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Differential Diagnosis of Axillary Inflammatory and Metastatic Lymph Nodes in Rabbit Models by Using Diffusion-Weighted Imaging: Compared with Conventional Magnetic Resonance Imaging

  • Wang, Junping (Department of Radiology, Tianjin Medical University General Hospital) ;
  • Liao, Qian (Department of Radiology, The First Affiliated Hospital of Nanchang University) ;
  • Zhang, Yunting (Department of Radiology, Tianjin Medical University General Hospital) ;
  • Yu, Chunshui (Department of Radiology, Tianjin Medical University General Hospital) ;
  • Bai, Renju (Department of Radiology, Tianjin Medical University General Hospital) ;
  • Sun, Haoran (Department of Radiology, Tianjin Medical University General Hospital)
  • Published : 2012.08.01

Abstract

Objective: This experiment aims to determine the diagnostic value of diffusion-weighted imaging (DWI) in the differentiation of axillary inflammatory lymph nodes from metastatic lymph nodes in rabbit models in comparison with conventional magnetic resonance imaging (MRI). Materials and Methods: Conventional MRI and DWI were performed at 4 weeks after successful inoculation into the forty female New Zealand white rabbits' mammary glands. The size-based and signal-intensity-based criteria and the relative apparent diffusion coefficient (rADC) value were compared between the axillary inflammatory lymph nodes and metastatic lymph nodes, with histopathological findings as the reference standard. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of the aforementioned criteria and rADC value in differentiating the axillary inflammatory lymph nodes from metastatic lymph nodes. Results: Thirty-two axillary inflammatory lymph nodes and 46 metastatic ones were successfully isolated and taken into pathological analysis. The differences of the aforementioned criteria between the two groups were not statistically significant (p > 0.05). However, the rADC value of the inflammatory lymph nodes (0.9 ${\pm}$ 0.14) was higher than that of metastatic ones (0.7 ${\pm}$ 0.18), with significant difference (p = 0.016). When the rADC value was chosen as 0.80, the area under the ROC curve is greater than all other criteria, and the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for differentiating two groups were 86.2%, 79.3%, 81.2%, 84.2%, and 85.6%, respectively. Conclusion: Diffusion-weighted imaging is a promising new technique for differentiating axillary inflammatory lymph nodes from metastatic lymph nodes. Compared with routine magnetic resonance sequences, DWI could provide more useful physiological and functional information for diagnosis.

Keywords

References

  1. Orel SG, Schnall MD. MR imaging of the breast for the detection, diagnosis, and staging of breast cancer. Radiology 2001;220:13-30
  2. Morrow M. Role of axillary dissection in breast cancer management. Ann Surg Oncol 1996;3:233-234 https://doi.org/10.1007/BF02306276
  3. Stets C, Brandt S, Wallis F, Buchmann J, Gilbert FJ, Heywang- Kobrunner SH. Axillary lymph node metastases: a statistical analysis of various parameters in MRI with USPIO. J Magn Reson Imaging 2002;16:60-68 https://doi.org/10.1002/jmri.10134
  4. Michel SC, Keller TM, Frohlich JM, Fink D, Caduff R, Seifert B, et al. Preoperative breast cancer staging: MR imaging of the axilla with ultrasmall superparamagnetic iron oxide enhancement. Radiology 2002;225:527-536 https://doi.org/10.1148/radiol.2252011605
  5. Pressman PI. Surgical treatment and lymphedema. Cancer 1998;83:2782-2787 https://doi.org/10.1002/(SICI)1097-0142(19981215)83:12B+<2782::AID-CNCR26>3.0.CO;2-2
  6. Yeoh EK, Denham JW, Davies SA, Spittle MF. Primary breast cancer. Complications of axillary management. Acta Radiol Oncol 1986;25:105-108 https://doi.org/10.3109/02841868609136386
  7. Shin JH, Choi HY, Moon BI, Sung SH. In vitro sonographic evaluation of sentinel lymph nodes for detecting metastasis in breast cancer: comparison with histopathologic results. J Ultrasound Med 2004;23:923-928
  8. Shetty MK, Carpenter WS. Sonographic evaluation of isolated abnormal axillary lymph nodes identified on mammograms. J Ultrasound Med 2004;23:63-71
  9. Krishnamurthy S, Sneige N, Bedi DG, Edieken BS, Fornage BD, Kuerer HM, et al. Role of ultrasound-guided fine-needle aspiration of indeterminate and suspicious axillary lymph nodes in the initial staging of breast carcinoma. Cancer 2002;95:982-988 https://doi.org/10.1002/cncr.10786
  10. Steinkamp HJ, Cornehl M, Hosten N, Pegios W, Vogl T, Felix R. Cervical lymphadenopathy: ratio of long- to shortaxis diameter as a predictor of malignancy. Br J Radiol 1995;68:266-270 https://doi.org/10.1259/0007-1285-68-807-266
  11. Roth Y, Tichler T, Kostenich G, Ruiz-Cabello J, Maier SE, Cohen JS, et al. High-b-value diffusion-weighted MR imaging for pretreatment prediction and early monitoring of tumor response to therapy in mice. Radiology 2004;232:685-692 https://doi.org/10.1148/radiol.2322030778
  12. Squillaci E, Manenti G, Cova M, Di Roma M, Miano R, Palmieri G, et al. Correlation of diffusion-weighted MR imaging with cellularity of renal tumours. Anticancer Res 2004;24:4175- 4179
  13. de Bondt RB, Hoeberigs MC, Nelemans PJ, Deserno WM, Peutz-Kootstra C, Kremer B, et al. Diagnostic accuracy and additional value of diffusion-weighted imaging for discrimination of malignant cervical lymph nodes in head and neck squamous cell carcinoma. Neuroradiology 2009;51:183- 192 https://doi.org/10.1007/s00234-008-0487-2
  14. Ono K, Ochiai R, Yoshida T, Kitagawa M, Omagari J, Kobayashi H, et al. Comparison of diffusion-weighted MRI and 2-[fluorine-18]-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) for detecting primary colorectal cancer and regional lymph node metastases. J Magn Reson Imaging 2009;29:336-340 https://doi.org/10.1002/jmri.21638
  15. Heo SH, Jeong YY, Shin SS, Kim JW, Lim HS, Lee JH, et al. Apparent diffusion coefficient value of diffusion-weighted imaging for hepatocellular carcinoma: correlation with the histologic differentiation and the expression of vascular endothelial growth factor. Korean J Radiol 2010;11:295-303 https://doi.org/10.3348/kjr.2010.11.3.295
  16. Kim JK, Kim KA, Park BW, Kim N, Cho KS. Feasibility of diffusion-weighted imaging in the differentiation of metastatic from nonmetastatic lymph nodes: early experience. J Magn Reson Imaging 2008;28:714-719 https://doi.org/10.1002/jmri.21480
  17. Park SO, Kim JK, Kim KA, Park BW, Kim N, Cho G, et al. Relative apparent diffusion coefficient: determination of reference site and validation of benefit for detecting metastatic lymph nodes in uterine cervical cancer. J Magn Reson Imaging 2009;29:383-390 https://doi.org/10.1002/jmri.21635
  18. Choi EK, Kim JK, Choi HJ, Park SH, Park BW, Kim N, et al. Node-by-node correlation between MR and PET/CT in patients with uterine cervical cancer: diffusion-weighted imaging versus size-based criteria on T2WI. Eur Radiol 2009;19:2024- 2032 https://doi.org/10.1007/s00330-009-1350-5
  19. Lin G, Ho KC, Wang JJ, Ng KK, Wai YY, Chen YT, et al. Detection of lymph node metastasis in cervical and uterine cancers by diffusion-weighted magnetic resonance imaging at 3T. J Magn Reson Imaging 2008;28:128-135 https://doi.org/10.1002/jmri.21412
  20. Nakai G, Matsuki M, Inada Y, Tatsugami F, Tanikake M, Narabayashi I, et al. Detection and evaluation of pelvic lymph nodes in patients with gynecologic malignancies using body diffusion-weighted magnetic resonance imaging. J Comput Assist Tomogr 2008;32:764-768 https://doi.org/10.1097/RCT.0b013e318153fd43
  21. Nakai G, Matsuki M, Harada T, Tanigawa N, Yamada T, Barentsz J, et al. Evaluation of axillary lymph nodes by diffusionweighted MRI using ultrasmall superparamagnetic iron oxide in patients with breast cancer: Initial clinical experience. J Magn Reson Imaging 2011 [Epub ahead of print]
  22. Chen JH, Ling R, Yao Q, Li Y, Chen T, Wang Z, et al. Effect of small-sized liposomal Adriamycin administered by various routes on a metastatic breast cancer model. Endocr Relat Cancer 2005;12:93-100 https://doi.org/10.1677/erc.1.00871
  23. van den Brekel MW, Castelijns JA, Snow GB. The size of lymph nodes in the neck on sonograms as a radiologic criterion for metastasis: how reliable is it? AJNR Am J Neuroradiol 1998;19:695-700
  24. Kim SH, Kim SC, Choi BI, Han MC. Uterine cervical carcinoma: evaluation of pelvic lymph node metastasis with MR imaging. Radiology 1994;190:807-811
  25. Williams AD, Cousins C, Soutter WP, Mubashar M, Peters AM, Dina R, et al. Detection of pelvic lymph node metastases in gynecologic malignancy: a comparison of CT, MR imaging, and positron emission tomography. AJR Am J Roentgenol 2001;177:343-348 https://doi.org/10.2214/ajr.177.2.1770343
  26. Obwegeser R, Lorenz K, Hohlagschwandtner M, Czerwenka K, Schneider B, Kubista E. Axillary lymph nodes in breast cancer: is size related to metastatic involvement? World J Surg 2000;24:546-550 https://doi.org/10.1007/s002689910088
  27. Som PM. Detection of metastasis in cervical lymph nodes: CT and MR criteria and differential diagnosis. AJR Am J Roentgenol 1992;158:961-969 https://doi.org/10.2214/ajr.158.5.1566697
  28. Vandecaveye V, De Keyzer F, Vander Poorten V, Dirix P, Verbeken E, Nuyts S, et al. Head and neck squamous cell carcinoma: value of diffusion-weighted MR imaging for nodal staging. Radiology 2009;251:134-146 https://doi.org/10.1148/radiol.2511080128
  29. Kim JK, Jang YJ, Cho G. Multidisciplinary functional MR imaging for prostate cancer. Korean J Radiol 2009;10:535-551 https://doi.org/10.3348/kjr.2009.10.6.535
  30. Koh DM, Collins DJ. Diffusion-weighted MRI in the body: applications and challenges in oncology. AJR Am J Roentgenol 2007;188:1622-1635 https://doi.org/10.2214/AJR.06.1403
  31. Rahbar H, Partridge SC, Eby PR, Demartini WB, Gutierrez RL, Peacock S, et al. Characterization of ductal carcinoma in situ on diffusion weighted breast MRI. Eur Radiol 2011;21:2011- 2019 https://doi.org/10.1007/s00330-011-2140-4
  32. Imamura T, Isomoto I, Sueyoshi E, Yano H, Uga T, Abe K, et al. Diagnostic performance of ADC for Non-mass-like breast lesions on MR imaging. Magn Reson Med Sci 2010;9:217-225 https://doi.org/10.2463/mrms.9.217
  33. Jeh SK, Kim SH, Kim HS, Kang BJ, Jeong SH, Yim HW, et al. Correlation of the apparent diffusion coefficient value and dynamic magnetic resonance imaging findings with prognostic factors in invasive ductal carcinoma. J Magn Reson Imaging 2011;33:102-109 https://doi.org/10.1002/jmri.22400
  34. Kul S, Cansu A, Alhan E, Dinc H, Gunes G, Reis A. Contribution of diffusion-weighted imaging to dynamic contrast-enhanced MRI in the characterization of breast tumors. AJR Am J Roentgenol 2011;196:210-217 https://doi.org/10.2214/AJR.10.4258
  35. DeLano MC, Cooper TG, Siebert JE, Potchen MJ, Kuppusamy K. High-b-value diffusion-weighted MR imaging of adult brain: image contrast and apparent diffusion coefficient map features. AJNR Am J Neuroradiol 2000;21:1830-1836
  36. Mulkern RV, Barnes AS, Haker SJ, Hung YP, Rybicki FJ, Maier SE, et al. Biexponential characterization of prostate tissue water diffusion decay curves over an extended b-factor range. Magn Reson Imaging 2006;24:563-568

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