Performance of breast magnetic resonance imaging in axillary nodal staging in newly diagnosed breast cancer patients

Abstract

Purpose: To determine the diagnostic value of breast magnetic resonance imaging (MRI) in detecting axillary metastatic node in newly diagnosed breast cancer, we assessed the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of breast MRI. Material and methods: Data were collected retrospectively from January 2011 to December 2018. Preoperative breast MRI of women with newly diagnosed breast cancer were reviewed to evaluate the axillary nodal staging by using the morphological characteristic of metastatic axillary lymph node. Statistical analysis was performed to assess the performance of breast MRI in diagnosing metastatic axillary lymph nodes based on the pathological result. Results: A total of 131 women with breast cancer were analysed. Two hundred and twenty-seven axillary lymph nodes from preoperative breast MRIs were considered to be metastasis. 65.65% (86 patients) of the breast MRI results matched with the pathological results: 37 patients with N0 stage, 39 patients with N1 stage, eight patients with N2 stage, and two patients with N3 stage. Sensitivity of breast MRI for axillary nodal staging was 98.5% (95% CI: 92-100%), and the negative predictive value was 96.4% (86.2-99.9%). Specificity of breast MRI for axillary nodal staging was 57.8% (44.8-70.1%) and the positive predictive value was 71% (60.6-79.9%). Conclusions: Our study showed that the breast MRI had a high sensitivity (98.5%) and high NPV (96.4%) in detecting metastatic axillary lymph nodes, but its specificity was only fair (57.8%). Overestimation and underestimation of the MRI in N staging were also found in 20.61% and 12.98% of cases, respectively.

Prediction of Metastasis in the Axillary Lymph Nodes of Patients With Breast Cancer: A Radiomics Method Based on Contrast-Enhanced Computed Tomography

“…In particular, breast MRI, which is widely used in the preoperative assessment of ALN status in breast cancer patients, exhibits better performance than some other techniques such as US and mammography (26). Compared with CT, MRI and PET/CT display improved sensitivity and specificity in the assessment of ALNM, with the sensitivities ranging from 47.1-98.5% and 48.1-85.7% and the specificities ranging from 57.8-98.0% and 61.5-94.7%, respectively (27)(28)(29)(30)(31)(32). However, the diagnostic accuracy of MRI and PET/CT varies depending on the study.…”

MRI‐based predictive factors of axillary lymph node status in breast cancer

“…For example, when reviewing the MRI of 99 patients, Ren et al found a specificity of 79.3% ± 5.1%, sensitivity of 92.1% ± 2.9%, PPV of 76.9% ± 4.0%, and NPV of 93.3% ± 1.9% 27 . While findings of a series of 131 patients were different, sensitivity of breast MRI for axillary nodal staging was 98.5% (95% confidence interval [CI]: 92‐100%), NPV was 96.4% (95% CI: 86.2‐99.9%), specificity of breast MRI for axillary nodal staging was 57.8% (95% CI: 44.8‐70.1%) and PPV was 71% (95% CI: 60.6‐79.9%) 28 . However, a previous meta‐analysis concluded that MRI is an effective method to differentiate metastatic ALN in BC patients with high sensitivity of 0.77 (95% CI: 0.75‐0.80) and specificity of 0.90 (95% CI 0.89‐0.91) 29 …”

Diagnostic Value of Axillary Ultrasound, MRI, and ¹⁸F-FDG-PET/ CT in Determining Axillary Lymph Node Status in Breast Cancer Patients

“…In the daily practice of our clinic, AUS is routinely performed in the evaluation of axillary metastasis in patients with breast cancer. MRI is used to evaluate whether breast cancer is multicentric or not, and especially 18 F-FDG-PET/CT is used in the evaluation of distant metastasis. Of the 528 patients, a total of 336 patients who…”

“…The aim of our study was to evaluate the diagnostic value of axillary ultrasound (AUS), magnetic resonance imaging (MRI), and 18 F-fluorodeoxyglucose-positron emission tomography/computed tomography ( 18 F-FDG-PET/CT) in determining ALN status in breast cancer patients with and without neoadjuvant chemotherapy compared to the golden standard of pathohistological or cytologic findings.…”

“…underwent AUS, MRI, and 18 F-FDG-PET/CT imaging were included. Patients who did not receive the AUS, MRI, or 18 F-FDG-PET/CT imaging modalities and whose ALNs were not confirmed histo-or cyto-pathologically by FNAC, SLNB, or ALND were not included in the study. Patients with distant metastases at the time of diagnosis were also excluded.…”