Original Research

Dynamic contrast-enhanced and diffusion-weighted MRI of invasive breast cancer for the prediction of sentinel lymph node status

Eun Jung Choi MD, PhD

orcid.org/0000-0002-2339-4327

Department of Radiology, Research Institute of Clinical Medicine of Chonbuk National University – Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju City, South Korea

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Ji Hyun Youk MD, PhD,

Corresponding Author

Ji Hyun Youk MD, PhD

[email protected]

Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea

Address reprint requests to: J.H.Y., Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-Gu, Seoul 06273, South Korea. E-mail: [email protected]Search for more papers by this author

Hyemi Choi PhD,

Hyemi Choi PhD

Department of Statistics, Research Institute of Applied Statistics, Chonbuk National University, Jeonbuk, 54896 South Korea

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Ji Soo Song MD, PhD,

Ji Soo Song MD, PhD

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Eun Jung Choi MD, PhD,

Eun Jung Choi MD, PhD

orcid.org/0000-0002-2339-4327

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Ji Hyun Youk MD, PhD,

Corresponding Author

Ji Hyun Youk MD, PhD

[email protected]

Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea

Hyemi Choi PhD,

Hyemi Choi PhD

Department of Statistics, Research Institute of Applied Statistics, Chonbuk National University, Jeonbuk, 54896 South Korea

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Ji Soo Song MD, PhD,

Ji Soo Song MD, PhD

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First published: 16 July 2019

https://doi.org/10.1002/jmri.26865

Citations: 39

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Abstract

Background

Although sentinel lymph node biopsy (SLNB) is the current standard for identifying lymph metastasis in breast cancer patients, there are complications of SLNB.

Purpose

To evaluate preoperative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) of invasive breast cancer for predicting sentinel lymph node metastasis.

Study Type

Retrospective.

Population

In all, 309 patients who underwent clinically node-negative invasive breast cancer surgery

Field Strength/Sequence

3.0T, DCE-MRI, DWI.

Assessment

We collected clinicopathologic variables (age, histologic and nuclear grade, extensive intraductal carcinoma component, lymphovascular invasion, and immunohistochemical profiles) and preoperative MRI features (tumor size, background parenchymal enhancement, internal enhancement, adjacent vessel sign, whole-breast vascularity, initial enhancement pattern, kinetic curve types, quantitative kinetic parameters, tumoral apparent diffusion coefficient [ADC], peritumoral maximal ADC, and peritumoral-tumoral ADC ratio).

Statistical Tests

Multivariate logistic regressions were performed to determine independent variables associated with SLN metastasis, and the area under the receiver operating characteristic curve (AUC) was analyzed for those variables.

Results

41 (13.3%) of the patients showed SLN metastasis. With MRI, tumor size (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.06–1.17), heterogeneous (OR, 5.33; 95% CI, 1.71–16.58), and rim (OR, 15.54; 95% CI, 2.12–113.72) enhancement and peritumoral–tumoral ADC ratio (OR, 72.79; 95% CI, 7.15–740.82) were independently associated with SLN metastasis. Clinicopathologic variables independently associated with SLN metastasis included age (OR, 0.96; 95% CI, 0.92–0.99) and CD31 (OR, 2.90; 95% CI, 1.04–8.92). The area under the curve (AUC) of MRI features (0.80; 95% CI, 0.73–0.87) was significantly higher than for clinicopathologic variables (0.68; 95% CI, 0.60–0.77; P = 0.048) and was barely below statistical significance for combined MRI features with clinicopathologic variables (0.84; 95% CI 0.78–0.90, P = 0.057).

Data Conclusion

Preoperative internal enhancement on DCE-MRI and peritumoral-tumoral ADC ratio on DWI might be useful for predicting SLN metastasis in patients with invasive breast cancer.

Level of Evidence: 3

Technical Efficacy: Stage 2

J. Magn. Reson. Imaging 2020;51:615–626.

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Dynamic contrast-enhanced and diffusion-weighted MRI of invasive breast cancer for the prediction of sentinel lymph node status

Abstract

Background

Purpose

Study Type

Population

Field Strength/Sequence

Assessment

Statistical Tests

Results

Data Conclusion

References

Citing Literature