Department of Medical Imaging & Interventional Radiology, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.
Eur J Radiol. 2012 Oct;81(10):2602-12. doi: 10.1016/j.ejrad.2012.03.019. Epub 2012 Apr 21.
Malignant axillary lymph nodes are an important predictor for breast cancer recurrence, but invasive dissection or biopsy is required for the diagnosis. We determined whether and how malignant nodes could be diagnosed preoperatively with magnetic resonance (MR) imaging.
We obtained MR images of all women evaluated for breast cancer at the Sun Yat-Sen University Cancer Center in 2010 and correlated the image characteristics of each axillary node with the pathologic diagnosis of the same node.
We analyzed 251 nodes (117 benign; 134 malignant) from 136 women (mean age, 44 years; range, 20-67). Mean diameter of the nodes was 18 mm (range, 5-58 mm). With pathologic diagnosis as the reference standard, MRI-based interpretations were 66.4% sensitive, 94% specific, and 79% accurate. Diameter, pathologic type, apparent diffusion coefficient value (ADC, b=500 and 800), time-intensity curve (TIC) type of breast tumors correlated with node metastasis; ADC value (b=500 and 800), TIC type, early enhancement rate, long-axis, short-axis, shape, margin and the location of nodes correlated with node metastasis (P<0.001 for all). Tumor immunohistochemistry results for estrogen receptors, progesterone receptors, c-erbB-2, vascular endothelial growth factor, and Ki67 were not. An MRI-based lymph node scoring system based on these correlations had a specificity of 91%, a sensitivity of 93%, and an area under the ROC curve of 0.95 (P<0.001).
Metastatic axillary lymph nodes can be accurately diagnosed by MR in women with early breast cancer preoperatively and non-invasively. The scoring system appears to be superior to current methods.
腋窝恶性淋巴结是乳腺癌复发的重要预测指标，但需要通过侵入性解剖或活检来诊断。我们旨在确定磁共振成像（MRI）术前是否以及如何能够诊断恶性淋巴结。
我们获取了中山大学肿瘤防治中心 2010 年所有乳腺癌患者的 MRI 图像，并将每个腋窝淋巴结的图像特征与同一淋巴结的病理诊断进行了相关性分析。
我们分析了 136 名女性（年龄 44 岁，范围 20-67 岁）的 251 个腋窝淋巴结（117 个良性，134 个恶性）。淋巴结平均直径为 18mm（范围 5-58mm）。以病理诊断为参考标准，MRI 诊断的敏感性为 66.4%，特异性为 94%，准确性为 79%。淋巴结直径、病理类型、表观扩散系数值（ADC 值，b=500 和 800）、肿瘤时间-强度曲线（TIC）类型与淋巴结转移相关；ADC 值（b=500 和 800）、TIC 类型、早期强化率、长轴、短轴、形状、边缘和淋巴结位置与淋巴结转移相关（P<0.001）。肿瘤免疫组化结果显示雌激素受体、孕激素受体、c-erbB-2、血管内皮生长因子和 Ki67 与淋巴结转移无关。基于这些相关性的基于 MRI 的淋巴结评分系统具有 91%的特异性、93%的敏感性和 0.95 的 ROC 曲线下面积（P<0.001）。
在早期乳腺癌女性中，术前通过 MRI 可准确、无创地诊断腋窝转移淋巴结。该评分系统似乎优于目前的方法。
