Preoperative Breast Cancer Staging: MR Imaging of the Axilla with Ultrasmall Superparamagnetic Iron Oxide Enhancement

Michel, Sven; Keller, Thomas; Fröhlich, Johannes; Fink, Daniel; Caduff, Rosmarie; Seifert, Burkhardt; Marinček, Borut; Kubik‐Huch, Rahel A.

doi:10.1148/radiol.2252011605

Cited by 187 publications

(124 citation statements)

References 41 publications

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“…Its value awaits further evaluation in a large number of cases to conclude whether ADC value measurement of the nodes is helpful in differentiating metastatic from nonmetastatic nodes in breast cancer. USPIO, a lymphographic contrast medium of ironcontaining nanoparticles, has been shown to be useful in the characterization of lymph nodes in neck (7), esophageal (13), gastric (14), prostate (15), bladder (16), and breast cancers (17)(18)(19)(20). After IV injection of USPIO, the nanoparticles circulate systemically and access the interstitium.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of axillary lymph nodes by diffusion‐weighted MRI using ultrasmall superparamagnetic iron oxide in patients with breast cancer: Initial clinical experience

Nakai

Matsuki

Harada

et al. 2011

Magnetic Resonance Imaging

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Purpose: To investigate the diagnostic performance and clinical feasibility of diffusion-weighted magnetic resonance imaging (MRI) using ultrasmall superparamagnetic iron oxide (USPIO) in the evaluation of axillary lymph nodes (ALNs) in patients with breast cancer. Materials and Methods:Sixteen patients with known breast cancer underwent 1.5 T MRI. Axial diffusionweighted images (DWIs) and conventional T1-and T2*-weighted images (CIs) were acquired before and 24-36 hours after intravenous administration of USPIO. Detection of ALNs was evaluated on DWIs in comparison with CIs. The apparent diffusion coefficient values (ADCvs) of the nonmetastatic and metastatic nodes in precontrast DWIs were determined. The diagnostic performance of DWI using USPIO was compared with that of CIs using USPIO with pathological correlation.Results: Out of a total of 286 ALNs, 216/286 (76%) nodes were detected on DWIs and 238/286 (83%) on CIs. The differences in the ADCvs between metastatic and nonmetastatic nodes were not significant (P ¼ 0.06). Sensitivity of CIs and DWIs using USPIO were respectively 70% and 83%, specificity 98% and 98%, and overall accuracy 93% and 95%.Conclusion: Although the detection on DWIs of ALNs in patients with breast cancer was inferior compared to CIs, the sensitivity and accuracy of DWIs using USPIO were superior in the diagnosis of ALNs metastasis.

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Section: Discussionmentioning

confidence: 99%

“…With regard to axillary lymph node staging, there are published data for USPIO-enhanced MRI (17)(18)(19)(20). Researchers in those studies reported a sensitivity of 73%-100% and a specificity of 92%-98% in the nodeby-node evaluation using USPIO.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of axillary lymph nodes by diffusion‐weighted MRI using ultrasmall superparamagnetic iron oxide in patients with breast cancer: Initial clinical experience

Nakai

Matsuki

Harada

et al. 2011

Magnetic Resonance Imaging

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“…Conventional MRI demonstrated figures of 59.1, 86.7 and 80.4 % for sensitivity, specificity and overall accuracy, respectively, whereas post-contrast SPIO-enhanced MRI these were 100, 80 and 94 % [25]. In the study by Stadnik et al [28] the sensitivity, specificity, positive and negative predictive values for SPIO-enhanced MRI were recorded at 100, 80, 80 and 100 %, respectively, whilst Michel et al [29] found a sensitivity, specificity and positive predictive value of 82, 100 and 82 %, respectively. These in-vivo and clinical evidence suggests that SPIO-enhanced MRI could prove to be clinically useful as an non-invasive alternative to SLNB.…”

Section: The Role Of Mnps In Diagnosis Of Metastatic Lymph Node Spreadmentioning

confidence: 93%

“…The challenge of applying this model to clinical practice, is the high false positive rate for MRI of 6.3 versus 0.2 % for the current baseline strategy of SLNB. The technique of MRI lymphangiography has not yet been developed sufficiently to achieve the specificity and positive predictive value of SLNB [29].…”

Section: The Future Role Of Mnps In the Management Of The Axilla In Bmentioning

confidence: 99%

What is the future of magnetic nanoparticles in the axillary management of breast cancer?

Ahmed

Douek

2013

Breast Cancer Res Treat

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Magnetic nanoparticles (MNPs) possess unique properties, which make them highly attractive for medical applications. The use of MNPs in surgery has mainly been focused on their role in the identification of metastatic lymph node involvement. There have been developments within this field, including ongoing and newly conducted clinical trials. The current published evidence for the use of MNPs in assessing metastatic lymph node spread using sentinel lymph node biopsy and non-invasive imaging modalities is reviewed and future applications considered.

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“…Despite lots of promising results concerning USPIOenhanced MRI, there are still many important challenges to overcome, in which one problem is false-positive and false-negative results, affecting the accuracy of diagnosis (2,(4)(5)(6)(7)(8)(9)(10)(11)(12). Harisinghani et al (2) reported that there were metastasis nodes that went undetected, and the false diagnosis was not negligible.…”

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confidence: 99%

Possible pathological basis for false diagnoses of lymph nodes by USPIO‐enhanced MRI in rabbits

Lei

Xue

et al. 2010

Magnetic Resonance Imaging

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Purpose: To determine the cause of misdiagnosis of lymph nodes in ultrasmall superparamagnetic iron oxide (USPIO) enhanced magnetic resonance imaging (MRI) using histological findings in rabbit tumor and inflammatory models.Materials and Methods: Thirty-six rabbits were randomly divided into inflammatory and tumor groups. MRI of the popliteal fossa was performed before and 24 hours after USPIO administration. Diagnoses of popliteal lymph nodes were evaluated based on dedicated criteria and were compared with histological and electronic microscopic findings.Results: There were 46 inflammatory and 26 metastatic lymph nodes. Sensitivity, specificity, and positive and negative predictive values of the diagnosis of nodal metastasis were 84.6%, 87.0%, 78.6%, and 90.9%, respectively. There were four false-negatives with subcapsular metastatic foci and six false-positives with predominant cortex and paracortex hyperplasia. Electron microscopy showed that in inflammatory nodes, cytophagic bubbles contain many USPIO particles, while in metastatic nodes they contained predominantly cellular residues.Conclusion: Diagnosis of lymph node malignancy is largely determined by the location and number of metastatic tumor cells. A profound understanding of the physiological role of macrophages in nodes with tumor burden will contribute to better diagnoses for clinical application. THE ACCURATE DETECTION of metastasis in lymph nodes is crucial for the prognosis and treatment plans of patients with malignant tumor. In the last few years ultrasmall superparamagnetic iron oxide (USPIO) agents have revolutionized lymph node imaging and have introduced functional imaging to conventional magnetic resonance imaging (MRI) (1-3). The nanoparticles are internalized by macrophages within the lymph nodes, and these intracellular iron-containing particles cause changes in magnetic properties detectable by MRI. These differences in signal intensity between normal and metastatic nodes can be easily detected visually (3). Several clinical studies have demonstrated that USPIO-enhanced MR is a particularly promising technique that improves the sensitivity and specificity of metastatic lymph node detection in pelvic, head and neck, chest, and other malignancies (2,4-13).Despite lots of promising results concerning USPIOenhanced MRI, there are still many important challenges to overcome, in which one problem is false-positive and false-negative results, affecting the accuracy of diagnosis (2,4-12). Harisinghani et al (2) reported that there were metastasis nodes that went undetected, and the false diagnosis was not negligible.In this work we established an animal model of inflammation and tumor in rabbit to thoroughly analyze the USPIO enhancement pattern of nodes. We used all types of images strictly paralleling the histologic microstructure of nodes in order to identify possible reasons for false diagnoses to refine the imaging diagnostic criteria of malignancy in lymph nodes. MATERIALS AND METHODS Animal ModelsThe experiments were performed using 36...

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Preoperative Breast Cancer Staging: MR Imaging of the Axilla with Ultrasmall Superparamagnetic Iron Oxide Enhancement

Abstract: USPIO-enhanced MR imaging has the potential to become an adjunct to conventional MR imaging of the breast for preoperative assessment of axillary lymph nodes in patients with breast cancer.

Cited by 187 publications

References 41 publications

Evaluation of axillary lymph nodes by diffusion‐weighted MRI using ultrasmall superparamagnetic iron oxide in patients with breast cancer: Initial clinical experience

Evaluation of axillary lymph nodes by diffusion‐weighted MRI using ultrasmall superparamagnetic iron oxide in patients with breast cancer: Initial clinical experience

What is the future of magnetic nanoparticles in the axillary management of breast cancer?

Possible pathological basis for false diagnoses of lymph nodes by USPIO‐enhanced MRI in rabbits

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