Luciani Alain, Pigneur Frederic, Ghozali Faridah, Dao Thu-Ha, Cunin Patrick, Meyblum Evelyne, De Baecque-Fontaine Cecile, Alamdari Ali, Maison Patrick, Deux Jean François, Lagrange Jean Léon, Lantieri Laurent, Rahmouni Alain
Department of Radiology, AP-HP, Groupe Henri Mondor-Albert Chenevier, 94010 Créteil, France.
Eur J Radiol. 2009 Jan;69(1):59-66. doi: 10.1016/j.ejrad.2008.07.040. Epub 2008 Dec 27.
To provide a strategy for precise co-localization of lymph nodes on axillary lymph-node dissection (ALND) specimens both on pathology and MR. To identify nodal features suggestive of metastatic involvement on a node-to-node basis.
National Institutional review-board approved this prospective study of 18 patients with breast cancer referred for ALND. Ex vivo T1 and inversion recovery (IR) T2 WI of ALND specimens tightly positioned within scaled plastic cranes was performed immediately after surgery. The correspondence of MR-based or pathologically based nodes location was assessed. The MR size and morphological presentation of metastatic and normal nodes were compared (Student's t-test or Mann-Whitney test). Quantitative variables were compared using Pearson coefficient.
207 nodes were retrieved on pathology and 165 on MR. MR-pathological correlation of nodes location was high regarding MR-identified nodes (r=0.755). An MR short axis threshold of 4mm yielded the best predictive value for metastatic nodal involvement (Se=78.6%; Sp=62.3%). Irregular contours (Se=35.7%; Sp=96.7%), central nodal hyper-intensity on IR T2 WI (Se=57.1%; Sp=91.4%), and a cortical thickness above 3mm (Se=63.6%; Sp=83.2%) were significantly associated with metastatic involvement.
Ex vivo MR allows node-to-node correlation with pathology. Morphological MR criteria can suggest metastatic involvement.
提供一种策略，用于在病理学和磁共振成像（MR）上精确共定位腋窝淋巴结清扫（ALND）标本中的淋巴结。在逐个淋巴结的基础上识别提示转移累及的淋巴结特征。
国家机构审查委员会批准了这项对18例因ALND就诊的乳腺癌患者的前瞻性研究。手术后立即对紧密放置在带刻度塑料容器中的ALND标本进行离体T1加权和反转恢复（IR）T2加权成像。评估基于MR或病理学的淋巴结位置的对应关系。比较转移淋巴结和正常淋巴结的MR大小及形态表现（采用学生t检验或曼-惠特尼检验）。使用皮尔逊系数比较定量变量。
病理学检查发现207个淋巴结，MR检查发现165个淋巴结。对于MR识别出的淋巴结，淋巴结位置的MR-病理相关性较高（r = 0.755）。4mm的MR短轴阈值对转移淋巴结累及具有最佳预测价值（敏感性=78.6%；特异性=62.3%）。不规则轮廓（敏感性=35.7%；特异性=96.7%）、IR T2加权成像上的淋巴结中央高信号（敏感性=57.1%；特异性=91.4%）以及皮质厚度超过3mm（敏感性=63.6%；特异性=83.2%）与转移累及显著相关。
离体MR可实现淋巴结与病理学的逐个对应。MR形态学标准可提示转移累及情况。
