Sentinel lymph node detection using magnetic resonance lymphography with conventional gadolinium contrast agent in breast cancer: a preliminary clinical study

Abstract

BackgroundSentinel lymph node (SLN) mapping is the standard method for axillary lymph node staging in patients with breast cancer. Blue dye and radioisotopes are commonly used agents to localize SLNs, but both have several disadvantages. The purpose of this study was to evaluate magnetic resonance lymphography with a gadolinium-based contrast agent (Gd-MRL) in sentinel lymph node identification and metastasis detection in patients with breast cancer.MethodsSixty patients (mean age: 46.2 ± 8.8 years) with stage T1- 2 breast cancer and clinically negative axillary lymph nodes participated in this study. After 0.9 ml of contrast material and 0.1 ml of mepivacaine hydrochloride 1% were mixed and injected intradermally into the upper-outer periareolar areas, axillary lymph flow was tracked and sentinel lymph nodes were identified by Gd-MRL. After SLN biopsy and/or surgery, the efficacy of SLN identification and metastasis detection of Gd-MRL were examined.ResultsNinety-six lymph nodes were identified by Gd-MRL as SLNs (M-SLN), and 135 lymph nodes were detected by blue dye-guided methods as SLNs (D-SLN). There was a strong correlation (P < 0.001) between the SLN numbers found by these two methods. Using blue dye-guided methods as the gold standard, the sensitivity of Gd-MRL was 95.65% and the false-negative rate was 4.3% for axillary lymphatic metastasis detection. With heterogeneous enhancement and enhancement defect as the diagnostic criteria, Gd-MRL gave a sensitivity of 89.29% and specificity of 89.66% in discriminating malignant from benign SLNs.ConclusionGd-MRL offers a new method for SLN identification and metastasis detection in patients with breast cancer.

PEG‐poly(L‐lysine)‐based polymeric micelle MRI contrast agent: Feasibility study of a Gd‐micelle contrast agent for MR lymphography

“…Of these pathways, interstitial administration of contrast medium enables assessing the lymphatic system with lower doses, visualizing both lymph nodes and lymph vessels, and allowing morphological and functional evaluations of the lymphatic system . This method is also used to detect sentinel lymph nodes …”

Sentinel Lymph Node Characterization with a Dual-Targeted Molecular Ultrasound Contrast Agent

“…A SLN biopsy has some limitations. Since lymphoscintigraphy utilizes a radioisotope, some clinics may not have the necessary capabilities [5]. Also, allergic/anaphylactic reaction to use of blue dyes has been reported [6].…”

Short-Term Dynamic Observation of the Color Change and Enhancement Effect of Polyethylenimine-Entrapped Gold Nanoparticles Used for Indirect Lymphography

“…Indirect lymphography is a alternative method to identify SLNs. Indirect CT lymphography (CT-LG) with iodine contrast agent and MRI lymphography (MRI-LG) with gadolinium-containing contrast agents have the advantages of high sensitivity, excellent spatial resolution and low doses of contrast agent needed [7], and have been widely used in SLNB [8,9,10]. However, there have been few clinical applications to identify SLNs in head and neck tumors [11,12] because of the very short duration of enhanced imaging with iodine or gadolinium-containing contrast agents.…”