Dynamic contrast‐enhanced magnetic resonance imaging and invasive breast cancer: Primary lesion kinetics correlated with axillary lymph node extracapsular extension

Abstract

Purpose: To determine if dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) peak enhancement (PE) of primary breast cancer can predict the presence of lymph node extracapsular extension (LNECE) in patients with axillary metastatic disease. Materials and Methods:In all, 167 patients treated with radiotherapy for invasive breast cancer from January 1, 2006 to November 1, 2007 were retrospectively identified. Patients with DCE-MRI and surgical axillary staging were included in this study. PE of primary tumors was compared according to axillary nodal status: negative, positive without LNECE, or positive with LNECE. A receiver operator characteristic curve (ROC) was plotted to determine accuracy of PE to predict LNECE.Results: Forty-six patients met the study criteria. Thirtytwo (70%) were node-negative, 9 (19%) were node-positive without LNECE, and 5 (11%) were node-positive with LNECE. PE was greater for patients with LNECE (mean 365%) compared to node-positive patients without LNECE (mean 183%) P ¼ 0.05 and node-negative patients (mean 144%) P ¼ 0.0012. Area under the ROC curve was 0.93.Conclusion: DCE-MRI PE may be a surrogate marker for LNECE. If validated, DCE-MRI may provide noninvasive kinetic information informing axillary nodal status for patients who receive chemotherapy prior to surgical axillary staging or forego axillary dissection after a positive sentinel node biopsy.

Identification of Intrinsic Imaging Phenotypes for Breast Cancer Tumors: Preliminary Associations with Gene Expression Profiles

“…The selection frequency of the features in the leave-one-out cross validation indicates the importance of considering the phenotype categories in the prediction of breast cancer recurrence, as they are consistently selected by our model in all cross-validation loops. In addition, the selection frequency of the heterogeneity kinetic statistic features largely outperforms the standard aggregate kinetic measures (9,31–33), such as maximum peak enhancement, hot spot signal enhancement ratio, and features from the characteristic kinetic curve, which suggests that more comprehensive characterization of spatial tumor heterogeneity from imaging can ultimately result in better prognostic imaging markers.…”

“…The following kinetic features were extracted: maximum peak enhancement (33), peak enhancement, wash-in slope, washout slope, and time to peak (TTP) of the characteristic kinetic curve (31,32) and the hot spot signal enhancement ratio (34). …”

Predicting axillary lymph node metastasis from kinetic statistics of DCE-MRI breast images

“…3,7 However, surgical interrogation of axillary nodes is considerably invasive and can result in arm stiffness, pain, decreased mobility, and lymphedema. 3,6 Additionally, with the recent publication of Z0011 trial from the American College of Surgeons Oncology Group (ACOSOG), 8 the value of a completion axillary node dissection has been questioned as there was no significant difference in survival or disease free survival in women who underwent axillary node dissection after 1-2 positive sentinel nodes versus those women who did not. A non-invasive method for accurate assessment of nodal involvement would be a significant aid in making breast cancer treatment decisions.…”

“…However, there has been relatively less work in the literature that uses DCE-MRI for diagnostic evaluation of axillary lymph node metastasis. A representative work along this line is, 6 in which the authors use the maximum peak enhancement (MPE) of the primary lesion to predict axillary node extracapsular extension. DCE MRI kinetic features that represent the properties of contrast agent uptake by the tissue have been shown to be associated with tumor characterization.…”

“…[1][2][3] For post-mastectomy patients with axillary node metastasis, radiation therapy has been shown to result in improved disease free and overall survival. [4][5][6] Surgical assessment of the axilla either with axillary node dissection or sentinel node biopsy remains the gold standard for the assessment of nodal status. 3,7 However, surgical interrogation of axillary nodes is considerably invasive and can result in arm stiffness, pain, decreased mobility, and lymphedema.…”