浸润性乳腺癌的动态对比增强和扩散加权磁共振成像用于预测前哨淋巴结状态。

Dynamic contrast-enhanced and diffusion-weighted MRI of invasive breast cancer for the prediction of sentinel lymph node status.

作者信息

Choi Eun Jung, Youk Ji Hyun, Choi Hyemi, Song Ji Soo

机构信息

Department of Radiology, Research Institute of Clinical Medicine of Chonbuk National University - Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju City, South Korea.

Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.

出版信息

J Magn Reson Imaging. 2020 Feb;51(2):615-626. doi: 10.1002/jmri.26865. Epub 2019 Jul 16.

DOI:10.1002/jmri.26865

PMID:31313393

Abstract

BACKGROUND

Although sentinel lymph node biopsy (SLNB) is the current standard for identifying lymph metastasis in breast cancer patients, there are complications of SLNB.

PURPOSE

To evaluate preoperative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) of invasive breast cancer for predicting sentinel lymph node metastasis.

STUDY TYPE

Retrospective.

POPULATION

In all, 309 patients who underwent clinically node-negative invasive breast cancer surgery FIELD STRENGTH/SEQUENCE: 3.0T, DCE-MRI, DWI.

ASSESSMENT

We collected clinicopathologic variables (age, histologic and nuclear grade, extensive intraductal carcinoma component, lymphovascular invasion, and immunohistochemical profiles) and preoperative MRI features (tumor size, background parenchymal enhancement, internal enhancement, adjacent vessel sign, whole-breast vascularity, initial enhancement pattern, kinetic curve types, quantitative kinetic parameters, tumoral apparent diffusion coefficient [ADC], peritumoral maximal ADC, and peritumoral-tumoral ADC ratio).

STATISTICAL TESTS

Multivariate logistic regressions were performed to determine independent variables associated with SLN metastasis, and the area under the receiver operating characteristic curve (AUC) was analyzed for those variables.

RESULTS

41 (13.3%) of the patients showed SLN metastasis. With MRI, tumor size (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.06-1.17), heterogeneous (OR, 5.33; 95% CI, 1.71-16.58), and rim (OR, 15.54; 95% CI, 2.12-113.72) enhancement and peritumoral-tumoral ADC ratio (OR, 72.79; 95% CI, 7.15-740.82) were independently associated with SLN metastasis. Clinicopathologic variables independently associated with SLN metastasis included age (OR, 0.96; 95% CI, 0.92-0.99) and CD31 (OR, 2.90; 95% CI, 1.04-8.92). The area under the curve (AUC) of MRI features (0.80; 95% CI, 0.73-0.87) was significantly higher than for clinicopathologic variables (0.68; 95% CI, 0.60-0.77; P = 0.048) and was barely below statistical significance for combined MRI features with clinicopathologic variables (0.84; 95% CI 0.78-0.90, P = 0.057).

DATA CONCLUSION

Preoperative internal enhancement on DCE-MRI and peritumoral-tumoral ADC ratio on DWI might be useful for predicting SLN metastasis in patients with invasive breast cancer.

LEVEL OF EVIDENCE

3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:615-626.

摘要

背景

尽管前哨淋巴结活检（SLNB）是目前识别乳腺癌患者淋巴结转移的标准方法，但SLNB存在并发症。

目的

评估浸润性乳腺癌的术前动态对比增强磁共振成像（DCE-MRI）和扩散加权成像（DWI）以预测前哨淋巴结转移。

研究类型

回顾性研究。

研究对象

总共309例行临床腋窝淋巴结阴性的浸润性乳腺癌手术的患者。场强/序列：3.0T，DCE-MRI，DWI。

评估

我们收集了临床病理变量（年龄、组织学和核分级、广泛导管内癌成分、淋巴管浸润和免疫组化特征）以及术前MRI特征（肿瘤大小、背景实质强化、内部强化、相邻血管征、全乳血管分布、初始强化模式、动力学曲线类型、定量动力学参数、肿瘤表观扩散系数[ADC]、瘤周最大ADC以及瘤周-肿瘤ADC比值）。

统计分析

采用多因素logistic回归确定与前哨淋巴结转移相关的独立变量，并分析这些变量的受试者操作特征曲线下面积（AUC）。

结果

41例（13.3%）患者出现前哨淋巴结转移。MRI检查显示，肿瘤大小（比值比[OR]，1.11；95%置信区间[CI]，1.06 - 1.17）、不均匀强化（OR，5.33；95%CI，1.71 - 16.58）、边缘强化（OR，15.54；95%CI，2.12 - 113.72）以及瘤周-肿瘤ADC比值（OR，72.79；95%CI，7.15 - 740.82）与前哨淋巴结转移独立相关。与前哨淋巴结转移独立相关的临床病理变量包括年龄（OR，0.96；95%CI，0.92 - 0.99）和CD31（OR，2.90；95%CI，1.04 - 8.92）。MRI特征的曲线下面积（AUC）（0.80；95%CI，0.73 - 0.87）显著高于临床病理变量（0.68；95%CI，0.60 - 0.77；P = 0.048），而联合MRI特征与临床病理变量的AUC（0.84；95%CI，0.78 - 0.90，P = 0.057）略低于统计学意义。