Routine use of standard breast MRI compared to axillary ultrasound for differentiating between no, limited and advanced axillary nodal disease in newly diagnosed breast cancer patients

Nijnatten, Thiemo J A van; Ploumen, Eline H.; Schipper, Robert-Jan; Goorts, B.; Andriessen, E H; Vanwetswinkel, Sigrid; Schavemaker, M; Nelemans, Patty J.; Vries, Bart de; Beets‐Tan, Regina G. H.; Smidt, Marjolein L.; Lobbes, Marc

doi:10.1016/j.ejrad.2016.10.030

Cited by 68 publications

(61 citation statements)

References 25 publications

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“…In this study, the unenhanced MR sequence was used since it has been previously described that this sequence has the best anatomical presentation of the lymph nodes based on size and morphology [10,12,22]. In addition to the unenhanced T2W sequence, DW imaging has been investigated as an adjunct to help differentiate between benign and malignant lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

“…Breast MRI enables radiologists to simultaneously assess the breast tumor and axillary lymph nodes in the same field of view (FOV) if the axillary region is completely visualized with an acceptable signal-to-noise ratio (SNR). However, in 40% of the standard breast MRI exams, no complete FOVof the axillary region is planned, limiting the assessment of extensive axillary lymph node involvement in the upper part of the axilla [10]. Consequently, dedicated axillary MRI has been investigated to improve axillary lymph node imaging by representing the complete axillary region.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic performance of standard breast MRI compared to dedicated axillary MRI for assessment of node-negative and node-positive breast cancer

et al. 2020

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Objectives To investigate whether breast MRI has comparable diagnostic performance as dedicated axillary MRI regarding assessment of node-negative and node-positive breast cancer. Methods Forty-seven patients were included. All had undergone both breast MRI and dedicated axillary MRI, followed by surgery. All included breast MRI exams had complete field of view (FOV) of the axillary region. First, unenhanced T2-weighted (T2W) and subsequent diffusion-weighted (DW) images of both MRI exams were independently analyzed by two breast radiologists using a confidence scale and compared to histopathology. ADC values were measured by two researchers independently. Diagnostic performance parameters were calculated on a patient-by-patient basis. Results T2W breast MRI had the following diagnostic performance: sensitivity of 50.0% and 62.5%, specificity of 92.3%, PPV of 57.1% and 62.5%, NPV of 90.0% and 92.3%, and AUC of 0.72 for reader 1 and 0.78 for reader 2. T2W dedicated axillary MRI had the following diagnostic performance: sensitivity of 37.5% and 62.5%, specificity of 82.1% and 92.3%, PPVof 44.6% and 50.0%, NPVof 87.8% and 91.4%, and AUC of 0.65 for reader 1 and 0.73 for reader 2. In both evaluations, addition of DW images resulted in comparable diagnostic performance. For both breast MRI and dedicated axillary MRI, there was no significant difference between mean ADC values of benign and malignant lymph nodes. Conclusions T2W breast MRI with complete FOV of the axillary region has comparable diagnostic performance as T2W dedicated axillary MRI regarding assessment of node-negative and node-positive breast cancer. Optimization of T2W breast MRI protocol by including a complete FOV of the axillary region can, therefore, be recommended in clinical practice. Key Points • Breast MRI with complete field of view of the axillary region has comparable diagnostic performance as dedicated axillary MRI regarding assessment of node-negative and node-positive breast cancer. • Optimization of breast MRI protocol by including a complete field of view of the axillary region is recommended in clinical practice. • For both breast MRI and dedicated axillary MRI, DW imaging (including ADC measurements) is of no added value. European Radiology (2020) 30:4212-4222 Receiver operating characteristic ROI Region of interest SLNB Sentinel lymph node biopsy SNR Signal-to-noise ratio T2W T2-weighted TE Echo time TR Repetition time

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diagnostic performance of standard breast MRI compared to dedicated axillary MRI for assessment of node-negative and node-positive breast cancer

et al. 2020

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“…Cox and co-workers 27 found that core biopsy of sentinel lymph nodes identified using contrast-enhanced ultrasound imaging in the breast clinic correlated with higher total volume of metastatic lymph nodes when the core biopsy result was positive. van Nijnatten et al 30 suggested that standard breast MRI is comparable to dedicated AUS for the evaluation of advanced axillary nodal status. MRI using intravenously administered ultra-small superparamagnetic iron oxide has been reported to be promising for diagnostic imaging of lymph node metastases 26 .…”

Section: Discussionmentioning

confidence: 99%

Population-based study of the sensitivity of axillary ultrasound imaging in the preoperative staging of node-positive invasive lobular carcinoma of the breast

Morrow

Lannigan

Doughty

et al. 2018

British Journal of Surgery

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“…MMG is more suitable for the examination of breast disease but is not considered reliable for ALN evaluation, because part of the axillary area may not be visualized by routine MMG [22]. MRI is mostly used for assessment of newly diagnosed breast cancer and to examine the response to neoadjuvant treatment, but is also limited by an insu cient imaging eld of the axillary region [23]. While WB-PET/CT is recognized to be su ciently sensitive for the detection of distant metastases, it is not suitable to rule out ALN involvement.…”

Section: Discussionmentioning

confidence: 99%

A Novel High-resolution Dedicated Axillary PET Improve Sensitivity in the Assessment of Regional Nodal Spread of Disease in Early Breast Cancer.

Cheng¹,

Li²,

Li³

et al. 2020

Preprint

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Background: The aim of this study was to assess if a novel high-resolution dedicated axillary lymph node Positron Emission Tomography (LymphPET) system could improve sensitivity analysing Lymph Node involvement in early breast carcinoma with clinical N0-N1 stage. Methods: A total of 103 patients with clinical stage of T1-2N0-1M0 breast cancer were evaluated with LymphPET. The maximum single-voxel PET uptake value of Axillary Lymph Node (maxLUV) and the tumor-to-background ratio (TBR) for fat (TBR1) and muscle (TBR2) tissue were calculated. Then, seventy-eight patients with cN0 stage received sentinel lymph node biopsy (SLNB) alone or in combination with ALN dissection (ALND) and 25 patients with cN1 stage underwent fine-needle aspiration (FNA). Results: Ninety-nine invasive breast carcinoma entered this study. The diagnostic sensitivity of LymphPET was 87.80%, specificity was 79.31%, false-negative rate was 12.20%, false-positive rate was 20.69%, positive predictive value was 75.00%, negative predictive value was 90.20%, and accuracy was 82.83%. The maxLUV was superior to TBR1 and TBR2 in the detection of ALN, with 0.27 being the most optimal cutoff value. Conclusion: The 18F-FDG LymphPET could be used to identify and recognize more indolent ALNs of the breast cancer because of more sensitivity and much higher negative predictive value.

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Routine use of standard breast MRI compared to axillary ultrasound for differentiating between no, limited and advanced axillary nodal disease in newly diagnosed breast cancer patients

Cited by 68 publications

References 25 publications

Diagnostic performance of standard breast MRI compared to dedicated axillary MRI for assessment of node-negative and node-positive breast cancer

Diagnostic performance of standard breast MRI compared to dedicated axillary MRI for assessment of node-negative and node-positive breast cancer

Population-based study of the sensitivity of axillary ultrasound imaging in the preoperative staging of node-positive invasive lobular carcinoma of the breast

A Novel High-resolution Dedicated Axillary PET Improve Sensitivity in the Assessment of Regional Nodal Spread of Disease in Early Breast Cancer.

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