Correlation between the area of high-signal intensity on SPIO-enhanced MR imaging and the pathologic size of sentinel node metastases in breast cancer patients with positive sentinel nodes

BMC Medical Imaging - Tập 13 - Trang 1-7 - 2013
Kazuyoshi Motomura1, Tetsuta Izumi2, Souichirou Tateishi2, Hiroshi Sumino2, Atsushi Noguchi2, Takashi Horinouchi2, Katsuyuki Nakanishi2
1Department of Surgery Osaka Medical Center for Cancer and Cardiovascular Diseases Osaka Japan
2Department of Radiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan

Tóm tắt

We previously demonstrated that superparamagnetic iron oxide (SPIO)-enhanced MR imaging is promising for the detection of metastases in sentinel nodes localized by CT-lymphography in patients with breast cancer. The purpose of this study was to determine the predictive criteria of the size of nodal metastases with SPIO-enhanced MR imaging in breast cancer, with histopathologic findings as reference standard. This study included 150 patients with breast cancer. The patterns of SPIO uptake for positive sentinel nodes were classified into three; uniform high-signal intensity, partial high-signal intensity involving ≥50% of the node, and partial high-signal intensity involving <50% of the node. Imaging results were correlated with histopathologic findings. Thirty-three pathologically positive sentinel nodes from 30 patients were evaluated. High-signal intensity patterns that were uniform or involved ≥50% of the node were observed in 23 nodes that contained macro-metastases and no node that contained micro-metastases, while high-signal intensity patterns involving <50% of the node were observed in 2 nodes that contained macro-metastases and 8 nodes that contained micro-metastases. When the area of high-signal intensity was compared with the pathological size of the metastases, a pathologic >2 mm sentinel node metastases correlated with the area of high-signal intensity, however, a pathologic ≤2 mm sentinel node metastases did not. High-signal intensity patterns that are uniform or involve ≥50% of the node are features of nodes with macro-metastases. The area of high-signal intensity correlated with the pathological size of metastases for nodes with metastases >2 mm in this series.

Tài liệu tham khảo

Giuliano AE, Kirgan DM, Guenther JM, Morton DL: Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg. 1994, 220: 391-401. Giuliano AE, Jones RC, Brennan M, Statman R: Sentinel lymphadenectomy in breast cancer. J Clin Oncol. 1997, 15: 2345-2350. Motomura K, Inaji H, Komoike Y, Kasugai T, Nagumo S, Noguchi S, Koyama H: Sentinel node biopsy in breast cancer patients with clinically negative lymph-nodes. Breast Cancer. 1999, 6: 259-262. Krag D, Weaver D, Ashikaga T, Moffat F, Klimberg VS, Shriver C, Feldman S, Kusminsky R, Gadd M, Kuhn J, Harlow S, Beitsch P: The sentinel node in breast cancer: a multicenter validation study. N Engl J Med. 1998, 339: 941-946. Veronesi U, Paganelli G, Galimberti V, Viale G, Zurrida S, Bedoni M, Costa A, de Cicco C, Geraghty JG, Luini A, Sacchini V, Veronesi P: Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes. Lancet. 1997, 349: 1864-1867. Wilke LG, McCall LM, Posther KE, Whitworth PW, Reintgen DS, Leitch AM, Gabram SG, Lucci A, Cox CE, Hunt KK, Herndon JE, Giuliano AE: Surgical complications associated with sentinel lymph node biopsy: results from a prospective international cooperative group trial. Ann Surg Oncol. 2006, 13: 491-500. Lucci A, McCall LM, Beitsch PD, Whitworth PW, Reintgen DS, Blumencranz PW, Leitch AM, Saha S, Hunt KK, Giuliano AE: American College of Surgeons Oncology Group: Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group Trial Z0011. J Clin Oncol. 2007, 25: 3657-3663. McLaughlin SA, Wright MJ, Morris KT, Sampson MR, Brockway JP, Hurley KE, Riedel ER, Van Zee KJ: Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: objective measurements. J Clin Oncol. 2008, 26: 5213-5219. Harisinghani MG, Barentsz J, Hahn PF, Deserno WM, Tabatabaei S, van de Kaa CH, de la Rosette J, Weissleder R: Noninvasive detection of clinically occult lymph-node metastases in prostate cancer. N Engl J Med. 2003, 348: 2491-2499. Rockall AG, Sohaib SA, Harisinghani MG, Babar SA, Singh N, Jeyarajah AR, Oram DH, Jacobs IJ, Shepherd JH, Reznek RH: Diagnostic performance of nanoparticle-enhanced magnetic resonance imaging in the diagnosis of lymph node metastases in patients with endometrial and cervical cancer. J Clin Oncol. 2005, 23: 2813-2821. Stets C, Brandt S, Wallis F, Buchmann J, Gilbert FJ, Heywang-Köbrunner SH: Axillary lymph node metastases: a statistical analysis of various parameters in MRI with USPIO. J Magn Reson Imaging. 2002, 16: 60-68. Will O, Purkayastha S, Chan C, Athanasiou T, Darzi AW, Gedroyc W, Tekkis PP: Diagnostic precision of nanoparticle-enhanced MRI for lymph-node metastases: a meta-analysis. Lancet Oncol. 2006, 7: 52-60. Motomura K, Ishitobi M, Komoike Y, Koyama H, Noguchi A, Sumino H, Kumatani Y, Inaji H, Horinouchi T, Nakanishi K: SPIO-enhanced magnetic resonance imaging for the detection of metastases in sentinel nodes localized by computed tomography lymphography in patients with breast cancer. Ann Surg Oncol. 2011, 18: 3422-3429. Ohno Y, Hatabu H, Takenaka D, Higashino T, Watanabe H, Ohbayashi C, Sugimura K: CT-guided transthoracic needle aspiration biopsy of small (< or = 20 mm) solitary pulmonary nodules. AJR Am J Roentgenol. 2003, 180: 1665-1669. Hudgins PA, Anzai Y, Morris MR, Lucas MA: Ferumoxtran-10, a superparamagnetic iron oxide as a magnetic resonance enhancement agent for imaging lymph nodes: a phase 2 dose study. AJNR Am J Neuroradiol. 2002, 23: 649-656. Anzai Y, Piccoli CW, Outwater EK, Stanford W, Bluemke DA, Nurenberg P, Saini S, Maravilla KR, Feldman DE, Schmiedl UP, Brunberg JA, Francis IR, Harms SE, Som PM, Tempany CM, Group: Evaluation of neck and body metastases to nodes with ferumoxtran 10-enhanced MR imaging: phase III safety and efficacy study. Radiology. 2003, 228: 777-788. Motomura K, Inaji H, Komoike Y, Hasegawa Y, Kasugai T, Noguchi S, Koyama H: Combination technique is superior to dye alone in identification of the sentinel node in breast cancer patients. J Surg Oncol. 2001, 76: 95-99. Motomura K, Komoike Y, Hasegawa Y, Kasugai T, Inaji H, Noguchi S, Koyama H: Intradermal radioisotope injection is superior to subdermal injection for the identification of the sentinel node in breast cancer patients. J Surg Oncol. 2003, 82: 91-96. Motomura K, Nagumo S, Komoike Y, Koyama H, Inaji H: Accuracy of imprint cytology for intraoperative diagnosis of sentinel node metastases in breast cancer. Ann Surg. 2008, 247: 839-842. American Joint Committee on Cancer, et al: Breast. AJCC Cancer Staging Handbook. Edited by: Greene FL, Page DL, Fleming ID, Fritz AG, Balch CM, Haller DG. 2002, New York: Springer, 155-181. 6 Lahaye MJ, Engelen SM, Kessels AG, de Bruïne AP, von Meyenfeldt MF, van Engelshoven JM, van de Velde CJ, Beets GL, Beets-Tan RG: USPIO-enhanced MR imaging for nodal staging in patients with primary rectal cancer: predictive criteria. Radiology. 2008, 246: 804-811. de Boer M, van Deurzen CH, van Dijck JA, Borm GF, van Diest PJ, Adang EM, Nortier JW, Rutgers EJ, Seynaeve C, Menke-Pluymers MB, Bult P, Tjan-Heijnen VC: Micrometastases or isolated tumor cells and the outcome of breast cancer. N Engl J Med. 2009, 361: 653-663. de Boer M, van Dijck JA, Bult P, Borm GF, Tjan-Heijnen VC: Breast cancer prognosis lymph node metastases, isolated tumor cells, and micrometastases. J Natl Cancer Inst. 2010, 102: 410-425. Hansen NM, Grube B, Ye X, Turner RR, Brenner RJ, Sim MS, Giuliano AE: Impact of in the sentinel node of patients with invasive breast cancer. J Clin Oncol. 2009, 27: 4679-4684. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2342/13/32/prepub