Skip to main content
Top
Published in: BMC Medical Imaging 1/2020

01-12-2020 | Breast Cancer | Research article

Diagnostic performance of standard breast MR imaging compared to dedicated axillary MR imaging in the evaluation of axillary lymph node

Authors: Su Min Ha, Eun Young Chae, Joo Hee Cha, Hee Jung Shin, Woo Jung Choi, Hak Hee Kim

Published in: BMC Medical Imaging | Issue 1/2020

Login to get access

Abstract

Background

Breast magnetic resonance (MR) imaging does not usually assess axillary lymph nodes -using dedicated axillary sequence. The additional utility of dedicated axillary sequence is poorly understood. We evaluated the diagnostic performance of dedicated axillary imaging sequence for evaluation of axillary lymph node.

Methods

In this retrospective study from January 2018 to March 2018, 750 consecutive women underwent breast MR imaging. 263 patients were excluded, due to neoadjuvant chemotherapy (n = 235), incomplete histopathological information (n = 14) and follow-up loss (n = 14), 487 women were included. Two radiologists scored lymph node on confidence level scale from 0 (definitely benign) to 4 (definitely malignant), −using standard MR and dedicated axillary imaging sequences. Diagnostic performance parameters were compared and calculated correlation coefficient of quantitative features (largest dimension, cortical thickness, and the ratio of cortical thickness to largest dimension of lymph node).

Results

68 (14.0%) were node-positive and 419 (86.0%) were node-negative. The sensitivity, specificity, positive, negative predictive values and accuracy were respectively, 66.2, 93.3, 61.6, 94.4, and 89.5% for dedicated axillary sequence and 64.7, 94.0, 63.8, 94.3, 89.9% for standard MR sequence The dedicated axillary and standard sequences s did not exhibit significant differences in detection of positive lymph nodes (AUC, 0.794 for standard and 0.798 for dedicated axillary sequence, P = 0.825). The cortical thickness appeared to be the most discriminative quantitative measurement using both axillary (AUC, 0.846) and standard sequences (AUC, 0.823), with high correlation coefficient (0.947).

Conclusion

Evaluation of axillary nodal status using standard breast MR imaging is comparable to dedicated axillary MR imaging.
Appendix
Available only for authorised users
Literature
1.
go back to reference Fisher B, Bauer M, Wickerham DL, Redmond CK, Fisher ER, Cruz AB, Foster R, Gardner B, Lerner H, Margolese R, et al. Relation of number of positive axillary nodes to the prognosis of patients with primary breast cancer. An NSABP update. Cancer. 1983;52(9):1551–7.CrossRef Fisher B, Bauer M, Wickerham DL, Redmond CK, Fisher ER, Cruz AB, Foster R, Gardner B, Lerner H, Margolese R, et al. Relation of number of positive axillary nodes to the prognosis of patients with primary breast cancer. An NSABP update. Cancer. 1983;52(9):1551–7.CrossRef
2.
go back to reference Harris CK, Tran HT, Lee K, Mylander C, Pack D, Rosman M, Tafra L, Umbricht CB, Andrade R, Liang W, et al. Positive ultrasound-guided lymph node needle biopsy in breast Cancer may not mandate axillary lymph node dissection. Ann Surg Oncol. 2017;24(10):3004–10.CrossRef Harris CK, Tran HT, Lee K, Mylander C, Pack D, Rosman M, Tafra L, Umbricht CB, Andrade R, Liang W, et al. Positive ultrasound-guided lymph node needle biopsy in breast Cancer may not mandate axillary lymph node dissection. Ann Surg Oncol. 2017;24(10):3004–10.CrossRef
3.
go back to reference Galimberti V, Cole BF, Zurrida S, Viale G, Luini A, Veronesi P, Baratella P, Chifu C, Sargenti M, Intra M, et al. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): a phase 3 randomised controlled trial. Lancet Oncol. 2013;14(4):297–305.CrossRef Galimberti V, Cole BF, Zurrida S, Viale G, Luini A, Veronesi P, Baratella P, Chifu C, Sargenti M, Intra M, et al. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): a phase 3 randomised controlled trial. Lancet Oncol. 2013;14(4):297–305.CrossRef
4.
go back to reference Sola M, Alberro JA, Fraile M, Santesteban P, Ramos M, Fabregas R, Moral A, Ballester B, Vidal S. Complete axillary lymph node dissection versus clinical follow-up in breast cancer patients with sentinel node micrometastasis: final results from the multicenter clinical trial AATRM 048/13/2000. Ann Surg Oncol. 2013;20(1):120–7.CrossRef Sola M, Alberro JA, Fraile M, Santesteban P, Ramos M, Fabregas R, Moral A, Ballester B, Vidal S. Complete axillary lymph node dissection versus clinical follow-up in breast cancer patients with sentinel node micrometastasis: final results from the multicenter clinical trial AATRM 048/13/2000. Ann Surg Oncol. 2013;20(1):120–7.CrossRef
5.
go back to reference Kuijs VJ, Moossdorff M, Schipper RJ, Beets-Tan RG, Heuts EM, Keymeulen KB, Smidt ML, Lobbes MB. The role of MRI in axillary lymph node imaging in breast cancer patients: a systematic review. Insights Imaging. 2015;6(2):203–15.CrossRef Kuijs VJ, Moossdorff M, Schipper RJ, Beets-Tan RG, Heuts EM, Keymeulen KB, Smidt ML, Lobbes MB. The role of MRI in axillary lymph node imaging in breast cancer patients: a systematic review. Insights Imaging. 2015;6(2):203–15.CrossRef
6.
go back to reference Scaranelo AM, Eiada R, Jacks LM, Kulkarni SR, Crystal P. Accuracy of unenhanced MR imaging in the detection of axillary lymph node metastasis: study of reproducibility and reliability. Radiology. 2012;262(2):425–34.CrossRef Scaranelo AM, Eiada R, Jacks LM, Kulkarni SR, Crystal P. Accuracy of unenhanced MR imaging in the detection of axillary lymph node metastasis: study of reproducibility and reliability. Radiology. 2012;262(2):425–34.CrossRef
7.
go back to reference He N, Xie C, Wei W, Pan C, Wang W, Lv N, Wu P. A new, preoperative, MRI-based scoring system for diagnosing malignant axillary lymph nodes in women evaluated for breast cancer. Eur J Radiol. 2012;81(10):2602–12.CrossRef He N, Xie C, Wei W, Pan C, Wang W, Lv N, Wu P. A new, preoperative, MRI-based scoring system for diagnosing malignant axillary lymph nodes in women evaluated for breast cancer. Eur J Radiol. 2012;81(10):2602–12.CrossRef
8.
go back to reference Fornasa F, Nesoti MV, Bovo C, Bonavina MG. Diffusion-weighted magnetic resonance imaging in the characterization of axillary lymph nodes in patients with breast cancer. J Magnetic Resonance Imaging : JMRI. 2012;36(4):858–64.CrossRef Fornasa F, Nesoti MV, Bovo C, Bonavina MG. Diffusion-weighted magnetic resonance imaging in the characterization of axillary lymph nodes in patients with breast cancer. J Magnetic Resonance Imaging : JMRI. 2012;36(4):858–64.CrossRef
9.
go back to reference Orguc S, Basara I, Pekindil G, Coskun T. Contribution of kinetic characteristics of axillary lymph nodes to the diagnosis in breast magnetic resonance imaging. Balkan Med J. 2012;29(3):285–9.PubMedPubMedCentral Orguc S, Basara I, Pekindil G, Coskun T. Contribution of kinetic characteristics of axillary lymph nodes to the diagnosis in breast magnetic resonance imaging. Balkan Med J. 2012;29(3):285–9.PubMedPubMedCentral
10.
go back to reference Kvistad KA, Rydland J, Smethurst HB, Lundgren S, Fjosne HE, Haraldseth O. Axillary lymph node metastases in breast cancer: preoperative detection with dynamic contrast-enhanced MRI. Eur Radiol. 2000;10(9):1464–71.CrossRef Kvistad KA, Rydland J, Smethurst HB, Lundgren S, Fjosne HE, Haraldseth O. Axillary lymph node metastases in breast cancer: preoperative detection with dynamic contrast-enhanced MRI. Eur Radiol. 2000;10(9):1464–71.CrossRef
11.
go back to reference Mortellaro VE, Marshall J, Singer L, Hochwald SN, Chang M, Copeland EM, Grobmyer SR. Magnetic resonance imaging for axillary staging in patients with breast cancer. J Magn Reson Imaging. 2009;30(2):309–12.CrossRef Mortellaro VE, Marshall J, Singer L, Hochwald SN, Chang M, Copeland EM, Grobmyer SR. Magnetic resonance imaging for axillary staging in patients with breast cancer. J Magn Reson Imaging. 2009;30(2):309–12.CrossRef
12.
go back to reference Mumtaz H, Hall-Craggs MA, Davidson T, Walmsley K, Thurell W, Kissin MW, Taylor I. Staging of symptomatic primary breast cancer with MR imaging. AJR Am J Roentgenol. 1997;169(2):417–24.CrossRef Mumtaz H, Hall-Craggs MA, Davidson T, Walmsley K, Thurell W, Kissin MW, Taylor I. Staging of symptomatic primary breast cancer with MR imaging. AJR Am J Roentgenol. 1997;169(2):417–24.CrossRef
13.
go back to reference Luciani A, Dao TH, Lapeyre M, Schwarzinger M, Debaecque C, Lantieri L, Revelon G, Bouanane M, Kobeiter H, Rahmouni A. Simultaneous bilateral breast and high-resolution axillary MRI of patients with breast cancer: preliminary results. AJR Am J Roentgenol. 2004;182(4):1059–67.CrossRef Luciani A, Dao TH, Lapeyre M, Schwarzinger M, Debaecque C, Lantieri L, Revelon G, Bouanane M, Kobeiter H, Rahmouni A. Simultaneous bilateral breast and high-resolution axillary MRI of patients with breast cancer: preliminary results. AJR Am J Roentgenol. 2004;182(4):1059–67.CrossRef
14.
go back to reference Baltzer PA, Dietzel M, Burmeister HP, Zoubi R, Gajda M, Camara O, Kaiser WA. Application of MR mammography beyond local staging: is there a potential to accurately assess axillary lymph nodes? Evaluation of an extended protocol in an initial prospective study. AJR Am J Roentgenol. 2011;196(5):W641–7.CrossRef Baltzer PA, Dietzel M, Burmeister HP, Zoubi R, Gajda M, Camara O, Kaiser WA. Application of MR mammography beyond local staging: is there a potential to accurately assess axillary lymph nodes? Evaluation of an extended protocol in an initial prospective study. AJR Am J Roentgenol. 2011;196(5):W641–7.CrossRef
15.
go back to reference Schipper RJ, Smidt ML, van Roozendaal LM, Castro CJ, de Vries B, Heuts EM, Keymeulen KB, Wildberger JE, Lobbes MB, Beets-Tan RG. Noninvasive nodal staging in patients with breast cancer using gadofosveset-enhanced magnetic resonance imaging: a feasibility study. Investig Radiol. 2013;48(3):134–9.CrossRef Schipper RJ, Smidt ML, van Roozendaal LM, Castro CJ, de Vries B, Heuts EM, Keymeulen KB, Wildberger JE, Lobbes MB, Beets-Tan RG. Noninvasive nodal staging in patients with breast cancer using gadofosveset-enhanced magnetic resonance imaging: a feasibility study. Investig Radiol. 2013;48(3):134–9.CrossRef
16.
go back to reference Murray AD, Staff RT, Redpath TW, Gilbert FJ, Ah-See AK, Brookes JA, Miller ID, Payne S. Dynamic contrast enhanced MRI of the axilla in women with breast cancer: comparison with pathology of excised nodes. Br J Radiol. 2002;75(891):220–8.CrossRef Murray AD, Staff RT, Redpath TW, Gilbert FJ, Ah-See AK, Brookes JA, Miller ID, Payne S. Dynamic contrast enhanced MRI of the axilla in women with breast cancer: comparison with pathology of excised nodes. Br J Radiol. 2002;75(891):220–8.CrossRef
17.
go back to reference Kuhl CK, Schrading S, Strobel K, Schild HH, Hilgers RD, Bieling HB. Abbreviated breast magnetic resonance imaging (MRI): first postcontrast subtracted images and maximum-intensity projection-a novel approach to breast cancer screening with MRI. J Clin Oncol. 2014;32(22):2304–10.CrossRef Kuhl CK, Schrading S, Strobel K, Schild HH, Hilgers RD, Bieling HB. Abbreviated breast magnetic resonance imaging (MRI): first postcontrast subtracted images and maximum-intensity projection-a novel approach to breast cancer screening with MRI. J Clin Oncol. 2014;32(22):2304–10.CrossRef
18.
go back to reference Uematsu T, Sano M, Homma K. In vitro high-resolution helical CT of small axillary lymph nodes in patients with breast cancer: correlation of CT and histology. AJR Am J Roentgenol. 2001;176(4):1069–74.CrossRef Uematsu T, Sano M, Homma K. In vitro high-resolution helical CT of small axillary lymph nodes in patients with breast cancer: correlation of CT and histology. AJR Am J Roentgenol. 2001;176(4):1069–74.CrossRef
19.
go back to reference Mann RM, Kuhl CK, Kinkel K, Boetes C. Breast MRI: guidelines from the European Society of Breast Imaging. Eur Radiol. 2008;18(7):1307–18.CrossRef Mann RM, Kuhl CK, Kinkel K, Boetes C. Breast MRI: guidelines from the European Society of Breast Imaging. Eur Radiol. 2008;18(7):1307–18.CrossRef
20.
go back to reference Pediconi F, Miglio E, Telesca M, Luciani ML, Kirchin MA, Passariello R, Catalano C. Effect of preoperative breast magnetic resonance imaging on surgical decision making and cancer recurrence rates. Investig Radiol. 2012;47(2):128–35.CrossRef Pediconi F, Miglio E, Telesca M, Luciani ML, Kirchin MA, Passariello R, Catalano C. Effect of preoperative breast magnetic resonance imaging on surgical decision making and cancer recurrence rates. Investig Radiol. 2012;47(2):128–35.CrossRef
21.
go back to reference Kuckelman J, Barron M, Bingham J, Mosier A, Sohn V. Pre-operative MRI exhibits limited utility in axillary staging for breast cancer. Cancer Treat Res Commun. 2017;12:49–52.CrossRef Kuckelman J, Barron M, Bingham J, Mosier A, Sohn V. Pre-operative MRI exhibits limited utility in axillary staging for breast cancer. Cancer Treat Res Commun. 2017;12:49–52.CrossRef
22.
go back to reference Li C, Meng S, Yang X, Wang J, Hu J. The value of T2* in differentiating metastatic from benign axillary lymph nodes in patients with breast cancer--a preliminary in vivo study. PLoS One. 2014;9(1):e84038.CrossRef Li C, Meng S, Yang X, Wang J, Hu J. The value of T2* in differentiating metastatic from benign axillary lymph nodes in patients with breast cancer--a preliminary in vivo study. PLoS One. 2014;9(1):e84038.CrossRef
23.
go back to reference Yoshimura G, Sakurai T, Oura S, Suzuma T, Tamaki T, Umemura T, Kokawa Y, Yang Q. Evaluation of Axillary Lymph Node Status in Breast Cancer with MRI. Breast Cancer (Tokyo, Japan). 1999;6(3):249–58.CrossRef Yoshimura G, Sakurai T, Oura S, Suzuma T, Tamaki T, Umemura T, Kokawa Y, Yang Q. Evaluation of Axillary Lymph Node Status in Breast Cancer with MRI. Breast Cancer (Tokyo, Japan). 1999;6(3):249–58.CrossRef
24.
go back to reference Harada T, Tanigawa N, Matsuki M, Nohara T, Narabayashi I. Evaluation of lymph node metastases of breast cancer using ultrasmall superparamagnetic iron oxide-enhanced magnetic resonance imaging. Eur J Radiol. 2007;63(3):401–7.CrossRef Harada T, Tanigawa N, Matsuki M, Nohara T, Narabayashi I. Evaluation of lymph node metastases of breast cancer using ultrasmall superparamagnetic iron oxide-enhanced magnetic resonance imaging. Eur J Radiol. 2007;63(3):401–7.CrossRef
25.
go back to reference Hwang SO, Lee SW, Kim HJ, Kim WW, Park HY, Jung JH. The comparative study of ultrasonography, contrast-enhanced MRI, and 18F-FDG PET/CT for detecting axillary lymph node metastasis in T1 breast cancer. J Breast Cancer. 2013;16(3):315–21.CrossRef Hwang SO, Lee SW, Kim HJ, Kim WW, Park HY, Jung JH. The comparative study of ultrasonography, contrast-enhanced MRI, and 18F-FDG PET/CT for detecting axillary lymph node metastasis in T1 breast cancer. J Breast Cancer. 2013;16(3):315–21.CrossRef
26.
go back to reference Abe H, Schacht D, Kulkarni K, Shimauchi A, Yamaguchi K, Sennett CA, Jiang Y. Accuracy of axillary lymph node staging in breast cancer patients: an observer-performance study comparison of MRI and ultrasound. Acad Radiol. 2013;20(11):1399–404.CrossRef Abe H, Schacht D, Kulkarni K, Shimauchi A, Yamaguchi K, Sennett CA, Jiang Y. Accuracy of axillary lymph node staging in breast cancer patients: an observer-performance study comparison of MRI and ultrasound. Acad Radiol. 2013;20(11):1399–404.CrossRef
27.
go back to reference Hieken TJ, Trull BC, Boughey JC, Jones KN, Reynolds CA, Shah SS, Glazebrook KN. Preoperative axillary imaging with percutaneous lymph node biopsy is valuable in the contemporary management of patients with breast cancer. Surgery. 2013;154(4):831–8 discussion 838-840.CrossRef Hieken TJ, Trull BC, Boughey JC, Jones KN, Reynolds CA, Shah SS, Glazebrook KN. Preoperative axillary imaging with percutaneous lymph node biopsy is valuable in the contemporary management of patients with breast cancer. Surgery. 2013;154(4):831–8 discussion 838-840.CrossRef
28.
go back to reference Kamitani T, Hatakenaka M, Yabuuchi H, Matsuo Y, Fujita N, Jinnouchi M, Nagao M, Shirahane K, Tokunaga E, Honda H. Detection of axillary node metastasis using diffusion-weighted MRI in breast cancer. Clin Imaging. 2013;37(1):56–61.CrossRef Kamitani T, Hatakenaka M, Yabuuchi H, Matsuo Y, Fujita N, Jinnouchi M, Nagao M, Shirahane K, Tokunaga E, Honda H. Detection of axillary node metastasis using diffusion-weighted MRI in breast cancer. Clin Imaging. 2013;37(1):56–61.CrossRef
29.
go back to reference Kim EJ, Kim SH, Kang BJ, Choi BG, Song BJ, Choi JJ. Diagnostic value of breast MRI for predicting metastatic axillary lymph nodes in breast cancer patients: diffusion-weighted MRI and conventional MRI. Magn Reson Imaging. 2014;32(10):1230–6.CrossRef Kim EJ, Kim SH, Kang BJ, Choi BG, Song BJ, Choi JJ. Diagnostic value of breast MRI for predicting metastatic axillary lymph nodes in breast cancer patients: diffusion-weighted MRI and conventional MRI. Magn Reson Imaging. 2014;32(10):1230–6.CrossRef
30.
go back to reference Chung J, Youk JH, Kim JA, Gweon HM, Kim EK, Ryu YH, Son EJ. Role of diffusion-weighted MRI: predicting axillary lymph node metastases in breast cancer. Acta radiologica (Stockholm, Sweden : 1987). 2014;55(8):909–16.CrossRef Chung J, Youk JH, Kim JA, Gweon HM, Kim EK, Ryu YH, Son EJ. Role of diffusion-weighted MRI: predicting axillary lymph node metastases in breast cancer. Acta radiologica (Stockholm, Sweden : 1987). 2014;55(8):909–16.CrossRef
Metadata
Title
Diagnostic performance of standard breast MR imaging compared to dedicated axillary MR imaging in the evaluation of axillary lymph node
Authors
Su Min Ha
Eun Young Chae
Joo Hee Cha
Hee Jung Shin
Woo Jung Choi
Hak Hee Kim
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Medical Imaging / Issue 1/2020
Electronic ISSN: 1471-2342
DOI
https://doi.org/10.1186/s12880-020-00449-4

Other articles of this Issue 1/2020

BMC Medical Imaging 1/2020 Go to the issue