Evaluation of axillary lymph node status in breast cancer with MRI

Abstract

BACKGROUND: We performed a retrospective study to establish the optimal radiological criteria for axillary lymph node metastases from breast cancer by measuring all dissected nodes, and to determine whether magnetic resonance imaging (MRI) could reliably reveal axillary involvement. METHODS: Pathological findings and MRI scans of 202 patients with invasive breast cancer were reviewed. The long- and short-axis dimensions of all level I an II lymph nodes were measured microscopically, and then the long-to-short axis (L/S) ratio of each node was calculated. These parameters were compared with pathological nodal status to define radiological criteria for axillary involvement. MRI was carried out using T1-weighted spin-eho sequences in the coronal and sagittal planes. On MRI, every detected lymph node was measured and the shape ofthe nodal cortex was also examined. Then the diagnostic ability of MRI was assessed using these morphologic criteria. RESULTS: On histopathological examinations of 4043 dissected lymph nodes, a long-axis dimension of 10 mm or larger combined with a long-to-short axis ratio of less than 1.6 was the most accurate criteria for predicting lymph node metastases. On MRI, eccentric cortical hypertrophy was seen in only metastatic axillae.When these morphologic features were used as criteria for malignancy, MRI had asensi-tivity of 79%, a specificity of 93%, and an accuracy of 88%. In 16 of 17 false-negative axillae, MRI showed normally sized lymph nodes (< 10 mm). CONCLUSION: Our study indicates that MRI is a useful diagnostic method for the evaluation of axillary nodal status, but is limited in the detection of small metastatic lymph nodes.

Diagnosis of axillary nodal metastases by ultrasound-guided core biopsy in primary operable breast cancer

“…The sensitivity and specificity achieved using these techniques does not allow a reliable selection of patients for full axillary clearance or a more minimally invasive procedure. More recent advances such as dynamic contrast enhanced MRI has a sensitivity and an NPV of 100% (Yoshimura et al, 1999;Murray et al, 2002) and 2-[(18) F] fluoro-2-deoxy-Dglucose-PET has a sensitivity of 82 -95% and an NPV of 88% (Greco et al, 2001;Wahl, 2001). These two imaging modalities may be reliable in predicting the absence of nodal metastases in women with breast cancer, but these techniques are not readily available, are expensive and the results need to be confirmed in large multicentre studies.…”

IV‐DSA is a new diagnostic tool for axillary lymph node metastasis in breast cancer patients

“…MRI has been reported to have a sensitivity of 79% [5] and this might be further improved by dynamic contrast-enhanced MRI [6]. Shimizu et al [11] found that visualization of axillary lymph node metastasis by IV-DSA correlated with higher MVD within the lesion than in nonmetastatic nodes, and suggested that IV-DSA assesses the neovascularization of lymph nodes that become metastasis-positive.…”

“…A number of diagnostic imaging modalities are currently available for the evaluation of axillary node metastasis, including ultrasonography [1,2], computed tomography (CT) [3,4], and magnetic resonance imaging (MRI) [5,6], and more recently positron emission tomography (PET) has been shown to provide useful information in these patients [7]. However, none of these modalities may yet be considered to be a definitive method.…”

The Clinical Value of Hybrid Sentinel Lymphoscintigraphy to Predict Metastatic Sentinel Lymph Nodes in Breast Cancer

“…A study by Gajdos et al [25] found that main tumor size and age were independently associated with lymph node metastases. Yoshimura et al [18] studied axillary lymph node status in breast cancer patients. Of 97 axilla lymph nodes, 27 showed eccentric cortical hypertrophy, and all were pathologically malignant.…”

“…Most prior studies have predicted lymph node status by assessing the size and shape of lymph nodes [18][19][20][21]. Attempts at axillary staging by means of anatomical imaging of the axilla with CT or magnetic resonance imaging (MRI) have proved more useful than clinical examination [22].…”