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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) clinicopathologic 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 clinicopathologic 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 clinicopathologic variables, was higher than that of clinicopathologic variables (P < 0.05).
References
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Fig. 1.
Maximum-intensity-projection image (a) and ADC map (b) in a 70-year-old woman with invasive ductal carcinoma, show the method used for placing ROIs to obtain the tumor ADC, peritumor ADC. Regarding the tumor ADC, the slice with the largest tumor cross section is selected, and the largest oval ROI is placed inside the tumor (b) with reference to the MIP image (a). Mean value of the ROI 1193 × 10-6 mm2/s, is recorded as tumor ADC. For the peritumor ADC, three ROIs are placed where the ADC visually appears to be most increased on breast parenchymal tissue, adjacent to tumor contour on the ADC map (b): the three ROIs are 2328, 2062, and 2646 × 10-6 mm2/s, respectively. Maximum value 2646 × 10-6 mm2/s is recorded as peritumor ADC. ADC=apparent diffusion coefficient; ROI=region of interest
Fig. 2.
A 66-year-old woman with palpable mass (arrows) on the left breast, had pathologically confirmed invasive ductal carcinoma, with axillary lymph node metastasis after surgery. (a) Maximum-intensity-projection images show that the adjacent vessel sign is positive, and increased breast vascularity is prominent. (b) T2-weighted image shows that degree of edema around the tumor, corresponds to grade 1. Peritumor-tumor ADC ratio was calculated, using DWI (c) and ADC (d). On an ADC map, mean value of the tumor ADC, and mean value of three ROIs for peritumor ADC, were 782, 654, and 1615 × 10-6 mm2/s, respectively. So, peritumor-tumor ratio was calculated as 2.0. ADC = apparent diffusion coefficient; DWI = diffusion weighted image; ROI = region of interest
Fig. 3.
Receiver-operating characteristic (ROC) curve of predictive variables in MRI, and clinicopathologic validation, clinicopathologic validation and MRI validation. The area under the receiver operating characteristics curve (AUC) of MRI and clinicopathologic, clinicopathologic, and MRI variables, were 0.879, 0.835, and 0.729, respectively (P < 0.05).
Table 1.
Comparison of Clinicopathologic Variables between No Axillary Lymph Node Metastasis and Axillary Lymph Node Metastasis
Table 2.
Comparison of DCE-MRI and DWI Variables between No Axillary Lymph Node Metastasis and Axillary Lymph Node Metastasis
| Variables | No ALN metastasis (n = 148) | ALN metastasis (n = 92) | P value |
|---|---|---|---|
| Adjacent vessel sign | < 0.001 | ||
| Negative | 87 (58.8) | 32 (34.8) | |
| Positive | 61 (41.2) | 60 (65.2) | |
| Whole breast vascularity | 0.001 | ||
| Negative | 102 (68.9) | 46 (50.0) | |
| Mild | 28 (18.9) | 20 (21.7) | |
| Moderate | 16 (10.8) | 14 (15.2) | |
| Prominent | 2 (1.4) | 12 (13.0) | |
| Quantitative parameters | |||
| E1* | 89.7 ± 65.6 | 86.6 ± 68.5 | 0.726 |
| Epeak* | 137.0 ± 104.1 | 126.4 ± 132.6 | 0.518 |
| SER* | 0.9 ± 0.5 | 1.4 ± 1.9 | 0.017 |
| TTP* | 176.3 ± 89.6 | 161.1 ± 84.1 | 0.187 |
| T2WI edema | < 0.001 | ||
| Grade 0 | 66 (44.6) | 32 (34.8) | |
| Grade 1 | 56 (37.8) | 22 (23.9) | |
| Grade 2 | 26 (17.6) | 38 (41.3) | |
| Diffusion weighted imaging | |||
| Tumor ADC* (10-6 mm2/s) | 1056 ± 249.7 | 991.1 ± 215.4 | 0.04 |
| Peritumor ADC* (10-6 mm2/s) | 1451.6 ± 331.2 | 1588.3 ± 328.5 | 0.002 |
| Peritumor-tumor ADC ratio* | 1.4 ± 0.3 | 1.6 ± 0.4 | < 0.001 |
Table 3.
Univariate Analysis for Clinicopathologic Variables Associated with Axillary Lymph Node Metastasis
Table 4.
Univariate Analysis for MRI Variables Associated with Axillary Lymph Node Metastasis
Table 5.
Multivariate Analysis for Factors Associated with Axillary Lymph Node Metastasis
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