From the Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea (J.H.B., Y.V.P., J.H.Y., H.J.M., E.K.K., M.J.K.); Department of Radiology and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Republic of Korea (J.H.B.); Department of Radiology, Yonsei University College of Medicine, Yongin Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yongin, Gyeonggi-do, Republic of Korea (E.K.K.); and Department of Radiology, NHIS Ilsan Hospital, Goyang, Republic of Korea (J.K.Y.).
Radiology. 2021 Jul;300(1):46-54. doi: 10.1148/radiol.2021202683. Epub 2021 Apr 27.
Background In the post-American College of Surgeons Oncology Group Z0011 trial era, radiologists have increasingly focused on excluding high-level or advanced axillary lymph node metastasis (ALNM) by using an additional MRI scan positioned higher than lower axillae; however, the value of these additional scans remains undetermined. Purpose To evaluate whether a standard MRI protocol is sufficient to exclude high-level or advanced ALNM in breast cancer or additional MRI of entire axilla is needed. Materials and Methods This retrospective study evaluated women with invasive breast cancer who underwent breast MRI from April 2015 to December 2016. Some underwent neoadjuvant chemotherapy (NAC) and others underwent upfront surgery. Standard (routine axial scans including the lower axillae) and combined (routine axial scans plus additional scans including the entire axilla) MRI protocols were compared for high-level or advanced ALNM detection. Clinical-pathologic characteristics were analyzed. Uni- and multivariable logistic regression was performed to identify predictors of high-level or advanced ALNM. Results A total of 435 women (mean age ± standard deviation, 52 years ± 11) were evaluated (65 in the NAC group, 370 in the non-NAC group). With the standard MRI protocol, predictors of high-level ALNM were peritumoral edema (odds ratio [OR], 12.3; 95% CI: 3.9, 39.4; < .001) and positive axilla (OR, 5.9; 95% CI: 2.0, 15.2; < .001). Only three of 289 women with negative axillae without peritumoral edema had high-level ALNM. Predictors of advanced ALNM were positive axillae (OR, 8.9; 95% CI: 3.7, 21.5; < .001) and peritumoral edema (OR, 2.8; 95% CI: 1.1, 6.9; = .03). Only six of 310 women who had negative axillae without peritumoral edema had advanced ALNM. Conclusion The performance of standard MRI was satisfactory in excluding high-level and advanced axillary lymph node metastasis in most patients with breast cancer. However, the presence of peritumoral edema or positive axillae in the MRI findings emphasizes the benefits of a combined MRI protocol. © RSNA, 2021 See also the editorial by Abe in this issue.
背景 在美国外科医师学院肿瘤学组 Z0011 试验之后的时代，放射科医生越来越关注通过使用位于腋窝下部之上的附加 MRI 扫描来排除高级或晚期腋窝淋巴结转移（ALNM）；然而，这些附加扫描的价值仍未确定。目的 评估标准 MRI 方案是否足以排除乳腺癌中的高级或晚期 ALNM，还是需要对整个腋窝进行额外的 MRI 检查。材料与方法 本回顾性研究纳入了 2015 年 4 月至 2016 年 12 月期间接受乳腺 MRI 检查的浸润性乳腺癌女性患者。一些患者接受了新辅助化疗（NAC），另一些患者则接受了初始手术。比较了标准（包括腋窝下部的常规轴向扫描）和联合（包括整个腋窝的常规轴向扫描加附加扫描）MRI 方案在检测高级或晚期 ALNM 方面的效果。分析了临床病理特征。进行了单变量和多变量逻辑回归分析，以确定高级或晚期 ALNM 的预测因素。结果 共评估了 435 名女性（平均年龄±标准差，52 岁±11 岁）（NAC 组 65 名，非 NAC 组 370 名）。使用标准 MRI 方案，高级 ALNM 的预测因素包括肿瘤周围水肿（比值比[OR]，12.3；95%CI：3.9，39.4； <.001）和阳性腋窝（OR，5.9；95%CI：2.0，15.2； <.001）。在 289 名无肿瘤周围水肿且腋窝阴性的女性中，仅有 3 名发生高级 ALNM。高级 ALNM 的预测因素包括阳性腋窝（OR，8.9；95%CI：3.7，21.5； <.001）和肿瘤周围水肿（OR，2.8；95%CI：1.1，6.9； =.03）。在 310 名无肿瘤周围水肿且腋窝阴性的女性中，仅有 6 名发生高级 ALNM。结论 在大多数乳腺癌患者中，标准 MRI 方案在排除高级和晚期腋窝淋巴结转移方面表现良好。然而，MRI 检查中存在肿瘤周围水肿或阳性腋窝会强调联合 MRI 方案的优势。 ©2021RSNA，见本期 Abe 编辑评论。
