Abbreviated MRI for Comprehensive Regional Lymph Node Staging during Pre-Operative Breast MRI.

Autor: Bode M; Department of Diagnostic and Interventional Radiology, University Hospital Aachen, 52074 Aachen, Germany., Schrading S; Department of Diagnostic and Interventional Radiology, University Hospital Aachen, 52074 Aachen, Germany., Masoumi A; Department of Diagnostic and Interventional Radiology, University Hospital Aachen, 52074 Aachen, Germany., Morscheid S; Department of Diagnostic and Interventional Radiology, University Hospital Aachen, 52074 Aachen, Germany., Schacht S; Department of Diagnostic and Interventional Radiology, University Hospital Aachen, 52074 Aachen, Germany., Dirrichs T; Department of Diagnostic and Interventional Radiology, University Hospital Aachen, 52074 Aachen, Germany., Gaisa N; Department of Pathology, University Hospital Aachen, 52074 Aachen, Germany., Stickeler E; Department of Gynecology and Obstetrics, University Hospital Aachen, 52074 Aachen, Germany., Kuhl CK; Department of Diagnostic and Interventional Radiology, University Hospital Aachen, 52074 Aachen, Germany.
Jazyk: angličtina
Zdroj: Cancers [Cancers (Basel)] 2023 Mar 20; Vol. 15 (6). Date of Electronic Publication: 2023 Mar 20.
DOI: 10.3390/cancers15061859
Abstrakt: Background: The detection of regional lymph node metastases (LNM), in particular significant LNM (≥N2), is important to guide treatment decisions in women with breast cancer. The purpose of this study was to determine whether a coronal pulse sequence as part of pre-operative breast MRI is useful to identify women without significant LNM.
Material: Retrospective study between January 2017 and December 2019 on 414 consecutive women with breast cancer who underwent pre-operative breast MRI on a 1.5 T system. For lymph node (LN) staging, a coronal pre-contrast non-fat-suppressed T1-weighted TSE sequence was acquired with the system's built-in body coil, covering the chest wall; acquisition time 3:12 min. Two radiologists rated the likelihood of LNM on a 3-point scale (absent/possible/present). Validation was obtained by histology from sentinel LN biopsy, axillary LN dissection, and/or PET/CT.
Results: 368/414 women were staged to have no or non-significant LNM (pN0 in 282/414, pN1 in 86/414), and significant LNM (≥pN2) in 46/414. For identification of women with significant LNM, MRI was true-positive in 42/46, false-negative in 4/46, true-negative in 327/368, and false-positive in 41/83, the latter mostly caused by women with N1-disease (38/41), yielding an NPV and PPV for significant LNM of 98.8% [95%-CI: 97.0-100%] and 50.6% [43.1-58.1%], respectively.
Conclusions: A 3 min coronal T1-weighted pulse sequence covering the chest wall as part of pre-operative breast MRI is useful to rule out significant LNM with high NPV. Where MRI staging is positive for significant LNM, additional work-up is indicated to improve the distinction of N1 and N2 disease.
Databáze: MEDLINE
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