Performance of breast magnetic resonance imaging in axillary nodal staging in newly diagnosed breast cancer patients

Jatuporn Chayakulkheeree, Dirapit Pungrassami, Jenjeera Prueksadee, Jatuporn Chayakulkheeree, Dirapit Pungrassami, Jenjeera Prueksadee

Abstract

Purpose: To determine the diagnostic value of breast magnetic resonance imaging (MRI) in detecting axillary metastatic node in newly diagnosed breast cancer, we assessed the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of breast MRI.

Material and methods: Data were collected retrospectively from January 2011 to December 2018. Preoperative breast MRI of women with newly diagnosed breast cancer were reviewed to evaluate the axillary nodal staging by using the morphological characteristic of metastatic axillary lymph node. Statistical analysis was performed to assess the performance of breast MRI in diagnosing metastatic axillary lymph nodes based on the pathological result.

Results: A total of 131 women with breast cancer were analysed. Two hundred and twenty-seven axillary lymph nodes from preoperative breast MRIs were considered to be metastasis. 65.65% (86 patients) of the breast MRI results matched with the pathological results: 37 patients with N0 stage, 39 patients with N1 stage, eight patients with N2 stage, and two patients with N3 stage. Sensitivity of breast MRI for axillary nodal staging was 98.5% (95% CI: 92-100%), and the negative predictive value was 96.4% (86.2-99.9%). Specificity of breast MRI for axillary nodal staging was 57.8% (44.8-70.1%) and the positive predictive value was 71% (60.6-79.9%).

Conclusions: Our study showed that the breast MRI had a high sensitivity (98.5%) and high NPV (96.4%) in detecting metastatic axillary lymph nodes, but its specificity was only fair (57.8%). Overestimation and underestimation of the MRI in N staging were also found in 20.61% and 12.98% of cases, respectively.

Keywords: axilla; breast MRI; breast cancer; lymph nodes; magnetic resonance imaging; metastasis.

Conflict of interest statement

The authors report no conflict of interest.

Copyright © Polish Medical Society of Radiology 2019.

Figures

Figure 1
Figure 1
Coronal magnetic resonance imaging (MRI) of the right axillary region, T2WI. The axilla is divided into three levels on the MRI in the coronal plane. Level I was inferolateral to the pectoralis minor muscle (yellow), level II was behind the pectoralis minor muscle (green), and level III was superomedial to the pectoralis minor muscle (blue)
Figure 2
Figure 2
Axillary level I (A) and II (B) on magnetic resonance imaging axial T2WI. The axillary lymph node level I (arrow) is located lateral to the pectoralis minor muscle (green) while the axillary level II lymph node (arrowhead) is located behind the pectoralis minor muscle (green)
Figure 3
Figure 3
A 70-year-old female with right breast cancer. Axial magnetic resonance imaging (MRI) of the right breast showed an enlarged level I axillary lymph node without fatty hilum and thickened cortex (arrow). From the breast MRI, there was a hyper signal intensity on T2-weighted image (A) with heterogeneous enhancement on contrast-enhanced T1-weighted image with fat suppression (B) and with subtraction (C), which looked suspiciously like a metastatic lymph node. This patient has pN3 stage from pathology

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Source: PubMed

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