Investig Magn Reson Imaging.  2019 Jun;23(2):125-135. 10.13104/imri.2019.23.2.125.

Prediction of Axillary Lymph Node Metastasis in Early Breast Cancer Using Dynamic Contrast-Enhanced Magnetic Resonance Imaging and Diffusion-Weighted Imaging

Affiliations
  • 1Department of Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea. cejcej80@hanmail.net
  • 2Department of Statistics, Chonbuk National University, Research Institute of Applied Statistics, Jeonju, Korea.

Abstract

PURPOSE
The purpose of this study was to evaluate dynamic contrast-enhanced breast magnetic resonance imaging (DCE-MRI), and diffusion-weighted imaging (DWI) variables, for axillary lymph node (ALN) metastasis in the early stage of breast cancer.
MATERIALS AND METHODS
January 2011-April 2015, 787 patients with early stage of breast cancer were retrospectively reviewed. Only cases of invasive ductal carcinoma, were included in the patient population. Among them, 240 patients who underwent 3.0-T DCE-MRI, including DWI with b value 0 and 800 s/mm² were enrolled. MRI variables (adjacent vessel sign, whole-breast vascularity, initial enhancement pattern, quantitative kinetic parameters, signal enhancement ratio (SER), tumor apparent diffusion coefficient (ADC), peritumoral ADC, and peritumor-tumor ADC ratio) clinico-pathologic variables (age, T stage, multifocality, extensive intraductal carcinoma component (EIC), estrogen receptor, progesterone receptor, HER-2 status, Ki-67, molecular subtype, histologic grade, and nuclear grade) were compared between patients with axillary lymph node metastasis and those with no lymph node metastasis. Multivariate regression analysis was performed, to determine independent variables associated with ALN metastasis, and the area under the receiver operating characteristic curve (AUC), for predicting ALN metastasis was analyzed, for those variables.
RESULTS
On breast MRI, moderate or prominent ipsilateral whole-breast vascularity (moderate, odds ratio [OR] 3.45, 95% confidence interval [CI] 1.28-9.51 vs. prominent, OR = 15.59, 95% CI 2.52-96.46), SER (OR = 1.68, 95% CI 1.09-2.59), and peritumor-tumor ADC ratio (OR = 6.77, 95% CI 2.41-18.99), were independently associated with ALN metastasis. Among clinico-pathologic variables, HER-2 positivity was independently associated, with ALN metastasis (OR = 23.71, 95% CI 10.50-53.54). The AUC for combining selected MRI variables and clinico-pathologic variables, was higher than that of clinico-pathologic variables (P < 0.05).
CONCLUSION
SER, moderate or prominent increased whole breast vascularity, and peritumor-tumor ADC ratio on breast MRI, are valuable in predicting ALN metastasis, in patients with early stage of breast cancer.

Keyword

Breast neoplasm; Lymph node; Magnetic resonance imaging; Diffusion magnetic resonance imaging

MeSH Terms

Area Under Curve
Breast Neoplasms*
Breast*
Carcinoma, Ductal
Carcinoma, Intraductal, Noninfiltrating
Diffusion
Diffusion Magnetic Resonance Imaging
Estrogens
Humans
Lymph Nodes*
Magnetic Resonance Imaging*
Neoplasm Metastasis*
Odds Ratio
Receptors, Progesterone
Retrospective Studies
ROC Curve
Estrogens
Receptors, Progesterone
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