Department of Radiology, Medical Park Ankara, Ankara, Turkey.
Departments of Radiology and Breast Imaging, The University of Texas M. D. Anderson Cancer Center, Houston, Texas.
Breast J. 2019 Jan;25(1):47-55. doi: 10.1111/tbj.13151. Epub 2018 Nov 16.
To evaluate the incremental value of diffusion-weighted imaging (DWI) to conventional MR imaging (CMRI) to predict ipsilateral metastatic axillary lymphadenopathy in patients with newly diagnosed breast cancer.
In an IRB approved retrospective single-institution study, newly diagnosed consecutive breast cancer patients with pathological verification of axillary lymph node (LN) status who had undergone breast MR imaging, including DWI as part of their standard MRI between August 1, 2010, and December 31, 2010, were reviewed. Lesion size, tumor grade, and tissue prognostic factors were noted. Ipsilateral axillary LNs were evaluated using morphological criteria on CMRI. Apparent diffusion coefficient (ADC) values of suspicious ipsilateral LNs were obtained and compared with ADC values of contralateral benign axillary LNs. Receiver operating characteristic curves and multivariate logistic regression analyses were used using pathology as the gold standard.
Eighty-five eligible patients were identified, with surgical pathology revealing 34 patients (40%) who had malignant and 51 (60%) had benign ipsilateral axillae. The sensitivity of CMRI was 79%, with a specificity of 81%, a positive predictive value (PPV) of 65%, and a negative predictive value (NPV) of 89%. On DWI, the mean ADC value was significantly lower for metastatic LNs (0.89 ± 0.18 × 10 mm /s) than for benign ipsilateral LNs (1.41 ± 0.21 × 10 mm /s; P < 0.0001). Using a cutoff ADC value of 0.985 × 10 mm /s, yielded improved sensitivity, specificity, PPV, and NPV of 83%, 98%, 95%, and 93%, respectively.
Apparent diffusion coefficient values increase the specificity of CMRI for predicting ipsilateral axillary LN metastases in patients with newly diagnosed breast cancer.
评估扩散加权成像（DWI）对常规磁共振成像（CMRI）的增量价值，以预测新诊断乳腺癌患者同侧转移性腋窝淋巴结的情况。
在一项经机构审查委员会批准的回顾性单中心研究中，我们对 2010 年 8 月 1 日至 12 月 31 日期间进行了乳腺磁共振成像（包括 DWI）的新诊断连续乳腺癌患者进行了回顾性分析，这些患者的腋窝淋巴结（LN）状态经病理证实，并对其进行了病理验证。记录了病变大小、肿瘤分级和组织预后因素。在 CMRI 上使用形态学标准评估同侧腋窝 LNs。获得可疑同侧 LNs 的表观扩散系数（ADC）值，并与对侧良性腋窝 LNs 的 ADC 值进行比较。使用病理作为金标准进行接收者操作特性曲线和多变量逻辑回归分析。
共确定了 85 例符合条件的患者，手术病理发现 34 例（40%）患者同侧腋窝有恶性淋巴结，51 例（60%）患者同侧腋窝有良性淋巴结。CMRI 的敏感性为 79%，特异性为 81%，阳性预测值（PPV）为 65%，阴性预测值（NPV）为 89%。在 DWI 上，转移性 LNs 的平均 ADC 值（0.89 ± 0.18×10 -3mm 2/s）明显低于良性同侧 LNs（1.41 ± 0.21×10 -3mm 2/s；P<0.0001）。使用 ADC 值截断值为 0.985×10 -3mm 2/s，可分别提高敏感性、特异性、PPV 和 NPV，分别为 83%、98%、95%和 93%。
表观扩散系数值提高了 CMRI 对新诊断乳腺癌患者预测同侧腋窝 LN 转移的特异性。
