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Role of diffusion-weighted MRI: predicting axillary lymph node metastases in breast cancer

Authors
 Jin Chung  ;  Ji Hyun Youk  ;  Jeong-Ah Kim  ;  Hye Mi Gweon  ;  Eun-Kyung Kim  ;  Young Hoon Ryu  ;  Eun Ju Son 
Citation
 ACTA RADIOLOGICA, Vol.55(8) : 909-916, 2014 
Journal Title
 ACTA RADIOLOGICA 
ISSN
 0284-1851 
Issue Date
2014
MeSH
Adult ; Aged ; Aged, 80 and over ; Axilla ; Breast Neoplasms/diagnosis* ; Breast Neoplasms/diagnostic imaging ; Carcinoma, Ductal, Breast/diagnosis* ; Carcinoma, Ductal, Breast/diagnostic imaging ; Contrast Media ; Diffusion Magnetic Resonance Imaging/methods* ; Female ; Gadolinium DTPA ; Humans ; Image Enhancement/methods ; Imaging, Three-Dimensional/methods ; Lymph Nodes/pathology* ; Lymphatic Metastasis/pathology ; Middle Aged ; Observer Variation ; ROC Curve ; Reproducibility of Results ; Retrospective Studies ; Sensitivity and Specificity ; Ultrasonography, Mammary/methods
Keywords
Breast cancer ; apparent diffusion coefficient (ADC) ; axillary lymph node ; diffusion ; magnetic resonance imaging (MRI) ; ultrasound (US)
Abstract
BACKGROUND: Ultrasound (US) is probably the standard imaging procedure in most centers, and US-guided fine needle aspiration can be added if suspicious lymph nodes are found. However, US-guided fine needle aspiration is an invasive method to diagnose a metastasis and has showed relatively low sensitivity. In general, diffusion-weighted (DW) magnetic resonance imaging (MRI) has become an emerging technique for discriminating benign from malignant breast lesions in a short imaging acquisition time. PURPOSE: To evaluate the potential for using DW MRI with an apparent diffusion coefficient (ADC) value to predict axillary lymph node metastases in patients with invasive breast cancer. MATERIAL AND METHODS: This study enrolled 110 axillary lymph nodes from 110 consecutive women who were diagnosed with invasive breast cancer for preoperative breast MRI and US. The largest enhancing ipsilateral axillary lymph nodes were included in this study, and benign and metastatic axillary lymph nodes were compared according to the pathologic reports. The cut-off ADC value to differentiate between benign and metastatic axillary lymph nodes was evaluated with receiver-operating characteristic curve analysis. Diagnostic performance of ultrasound and DW MRI was calculated for enhancing lymph node in dynamic contrast-enhanced MRI. RESULTS: Nodal metastases were documented in 68 (62%) axillary lymph nodes. The mean size of metastatic axillary lymph nodes was larger than that of benign axillary lymph nodes (15.5 mm vs. 10.9 mm, P < 0.001). The mean ADC value (0.69 × 10(-3 )mm(2)/s) of the metastases was significantly lower than that of the benign axillary lymph nodes (1.04 × 10(-3 )mm(2)/s) (P < 0.001). The ADC value cut-off between metastatic and benign axillary lymph nodes was 0.90 × 10(-3 )mm(2)/s. Using ADC cut-off, sensitivity, specificity, and accuracy of DW MRI were 100%, 83.3%, and 93.6%, respectively. The sensitivity, specificity, and accuracy of US showed 94.1%, 54.8%, and 79.1%, respectively. CONCLUSION: DW MRI of axillary lymph nodes can provide reliable information for the differentiation of benign from metastatic axillary lymph nodes in invasive breast cancer patients.
Full Text
http://acr.sagepub.com/content/55/8/909.long
DOI
10.1177/0284185113509094
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Nuclear Medicine (핵의학교실) > 1. Journal Papers
Yonsei Authors
Gweon, Hye Mi(권혜미) ORCID logo https://orcid.org/0000-0002-3054-1532
Kim, Eun-Kyung(김은경) ORCID logo https://orcid.org/0000-0002-3368-5013
Kim, Jeong Ah(김정아) ORCID logo https://orcid.org/0000-0003-4949-4913
Son, Eun Ju(손은주) ORCID logo https://orcid.org/0000-0002-7895-0335
Ryu, Young Hoon(유영훈) ORCID logo https://orcid.org/0000-0002-9000-5563
Youk, Ji Hyun(육지현) ORCID logo https://orcid.org/0000-0002-7787-780X
Chung, Jin(정진)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/138879
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