De Cataldo Camilla, Bruno Federico, Palumbo Pierpaolo, Di Sibio Alessandra, Arrigoni Francesco, Clemente Alfredo, Bafile Alberto, Gravina Giovanni Luca, Cappabianca Salvatore, Barile Antonio, Splendiani Alessandra, Masciocchi Carlo, Di Cesare Ernesto
Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
Radiology Unit, San Salvatore Hospital, L'Aquila, Italy.
Gland Surg. 2020 Dec;9(6):2225-2234. doi: 10.21037/gs-20-546.
The presence of axillary lymph nodes metastases in breast cancer is the most significant prognostic factor, with a great impact on morbidity, disease-related survival and management of oncological therapies; for this reason, adequate imaging evaluation is strictly necessary. Physical examination is not enough sensitive to assess breast cancer nodal status; axillary ultrasonography (US) is commonly used to detect suspected or occult nodal metastasis, providing exclusively morphological evaluation, with low sensitivity and positive predictive value. Currently, sentinel lymph node biopsy (SLNB) and/or axillary dissection are the milestone for the diagnostic assessment of axillary lymph node metastases, although its related morbidity. The impact of magnetic resonance imaging (MRI) in the detection of nodal metastases has been widely investigated, as it continues to represent the most promising imaging modality in the breast cancer management. In particular, diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) values represent additional reliable non-contrast sequences, able to improve the diagnostic accuracy of breast cancer MRI evaluation. Several studies largely demonstrated the usefulness of implementing DWI/ADC MRI in the characterization of breast lesions. Herein, in the light of our clinical experience, we perform a review of the literature regarding the diagnostic performance and accuracy of ADC value as potential pre-operative tool to define metastatic involvement of nodal structures in breast cancer patients. For the purpose of this review, PubMed, Web of Science, and SCOPUS electronic databases were searched with different combinations of "axillary lymph node", "breast cancer", "MRI/ADC", "breast MRI" keywords. All original articles, reviews and metanalyses were included.
乳腺癌腋窝淋巴结转移的存在是最重要的预后因素，对发病率、疾病相关生存率及肿瘤治疗管理有重大影响；因此，进行充分的影像学评估非常必要。体格检查评估乳腺癌淋巴结状态的敏感性不足；腋窝超声检查（US）常用于检测可疑或隐匿性淋巴结转移，但其仅提供形态学评估，敏感性及阳性预测值较低。目前，前哨淋巴结活检（SLNB）和/或腋窝清扫术是腋窝淋巴结转移诊断评估的关键方法，尽管存在相关并发症。磁共振成像（MRI）在检测淋巴结转移方面的影响已得到广泛研究，它仍然是乳腺癌管理中最具前景的成像方式。特别是，扩散加权成像（DWI）和表观扩散系数（ADC）值代表了额外可靠的非对比序列，能够提高乳腺癌MRI评估的诊断准确性。多项研究充分证明了在乳腺病变特征描述中应用DWI/ADC MRI的有效性。在此，根据我们的临床经验，我们对有关ADC值作为定义乳腺癌患者淋巴结结构转移累及的潜在术前工具的诊断性能和准确性的文献进行综述。为进行本综述，我们使用“腋窝淋巴结”、“乳腺癌”、“MRI/ADC”、“乳腺MRI”等关键词的不同组合在PubMed、科学网和Scopus电子数据库中进行检索。所有原创文章、综述和荟萃分析均被纳入。
