Noninvasive nodal staging in patients with breast cancer using gadofosveset-enhanced magnetic resonance imaging: a feasibility study
Autor: | Marc B. I. Lobbes, Bart de Vries, Kristien Keymeulen, C. Castro, Regina G. H. Beets-Tan, Joachim E. Wildberger, Marjolein L. Smidt, Lori M. van Roozendaal, Esther M. Heuts, Robert-Jan Schipper |
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Přispěvatelé: | Surgery, Beeldvorming, RS: NUTRIM - R2 - Gut-liver homeostasis, Pathologie, RS: MHeNs School for Mental Health and Neuroscience, RS: GROW - School for Oncology and Reproduction |
Rok vydání: | 2012 |
Předmět: |
Contrast Media
Gadolinium DISSECTION ULTRASOUND medicine.diagnostic_test Ultrasound General Medicine Middle Aged Magnetic Resonance Imaging medicine.anatomical_structure axillary lymph node staging Lymphatic Metastasis BIOPSY TRIAL Female Radiology medicine.drug MRI Adult medicine.medical_specialty Axillary lymph nodes Breast Neoplasms Sensitivity and Specificity MAMMOGRAPHY MORBIDITY Breast cancer breast cancer medicine Organometallic Compounds Mammography Humans Radiology Nuclear Medicine and imaging axillary lymph node dissection Aged Neoplasm Staging LYMPH-NODES business.industry Carcinoma Gadofosveset Axillary Lymph Node Dissection Reproducibility of Results Magnetic resonance imaging medicine.disease gadofosveset Axilla METASTASES AXILLARY Lymph Nodes business |
Zdroj: | Investigative Radiology, 48(3), 134-139. LIPPINCOTT WILLIAMS & WILKINS |
ISSN: | 1536-0210 0020-9996 |
Popis: | OBJECTIVES: The objectives of this study were to evaluate whether the axillary lymph nodes show enhancement on magnetic resonance imaging (MRI) after gadofosveset administration, to assess the time to peak enhancement, and to determine the diagnostic performance of gadofosveset-enhanced MRI for axillary nodal staging. MATERIALS AND METHODS: Ten women whose conditions had been diagnosed with invasive breast cancer (>2 cm) underwent both nonenhanced and gadofosveset-enhanced 3-dimensional T1-weighted axillary MRI. Signal intensity of the axillary lymph nodes and different adjacent tissues was measured, and relative signal intensity (rSI) was calculated. A Wilcoxon signed rank test was used to compare results of rSI between different time intervals. A radiologist evaluated all lymph nodes with regard to size, morphologic features, and gadofosveset uptake. All MRI-depicted lymph nodes were matched with the lymph nodes that were removed during surgery. Nodal status was investigated by a pathologist. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of gadofosveset-enhanced MRI for axillary lymph node staging were calculated. RESULTS: After contrast administration, a significant signal increase was observed in the lymph nodes (P < 0.05). When compared with muscle or fat, rSI of the lymph nodes demonstrated a significant postcontrast peak enhancement between 11 minutes and 30 seconds and 20 minutes and 50 seconds (P < 0.05). A total of 152 lymph nodes were harvested during sentinel lymph node biopsy or axillary lymph node dissection, of which 116 were matched with the lymph nodes that were depicted on MRI. Histopathological examination resulted in 21 macrometastases and 8 micrometastases. Using contrast-enhanced MRI, 20 lymph nodes were rated as true positive; 83 as true negative; 4 as false positive; and 9 as false negative. This resulted in an overall node-by-node sensitivity, specificity, PPV, and NPV of 69%, 95%, 83%, and 90%, respectively. If the micrometastases were excluded from the analysis, MRI showed a sensitivity of 86% and a specificity of 94%. Calculated PPV and NPV were 75% and 97%, respectively. CONCLUSIONS: The axillary lymph nodes show enhancement on MRI after gadofosveset administration, with a peak enhancement between 11 minutes and 30 seconds and 20 minutes and 50 seconds. Diagnostic performance of gadofosveset-enhanced axillary lymph node imaging in patients with breast cancer is promising, but further studies need to confirm these results. |
Databáze: | OpenAIRE |
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