Arslan Gozde, Altintoprak Kubra Murzoglu, Yirgin Inci Kizildag, Atasoy Mehmet Mahir, Celik Levent
Department of Radiology, Maltepe University Hospital, Maltepe University, Feyzullah Caddesi, Istanbul, Turkey.
Department of Radiology, Sakarya Hendek State Hospital, Sakarya, Turkey.
Springerplus. 2016 Jun 16;5(1):735. doi: 10.1186/s40064-016-2419-7. eCollection 2016.
The most important prognostic variable for early stage breast cancer is the status of axillary lymph nodes. The aim of this study was to evaluate the diagnostic accuracy of preoperative magnetic resonance imaging (MRI) for metastatic axillary lymph node in breast cancer cases with post-operative sentinel lymph node biopsy (SLNB) results.
Women aged between 21 and 73 years who were diagnosed with malignant mass lesion of the breast between 2013 and 2015 were included in this study. The preoperative MR images of patients with diagnosis of breast cancer was evaluated to determine axillary lymph node status. Axillary lymph node size, long axis to short axis ratio, lymph node contours, cortical thickness to anteroposterior diameter ratio, the presence of a fatty hilum and contrast enhancement patterns (homogenous or heterogenous) was noted. Additionally, the presence of comet tail sign which a tail extending from an enhancing breast lesion into the parenchyma and might represent ductal infiltration on post-contrast series was also noted. All data obtained from this evaluation was compared with postoperative SLNB results.
Metastatic nodes were found to have a longer short axis when compared to reactive nodes (p = 0.042; p < 0.05). The long axis to short axis ratio was notably lower in metastatic nodes when compared to reactive nodes. Cortical thickness was higher in metastatic nodes when compared to reactive nodes (p = 0.024; p < 0.05). Comet sign was observed in 15 of metastatic nodes (73.3 %) and in one (5 %) reactive node. This difference was statistically significant (p = 0.001; p < 0.01). While fatty hilum was seen in 40 % of metastatic nodes (n = 6), it was seen in all (n = 20) reactive nodes. This difference was statistically significant (p = 0.001; p < 0.01).
MRI is a non invasive sensitive and specific imaging modality for evaluating the axilla. We have shown that with the help of comet tail sign and status of fatty hilum contrast enhanced MRI has the highest sensitivity of 84.7 % for detecting axillary lymph node metastases (Singletary et al. in Semin Surg Oncol 21(1):53-59, 2003).
早期乳腺癌最重要的预后变量是腋窝淋巴结状态。本研究的目的是通过术后前哨淋巴结活检（SLNB）结果，评估术前磁共振成像（MRI）对乳腺癌腋窝转移淋巴结的诊断准确性。
本研究纳入了2013年至2015年间诊断为乳腺恶性肿块病变、年龄在21岁至73岁之间的女性。对诊断为乳腺癌患者的术前MR图像进行评估，以确定腋窝淋巴结状态。记录腋窝淋巴结大小、长轴与短轴之比、淋巴结轮廓、皮质厚度与前后径之比、脂肪门的存在情况以及对比增强模式（均匀或不均匀）。此外，还记录了在增强后序列上从增强的乳腺病变延伸至实质的彗尾征，其可能代表导管浸润。将本次评估获得的所有数据与术后SLNB结果进行比较。
与反应性淋巴结相比，转移淋巴结的短轴更长（p = 0.042；p < 0.05）。与反应性淋巴结相比，转移淋巴结的长轴与短轴之比明显更低。与反应性淋巴结相比，转移淋巴结的皮质厚度更高（p = 0.024；p < 0.05）。在15个转移淋巴结（73.3%）中观察到彗尾征，在1个（5%）反应性淋巴结中观察到彗尾征。这种差异具有统计学意义（p = 0.001；p < 0.01）。虽然在40%的转移淋巴结（n = 6）中可见脂肪门，但在所有（n = 20）反应性淋巴结中均可见脂肪门。这种差异具有统计学意义（p = 0.001；p < 0.01）。
MRI是一种用于评估腋窝的非侵入性敏感且特异的成像方式。我们已经表明，借助彗尾征和脂肪门状态，对比增强MRI检测腋窝淋巴结转移的最高灵敏度为84.7%（Singletary等人，《Semin Surg Oncol》21(1):53 - 59，2003年）。
