Mounir Ahmad M, Shokeir Farah Ahmed, Abd Elraouf Ghada H
Department of Diagnostic Radiology, Mansoura University Faculty of Medicine, Mansoura, Egypt.
Eur J Breast Health. 2025 Mar 25;21(2):141-153. doi: 10.4274/ejbh.galenos.2025.2024-10-4. Epub 2025 Mar 13.
Together with local invasion, one of the important characteristics of cancer is its capacity to spread, resulting in metastases. Before cancer cells metastasize to a secondary site, they must first enter and spread through the blood and lymph vasculature, this is known as lymphovascular invasion (LVI). This LVI and, to a much lesser extent, perineural and neural invasion are one of the biologic prerequisites for systemic spread and metastases. To evaluate the correlation between pre-operative apparent diffusion coefficient (ADC) of the ipsilateral enlarged axillary lymph nodes (LNs) and presence of LVI on post-operative pathology, in patients with invasive breast cancer.
This retrospective study was approved by the institutional review board. It included 100 female patients (mean age, 49 years; range, 30-68 years) with invasive breast cancer, who underwent preoperative magnetic resonance imaging (MRI) and breast surgery. On pre-operative MRI, the ADC was calculated for the ipsilateral enlarged axillary LN. Presence or absence of LVI was assessed on post-operative histopathology. Statistical analysis was performed to investigate any correlation between the ADC value of the axillary LNs and LVI in these patients.
The mean ADC value of the ipsilateral enlarged axillary LNs was significantly lower in LVI positive cases compared to LVI negative cases (0.735 × 10 mm/s) (1.024 × 10 mm/s), (<0.001). Moreover, the mean Ki-67 in LVI positive cases was 46.12%, compared to 21.58% for LVI negative cases. This higher Ki-67 level in LVI positive cases indicates a greater degree of proliferation and thus the more aggressive nature of these tumors, and this was positively correlated with ADC values of the ipsilateral enlarged axillary LNs.
In cases of invasive breast cancer, the ADC value of the ipsilateral enlarged axillary LNs assessed on pre-operative MRI, and Ki-67 status of the tumor were significantly correlated to the LVI status on histopathological assessment. This ADC value may be useful as a predictor of axillary LN involvement, metastasis, and prognosis in invasive breast cancer.
癌症的重要特征之一是其具有扩散能力并导致转移，这与局部侵袭并存。在癌细胞转移至继发部位之前，它们必须首先进入并通过血液和淋巴脉管系统扩散，这被称为淋巴管浸润（LVI）。这种LVI以及程度较轻的神经周围和神经浸润是全身扩散和转移的生物学前提条件之一。旨在评估浸润性乳腺癌患者同侧腋窝肿大淋巴结（LNs）术前表观扩散系数（ADC）与术后病理检查中LVI存在情况之间的相关性。
本回顾性研究经机构审查委员会批准。研究纳入了100例浸润性乳腺癌女性患者（平均年龄49岁；范围30 - 68岁），这些患者均接受了术前磁共振成像（MRI）检查及乳腺手术。在术前MRI上，计算同侧腋窝肿大淋巴结的ADC值。术后组织病理学评估LVI的存在与否。进行统计学分析以研究这些患者腋窝淋巴结ADC值与LVI之间的相关性。
与LVI阴性病例相比，LVI阳性病例同侧腋窝肿大淋巴结的平均ADC值显著更低（0.735×10⁻³mm²/s）（1.024×10⁻³mm²/s），（P<0.001）。此外，LVI阳性病例的平均Ki-67为46.12%，而LVI阴性病例为21.58%。LVI阳性病例中较高的Ki-67水平表明增殖程度更高，因此这些肿瘤具有更强的侵袭性，并且这与同侧腋窝肿大淋巴结的ADC值呈正相关。
在浸润性乳腺癌病例中，术前MRI评估的同侧腋窝肿大淋巴结的ADC值以及肿瘤的Ki-67状态与组织病理学评估的LVI状态显著相关。该ADC值可能有助于预测浸润性乳腺癌腋窝淋巴结受累、转移及预后情况。
