Michel Sven C A, Keller Thomas M, Fröhlich Johannes M, Fink Daniel, Caduff Rosmarie, Seifert Burkhardt, Marincek Borut, Kubik-Huch Rahel A
Institute of Diagnostic Radiology, University Hospital Zurich, Switzerland.
Radiology. 2002 Nov;225(2):527-36. doi: 10.1148/radiol.2252011605.
To evaluate magnetic resonance (MR) imaging with ultrasmall superparamagnetic iron oxide (USPIO) enhancement for preoperative axillary lymph node staging in patients with breast cancer by using histopathologic findings as the standard of reference.
MR imaging was performed with a 1.5-T system within 24-36 hours after the start of intravenous slow-drip infusion of USPIO in 20 patients with breast cancer who were scheduled for surgery, followed by gadolinium-enhanced MR imaging. Lymph nodes were staged prospectively by using newly established criteria, and results were correlated with histologic findings.
In two patients, preoperative findings led to a change in therapeutic approach, and neoadjuvant chemotherapy was given; both patients were excluded from statistical analysis. Results of axillary staging with USPIO-enhanced MR imaging were true-positive in nine, true-negative in seven, false-positive in zero, and false-negative in two of 18 patients (sensitivity, 82%; specificity, 100%; positive predictive value, 100%; second reader, kappa = 1.0). Four hundred five lymph nodes were detected with MR imaging. For first and second readers, respectively, lymph node-based sensitivity was 83% and 73% and specificity was 96% and 97% (kappa = 0.68). USPIO as the intravascular contrast agent could not replace gadolinium for assessment of the primary tumor; however, no clinically relevant interaction was seen. Thus, an integrated imaging approach was feasible in all patients.
USPIO-enhanced MR imaging has the potential to become an adjunct to conventional MR imaging of the breast for preoperative assessment of axillary lymph nodes in patients with breast cancer.
以组织病理学结果为参考标准，评估超小型超顺磁性氧化铁（USPIO）增强磁共振（MR）成像在乳腺癌患者术前腋窝淋巴结分期中的应用价值。
对20例计划手术的乳腺癌患者在静脉缓慢滴注USPIO开始后的24 - 36小时内，采用1.5-T系统进行MR成像，随后进行钆增强MR成像。采用新建立的标准对淋巴结进行前瞻性分期，并将结果与组织学结果进行对比。
2例患者术前检查结果导致治疗方案改变，给予了新辅助化疗，这2例患者被排除在统计分析之外。18例患者中，USPIO增强MR成像腋窝分期结果为真阳性9例，真阴性7例，假阳性0例，假阴性2例（敏感性82%；特异性100%；阳性预测值100%；第二位阅片者，kappa = 1.0）。MR成像检测到405个淋巴结。对于第一位和第二位阅片者，基于淋巴结的敏感性分别为83%和73%，特异性分别为96%和97%（kappa = 0.68）。USPIO作为血管内造影剂不能替代钆用于原发性肿瘤的评估；然而，未观察到临床相关的相互作用。因此，综合成像方法在所有患者中都是可行的。
USPIO增强MR成像有潜力成为乳腺癌患者术前腋窝淋巴结评估的常规乳腺MR成像的辅助手段。
