Investigative Magnetic Resonance Imaging

Korean Society of Magnetic Resonance in Medicine (대한자기공명의과학회)
권호 표지
DOI QR코드

DOI QR Code

MRI Features for Prediction Malignant Intra-Mammary Lymph Nodes: Correlations with Mammography and Ultrasound

  • Kim, Meejung (Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kang, Bong Joo (Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Park, Ga Eun (Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea)
  • Received : 2022.03.22
  • Accepted : 2022.05.23
  • Published : 2022.07.01
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: To assess clinically significant imaging findings of malignant intramammary lymph nodes (IMLNs) in breast cancer patients and to evaluate their diagnostic performance in predicting malignant IMLN. Materials and Methods: A total of 110 cases with IMLN of BI-RADS category 3 or more, not typical benign IMLN, in MR of breast cancer patients between January 2016 and January 2021 were retrospectively reviewed. After excluding 33 cases, 77 cases were finally included. Among them, 58 and 19 were confirmed as benign and malignant, respectively. Qualitative and quantitative MR imaging features of the IMLN were retrospectively analyzed. Sizes and final assessment categories of IMLN on MRI, mammography, and ultrasound were reviewed. Diagnostic performances of imaging features on MRI, mammography, and ultrasound were then evaluated. Results: For qualitative MR features, shape, margin, and preserved central hilum were significantly different between benign and malignant groups (P < 0.05). For quantitative MR features, long diameter over 6 mm, short diameter over 4 mm, and cortical thickening over 3 mm showed high sensitivities in predicting malignant IMLNs (89.5%, 94.7%, and 100%, respectively). Size exceeding 1 cm showed high specificity and accuracy in predicting malignant IMLN on MR, mammography, and ultrasound (91.4% and 80.5%; 96.6% and 79.25; 98.3% and 80.5%, respectively). Conclusion: Various MR imaging features and size can be helpful for predicting malignant IMLN in breast cancer patients.

Keywords

Acknowledgement

This study is supported by a fund for the breast MRI study group from the Korean Society of Magnetic Resonance in Medicine.

References

  1. Chang JM, Leung JWT, Moy L, Ha SM, Moon WK. Axillary nodal evaluation in breast cancer: state of the art. Radiology 2020;295:500-515 https://doi.org/10.1148/radiol.2020192534
  2. Kim SH, Shin HJ, Shin KC, et al. Diagnostic performance of fused diffusion-weighted imaging using T1-weighted imaging for axillary nodal staging in patients with early breast cancer. Clin Breast Cancer 2017;17:154-163 https://doi.org/10.1016/j.clbc.2016.10.010
  3. Kim EJ, Kim SH, Kang BJ, Choi BG, Song BJ, Choi JJ. Diagnostic value of breast MRI for predicting metastatic axillary lymph nodes in breast cancer patients: diffusion-weighted MRI and conventional MRI. Magn Reson Imaging 2014;32:1230-1236 https://doi.org/10.1016/j.mri.2014.07.001
  4. Shen J, Hunt KK, Mirza NQ, et al. Intramammary lymph node metastases are an independent predictor of poor outcome in patients with breast carcinoma. Cancer 2004;101:1330-1337 https://doi.org/10.1002/cncr.20515
  5. Hogan BV, Peter MB, Shenoy H, Horgan K, Shaaban A. Intramammary lymph node metastasis predicts poorer survival in breast cancer patients. Surg Oncol 2010;19:11-16 https://doi.org/10.1016/j.suronc.2008.12.009
  6. Abdullgaffar B, Gopal P, Abdulrahim M, Ghazi E, Mohamed E. The significance of intramammary lymph nodes in breast cancer: a systematic review and meta-analysis. Int J Surg Pathol 2012;20:555-563 https://doi.org/10.1177/1066896912448425
  7. Hashem T, Abdelmoez A, Rozeka AM, Abdelazeem H. Intramammary lymph nodes, an overlooked breast cancer prognostic tool? World J Surg Oncol 2021;19:114 https://doi.org/10.1186/s12957-021-02219-0
  8. Bitencourt AG, Ferreira EV, Bastos DC, et al. Intramammary lymph nodes: normal and abnormal multimodality imaging features. Br J Radiol 2019;92:20190517 https://doi.org/10.1259/bjr.20190517
  9. Guth AA, Mercado C, Roses DF, et al. Intramammary lymph nodes and breast cancer: a marker for disease severity, or just another lymph node? Am J Surg 2006;192:502-505 https://doi.org/10.1016/j.amjsurg.2006.05.011
  10. Lee SK, Kim S, Choi MY, et al. The clinical meaning of intramammary lymph nodes. Oncology 2013;84:1-5
  11. Bi Z, Chen P, Liu J, et al. Internal mammary sentinel lymph node biopsy after neoadjuvant chemotherapy in breast cancer. J Breast Cancer 2018;21:442-446 https://doi.org/10.4048/jbc.2018.21.e49
  12. Kim R, Chang JM, Lee HB, et al. Predicting axillary response to neoadjuvant chemotherapy: breast MRI and US in patients with node-positive breast cancer. Radiology 2019;293:49-57 https://doi.org/10.1148/radiol.2019190014
  13. Jeong YS, Kang J, Lee J, Yoo TK, Kim SH, Lee A. Analysis of the molecular subtypes of preoperative core needle biopsy and surgical specimens in invasive breast cancer. J Pathol Transl Med 2020;54:87-94 https://doi.org/10.4132/jptm.2019.10.14
  14. Goldhirsch A, Winer EP, Coates AS, et al. Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013. Ann Oncol 2013;24:2206-2223 https://doi.org/10.1093/annonc/mdt303
  15. Gunhan-Bilgen I, Memis A, Ustun EE. Metastatic intramammary lymph nodes: mammographic and ultrasonographic features. Eur J Radiol 2001;40:24-29 https://doi.org/10.1016/S0720-048X(01)00373-4
  16. Edeiken-Monroe BS, Monroe DP, Monroe BJ, et al. Metastases to intramammary lymph nodes in patients with breast cancer: sonographic findings. J Clin Ultrasound 2008;36:279-285 https://doi.org/10.1002/jcu.20445
  17. Ecanow JS, Abe H, Newstead GM, Ecanow DB, Jeske JM. Axillary staging of breast cancer: what the radiologist should know. Radiographics 2013;33:1589-1612 https://doi.org/10.1148/rg.336125060
  18. Baltzer PA, Dietzel M, Burmeister HP, et al. Application of MR mammography beyond local staging: is there a potential to accurately assess axillary lymph nodes? Evaluation of an extended protocol in an initial prospective study. AJR Am J Roentgenol 2011;196:W641-647 https://doi.org/10.2214/AJR.10.4889
  19. Jellici E, Minniti S, Malago R, Fanto C, Pozzi Mucelli R. Focal breast lesions with benign appearances. Review of eight breast cancers with initial features of intramammary lymph node. Radiol Med 2006;111:1078-1086 https://doi.org/10.1007/s11547-006-0106-4
  20. Harnan SE, Cooper KL, Meng Y, et al. Magnetic resonance for assessment of axillary lymph node status in early breast cancer: a systematic review and meta-analysis. Eur J Surg Oncol 2011;37:928-936 https://doi.org/10.1016/j.ejso.2011.07.007
  21. Zhao M, Wu Q, Guo L, Zhou L, Fu K. Magnetic resonance imaging features for predicting axillary lymph node metastasis in patients with breast cancer. Eur J Radiol 2020;129:109093 https://doi.org/10.1016/j.ejrad.2020.109093
  22. Dietzel M, Baltzer PA, Vag T, et al. Application of breast MRI for prediction of lymph node metastases - systematic approach using 17 individual descriptors and a dedicated decision tree. Acta Radiol 2010;51:885-894 https://doi.org/10.3109/02841851.2010.504232