Section: Discussionmentioning

confidence: 80%

Preoperative MRI Improves Prediction of Extensive Occult Axillary Lymph Node Metastases in Breast Cancer Patients with a Positive Sentinel Lymph Node Biopsy

et al. 2014

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Rationale and Objectives To test the ability of quantitative measures from preoperative Dynamic Contrast Enhanced MRI (DCE-MRI) to predict, independently and/or with the Katz pathologic nomogram, which breast cancer patients with a positive sentinel lymph node biopsy will have ≥ 4 positive axillary lymph nodes upon completion axillary dissection. Methods and Materials A retrospective review was conducted to identify clinically node-negative invasive breast cancer patients who underwent preoperative DCE-MRI, followed by sentinel node biopsy with positive findings and complete axillary dissection (6/2005 – 1/2010). Clinical/pathologic factors, primary lesion size and quantitative DCE-MRI kinetics were collected from clinical records and prospective databases. DCE-MRI parameters with univariate significance (p < 0.05) to predict ≥ 4 positive axillary nodes were modeled with stepwise regression and compared to the Katz nomogram alone and to a combined MRI-Katz nomogram model. Results Ninety-eight patients with 99 positive sentinel biopsies met study criteria. Stepwise regression identified DCE-MRI total persistent enhancement and volume adjusted peak enhancement as significant predictors of ≥4 metastatic nodes. Receiver operating characteristic (ROC) curves demonstrated an area under the curve (AUC) of 0.78 for the Katz nomogram, 0.79 for the DCE-MRI multivariate model, and 0.87 for the combined MRI-Katz model. The combined model was significantly more predictive than the Katz nomogram alone (p = 0.003). Conclusion Integration of DCE-MRI primary lesion kinetics significantly improved the Katz pathologic nomogram accuracy to predict presence of metastases in ≥ 4 nodes. DCE-MRI may help identify sentinel node positive patients requiring further localregional therapy.

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Section: Discussionmentioning

confidence: 80%

Preoperative MRI Improves Prediction of Extensive Occult Axillary Lymph Node Metastases in Breast Cancer Patients with a Positive Sentinel Lymph Node Biopsy

et al. 2014

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“…To date there is only one published study evaluating its ability to evaluate axillary lymph nodes in patients with newly diagnosed breast cancer, which reported ADC values were significantly lower in metastatic versus benign axillary nodes 98 . However, our own work investigating ADC for discriminating nodes deemed suspicious on conventional breast MRI has not reproduced these findings 99 .…”

Section: Potential Clinical Applicationsmentioning

confidence: 99%

Diffusion Weighted Magnetic Resonance Imaging of the Breast

Partridge

McDonald

2013

Magnetic Resonance Imaging Clinics of North America

151

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Synopsis There has been increasing interest in the use of diffusion weighted MRI (DWI) for breast imaging. This technique has shown promise for improving the positive predictive value of breast MRI for detection of breast cancer, evaluating tumor response to neoadjuvant chemotherapy, and as a non-contrast MRI alternative for breast cancer screening. However, there is currently no standardized approach to DWI of the breast and data quality varies widely. Prior to implementing DWI into clinical practice, it is important to understand the pertinent technical considerations and current evidence of clinical applications of DWI of the breast. This article provides an overview of basic principles of DWI, optimization of breast DWI protocols, imaging features of benign and malignant breast lesions, promising clinical applications, and potential future directions.

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“…Mortellaro et al found a significant association of the presence of any axillary node without a fatty hilum on MRI with the presence of ALN metastases (18). While that study found no associations of kinetic features with ALN positivity, two separate studies reported significant correlations of metastatic ALNs with rapid initial phase enhancement (Kvistad et al) and the presence of delayed washout (Kvistad et al and He et al) (4, 17). In further support of the use of MRI for axillary staging, Baltzer and colleagues applied a combination of MRI parameters including lymph node morphology (irregular margins, cortical nodularity or thickening, replaced fatty hilum, and rim enhancement) and presence of asymmetry and peri-nodal edema to develop a model to predict the presence of ALN metastases (19).…”

Section: Discussionmentioning

confidence: 84%

“…In further support of the use of MRI for axillary staging, Baltzer and colleagues applied a combination of MRI parameters including lymph node morphology (irregular margins, cortical nodularity or thickening, replaced fatty hilum, and rim enhancement) and presence of asymmetry and peri-nodal edema to develop a model to predict the presence of ALN metastases (19). Several additional recent studies have found that DW MRI also may provide useful quantitative measurements to aid in the identification of malignant ALNs through ADC calculations (4, 20), with Scaranelo et al reporting an 85% accuracy with DW MRI assessment of ALNs in patients newly diagnosed with breast cancer (8). …”

Section: Discussionmentioning

confidence: 99%

“…Several recent studies have suggested breast magnetic resonance imaging (MRI) features of ALNs (4–8) and breast primary malignancies (9) may hold promise to confirm presence or absence of metastatic ALNs. Since breast MRI is increasingly being used at centers for preoperative evaluation of patients newly diagnosed with breast cancer, this potential added benefit is appealing (10, 11).…”

Section: Introductionmentioning

confidence: 99%

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Suspicious Axillary Lymph Nodes Identified on Clinical Breast MRI in Patients Newly Diagnosed with Breast Cancer

et al. 2015

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Rationale and Objectives To determine whether quantitative dynamic contrast-enhanced (DCE) and diffusion-weighted (DW) MRI features can discriminate malignant from benign axillary lymph nodes (ALNs) identified as suspicious on clinical breast MRI in patients newly diagnosed with breast cancer. Materials and Methods After IRB approval, all clinical breast MR examinations performed from March 2006 through January 2010 describing at least one morphologically suspicious ipsilateral ALN in patients with newly diagnosed breast cancer were identified. Each suspicious ALN underwent ultrasound-guided core needle biopsy, and nodes with benign results were subsequently sampled surgically. Quantitative DCE and DW MRI parameters (diameters, volume, enhancement kinetics, and apparent diffusion coefficients [ADC]) were measured for each suspicious ALN and a representative contralateral normal node, and each feature was compared between the ALN groups (normal, benign, malignant). Results Thirty-four suspicious ALNs (18 malignant, 16 benign) and 34 contralateral normal-appearing ALNs were included. Suspicious malignant and benign nodes exhibited larger size, greater volume, and lower ADCs than normal ALNs (p<0.05). Among suspicious ALNs, the only quantitative measure that discriminated between malignant from benign outcome was percent of ALN demonstrating washout kinetics (p=0.02). Conclusion In ALNs deemed morphologically suspicious on breast MRI, quantitative MRI features show little value in identifying those with malignant etiology.

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A new, preoperative, MRI-based scoring system for diagnosing malignant axillary lymph nodes in women evaluated for breast cancer

Abstract: Metastatic axillary lymph nodes can be accurately diagnosed by MR in women with early breast cancer preoperatively and non-invasively. The scoring system appears to be superior to current methods.

Cited by 60 publications

References 17 publications

Preoperative MRI Improves Prediction of Extensive Occult Axillary Lymph Node Metastases in Breast Cancer Patients with a Positive Sentinel Lymph Node Biopsy

Preoperative MRI Improves Prediction of Extensive Occult Axillary Lymph Node Metastases in Breast Cancer Patients with a Positive Sentinel Lymph Node Biopsy

Diffusion Weighted Magnetic Resonance Imaging of the Breast

Suspicious Axillary Lymph Nodes Identified on Clinical Breast MRI in Patients Newly Diagnosed with Breast Cancer

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