Diagnostic Performance of Dedicated Axillary T2- and Diffusion-weighted MR Imaging for Nodal Staging in Breast Cancer

Schipper, Robert-Jan; Paiman, Elisabeth H.M.; Beets‐Tan, Regina G. H.; Nelemans, Patricia J.; Vries, Bart de; Heuts, E. M.; Vijver, Koen K. Van de; Keymeulen, Kristien; Brans, Boudewijn; Smidt, Marjolein L.; Lobbes, Marc

doi:10.1148/radiol.14141167

Cited by 55 publications

(56 citation statements)

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“…T 2 W images are often clinically used to detect lesions and to reveal the cystic architecture within a lesion; radiomic signatures derived by T 2 WI have been shown to be predictive of pathological response to neoadjuvant chemotherapy in breast cancer patients . DWI is used less in radiomic studies, possibly due to its low spatial resolution and image quality …”

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confidence: 99%

Differentiating axillary lymph node metastasis in invasive breast cancer patients: A comparison of radiomic signatures from multiparametric breast MR sequences

Chai

et al. 2019

Magnetic Resonance Imaging

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Background The axillary lymph node status is critical for breast cancer staging and individualized treatment planning. Purpose To assess the effect of determining axillary lymph node (ALN) metastasis by breast MRI‐derived radiomic signatures, and compare the discriminating abilities of different MR sequences. Study Type Retrospective. Population In all, 120 breast cancer patients, 59 with ALN metastasis and 61 without metastasis, all confirmed by pathology. Field Strength/Sequence 3 .0T scanner with T1‐weighted imaging, T2‐weighted imaging, diffusion‐weighted imaging, and dynamic contrast‐enhanced (DCE) sequences. Assessment Typical morphological and texture features of the segmented tumor were extracted from four sequences, ie, T1WI, T2WI, DWI, and the second postcontrast phase (CE2) of the dynamic contrast‐enhanced sequences. Additional contrast enhancement kinetic features were extracted from all DCE sequences (one pre‐ and seven postcontrast phases). Linear discriminant analysis classifiers were built and compared when using features from an individual sequence or the combination of the sequences in differentiating the ALN metastasis status. Statistical Tests Mann–Whitney U‐test, Fisher's exact test, least absolute shrinkage selection operator (LASSO) regression, and receiver operating characteristic analysis were performed. Results The accuracy/AUC of the four sequences was 79%/0.87, 77%/0.85, 74%/0.79, and 79%/0.85 for the T1WI, CE2, T2WI, and DWI, respectively. When CE2 was augmented by adding kinetic features, the model achieved the highest performance (accuracy = 0.86 and AUC = 0.91). When all features from the four sequences and the kinetics were combined, it did not lead to a further increase in the performance (P = 0.48). Data Conclusion Breast tumor's radiomic signatures from preoperative breast MRI sequences are associated with the ALN metastasis status, where CE2 phase and the contrast enhancement kinetic features lead to the highest classification effect. Level of Evidence 3 Technical Efficacy Stage 2 J. Magn. Reson. Imaging 2019;50:1125–1132.

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confidence: 99%

Differentiating axillary lymph node metastasis in invasive breast cancer patients: A comparison of radiomic signatures from multiparametric breast MR sequences

Chai

et al. 2019

Magnetic Resonance Imaging

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“…Several studies have investigated the features of LN on preoperative MRI that indicate metastatic infiltration . Although nodal size, cortical thickening, absent fatty hilum, irregularity, heterogeneity, matting, and asymmetry to the opposite axilla can be used to diagnose nodal metastasis, there is significant overlap between the imaging features of benign and malignant nodes.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have investigated MRI for LN assessment in breast cancer . Whereas morphology may be preserved in some LNs with metastatic infiltration, benign processes like inflammatory response may also cause significant changes in LN morphology.…”

Section: Introductionmentioning

confidence: 99%

“…To this date, there is no consensus in the literature about which MRI parameters should be used to raise suspicion. Nonetheless, the imaging features such as presence of enlargement, cortical thickening, lack of fatty hilum, irregular contours, matting, and axillary nodal asymmetry have been reported to be associated with malignant infiltration …”

Section: Introductionmentioning

confidence: 99%

“…Moreover, the investigation of LNs in breast cancer has mainly focused on the pretreatment setting and their imaging features on MRI in the postoperative period have not been fully explored. Changes in imaging features may be benign sequelae of surgery and radiation therapy, or may be related to postsurgical complications, such as infection that can be difficult to distinguish from recurrent or metastatic disease …”

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confidence: 99%

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MRI evaluation of axillary and intramammary lymph nodes in the postoperative period

et al. 2019

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Our study aimed to evaluate if breast‐conserving surgery and adjuvant treatment could affect the morphological features of axillary and intramammary lymph nodes on magnetic resonance imaging (MRI) in patients with invasive breast cancer and clinically negative axilla. In this single‐center study, we retrospectively evaluated 50 patients who had (a) breast‐conserving surgery, (b) clinically negative axilla, (c) preoperative MRI within 3 months before surgery, and (d) postoperative MRI within 12 months after surgery. Axillary and intramammary lymph nodes on postoperative MRI were identified and then compared with preoperative MRI by two breast radiologists with regards to the following: enlargement, cortical thickening, presence of fatty hilum, irregularity, heterogeneity, matting, and axillary lymph node asymmetry. Three hundred and two axillary and eight intramammary lymph nodes were evaluated. Enlargement and cortical thickening were seen in 5/50 (10%) patients in three axillary and two intramammary lymph nodes. None of the lymph nodes on postoperative MRI demonstrated occurrence of lack of fatty hilum, irregularity, heterogeneity, matting or axillary lymph node asymmetry. No evidence of recurrence was observed on 2‐year follow‐up. Lymph node enlargement and cortical thickening may be observed in a few patients in the postoperative period. Nevertheless, in patients with clinically negative axilla, these changes in morphology are often related to treatment rather than malignancy and favor short‐term follow‐up as an alternative to lymph node biopsy.

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PET/CT and MRI for Identifying Axillary Lymph Node Metastases in Breast Cancer Patients: Systematic Review and Meta‐Analysis

Zhang

Liu

Luo

et al. 2020

Magnetic Resonance Imaging

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Background: Axillary lymph node metastases (ALNM) is one of the most important prognostic factors in breast cancer. Positron emission tomography / computed tomography (PET/CT) and magnetic resonance imaging (MRI) are increasingly used to assess ALNM noninvasively. There has been no study investigating PET/CT and MRI in direct comparative studies. Purpose: To assess the diagnostic accuracy of PET/CT and MRI for ALNM in the same population of breast cancer. Study Type: Systematic review and meta-analysis. Data Source: PubMed-MEDLINE, Web of Science, Cochrane, EMBASE, and Chinese Biomedical Literature databases were searched (September 1993-January 2020) by using concerned keywords. Studies using both MRI and PET/CT as diagnostic methods were included. Eleven studies included 1203 breast cancer patients using PET/CT and 1186 patients using MRI. Field Strength: 1.5T or 3.0T. Assessment: The Quality Assessment of Diagnostic Accuracy Studies (v. 2) was used to assess the quality of the studies. Statistical Tests: A bivariate mixed-effects binary regression model was used to obtain the diagnostic performance. Metaregression analysis was conducted to investigate study heterogeneity. Results: A total of 369 articles were screened; out of these, 11 studies were included that meet the inclusion criteria. The respective pooled sensitivity and specificity values were 0.56 (95% confidence interval [CI]: 0.47-0.63) and 0.91 (95% CI: 0.87-0.93) for PET/CT and 0.55 (95% CI: 0.48-0.62) and 0.86 (95% CI: 0.82-0.89) for MRI. There was no statistically significant difference in sensitivity (P = 0.769) or specificity (P = 0.447) between PET/CT and MRI. There was no threshold effect in either of the imaging tests. The diagnostic performance of both imaging tests was affected by study design, breast cancer subtype, tumor stage, or imaging features. Data Conclusion: In the same population, PET/CT and MRI had comparable diagnostic performance for the detection of ALNM, with low sensitivity and high specificity. Level of Evidence: 3. Technical Efficacy Stage: Stage 2.

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Diagnostic Performance of Dedicated Axillary T2- and Diffusion-weighted MR Imaging for Nodal Staging in Breast Cancer

Cited by 55 publications

References 35 publications

Differentiating axillary lymph node metastasis in invasive breast cancer patients: A comparison of radiomic signatures from multiparametric breast MR sequences

Differentiating axillary lymph node metastasis in invasive breast cancer patients: A comparison of radiomic signatures from multiparametric breast MR sequences

MRI evaluation of axillary and intramammary lymph nodes in the postoperative period

PET/CT and MRI for Identifying Axillary Lymph Node Metastases in Breast Cancer Patients: Systematic Review and Meta‐Analysis

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