Abstract
Background
We performed a retrospective study to establish the optimal radiological criteria for axillary lymph node metastases from breast cancer by measuring all dissected nodes, and to determine whether magnetic resonance imaging (MRI) could reliably reveal axillary involvement.
Methods
Pathological findings and MRI scans of 202 patients with invasive breast cancer were re-viewed. The long- and short-axis dimensions of all level I and II lymph nodes were measured micro-scopically, and then the long-to-short axis (L/S) ratio of each node was calculated. These parameters were compared with pathological nodal status to define radiological criteria for axillary involvement. MRI was carried out using T1-weighted spin-eho sequences in the coronal and sagittal planes. On MRI, every detected lymph node was measured and the shape of the nodal cortex was also examined. Then the diagnostic ability of MRI was assessed using these morphologic criteria.
Results
On histopathological examinations of 4043 dissected lymph nodes, a long-axis dimension of 10 mm or larger combined with a long-to-short axis ratio of less than 1.6 was the most accurate criteria for predicting lymph node metastases. On MRI, eccentric cortical hypertrophy was seen in only metas-tatic axillae. When these morphologic features were used as criteria for malignancy, MRI had a sensi-tivity of 79%, a specificity of 93%, and an accuracy of 88%. In 16 of 17 false-negative axillae, MRI showed normally sized lymph nodes (<10 mm).
Conclusion
Our study indicates that MRI is a useful diagnostic method for the evaluation of axillary nodal status, but is limited in the detection of small metastatic lymph nodes.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
Abbreviations
- MRI:
-
Magnetic resonance imaging
- US:
-
Ultrasonography
- CT:
-
Computed tomography
- L/S ratio:
-
Long-to-short axis ratio
References
Tabar L, Fagerberg G, Day N,et al: Breast cancer treatment and natural history; New insights from results of screening.Lancet 339:412–414, 1992.
Chadha M, Chabon AB, Friedmann P,et al: Predictors of axillary lymph node metastases in patients with T1 breast cancer.Cancer 73:350–353, 1994.
Fein DA, Fowble BL, Hanlon AL,et al: Identification of women with T1-T2 breast cancer at low risk of positive axillary nodes.J Surg Oncol 65:34–39, 1997.
Barth A, Craig PH, Silverstein MJ: Predictors of axillary lymph node metastases in patients with T1 breast carcinoma.Cancer 79:1918–1922, 1997.
Cady B: The need to reexamine axillary lymph node dissection in invasive breast cancer.Cancer 73:505–508, 1994.
Dershaw DD, Panicek DM, Osborne MP: Significance of lymph nodes visualized by the mammographic axillary view.Breast Dis 4:271–280, 1991.
Bruneton JN, Caramella E, Hery M,et al: Axillary lymph node metastases in breast cancer; Preoperative detection with US.Radiology 158:325–326, 1986.
Vaidya JS, Vyas JJ, Thakur MH,et al: Role of ultrasonography to detect axillary node involvement in operable breast cancer.Eur J Surg Oncol 22:140–143, 1996.
Pamilo M, Soiva M, Lavast EM: Real-time ultrasound, axillary mammography, and clinical examination in the detection of axillary lymph node metastases in breast cancer patients.J Ultrasound Med 8:115–120, 1989.
March DE, Wechsler RJ, Kurtz AB,et al: CT-patho-logic correlation of axillary lymph nodes in breast carcinoma.J Comput Assist Tomogr 15:440–444, 1991.
Som PM: Detection of metastasis in cervical lymph nodes; CT and MR criteria and differential diagnosis.Am J Roentgenol 158:961–969, 1992.
Lehr L, Rupp N, Siewart JR: Assessment of resectabil-ity of oesphageal cancer by computed tomography and magnetic resonance imaging.Surgery 103:344–350, 1988.
Jager GJ, Barentsz JO, Oosterhof GO,et al: Pelvic adenopathy in prostatic and urinary bladder carcinoma; MR imaging with a three-dimensional T1-weighted magnetization-prepared rapid gradient-echo sequence.AJR 167:1503–1507, 1996.
Oura S: A clinical study of nipple preserved radical mastectomy; It is safetiness in the preservation of nipple-areola complex on breast cancer operation.J Wakayama Med Soc 45:525–536, 1994(in Japanese with English abstract).
Som PM: Lymph nodes of the neck.Radiology 165:593–600, 1987.
Close LG, Merkel M, Vuitch MF,et al: Computed tomographic evaluation of regional lymph node involvement in cancer of the oral cavity and oropharynx.Head Neck 11:309–317, 1989.
Sacre RA: Clinical evaluation of axillary lymph nodes compared to surgical and pathological findings.Eur J Surg Oncol 12:169–175, 1986.
Lein HH, Hindskold L, Stenwig AE,et al: Shape of retroperitoneal lymph nodes at computed tomography does not correlate to metastatic disease in early stage non-seminomatous testicular tumors.Acta Radiologica 28:271–273, 1987.
Takeshi A, Matsumoto T, Kuramitu T,et al: Is it possible differentiate malignant mediastinal nodes from benign nodes by size?Chest 110:1004–1008, 1996.
Vassallo P, Edel G, Roos N,et al: In-vitro high-resolution ultrasonography of benign and malignant lymph nodes; A sonographic-pathologic correlation.Invest Radiol 28:698–705, 1993.
Feu J, Tresserra F, Fabregas R,et al: Metastatic breast carcinoma in axillary lymph nodes; In vitro US detection.Radiology 205:831–835, 1997.
Yang WT, Ahuja A, Tang A,et al: High resolution sonographic detection of axillary lymph node metastases in breast cancer.J Ultrasound Med 16:241–246, 1996.
Marchal G, Oyen R, Verschakelen J,et al: Sonographic appearance of normal lymph nodes.J Ultrasound Med 4:417–419, 1985.
Verbanck J, Vandewiele I, De Winter H,et al: Value of axillary ultrasonography and sonographically guided puncture of axillary nodes; A prospective study in 144 consecutive patients.J Clin Ultrasound 25:53–56, 1997.
Bonnema J, van Geel AN, van Ooijen B,et al: Ultrasound-guided aspiration biopsy for detection of nonpalpable axillary node metastases in breast cancer patients; New diagnostic method.World J Surg 21:270–274, 1997.
Ogawa Y, Nishioka A, Hamada N,et al: Recent progress of imaging diagnosis for breast cancer; Role of CT and/or Helical CT for breast cancer.Jpn J Breast Cancer 11:243–253, 1996(in Japanese with English abstract).
Fossel ET, Brodsky G, Delayre JL,et al: Nuclear magnetic resonance for the differentiation of benign and malignant breast tissues and axillary lymph nodes.Ann Surg 198:541–545, 1983.
Yoshimoto M, Iwase T, Watanabe S,et al: Magnetic resonance imaging and metastatic pattern of the internal mammary lymph nodes of breast cancer.Jpn J Breast Cancer 6:221–227, 1991(in Japanese with English abstract).
Yoshimoto M, Iwase T, Kasumi F: Diagnostic accuracy of axillary lymph node metastases in breast cancer by palpation and diagnostic imaging.Jpn J Breast Cancer 10:460–467, 1995(in Japanese with English abstract).
Hergan K, Morrigl B, Kathrein A,et al: MR and CT anatomy of the axilla.Acta Radiologica 38:198–205, 1997.
Anzai Y, Blackwell KE, Hirshowitz SL: Initial clinical experience with dextran-coated superparamagnetic iron oxide for detection of lymph node metastases in patients with head and neck cancer.Radiology 192:709–715, 1994.
Albertini JJ, Lyman GH, Cox C,et al: Lymphatic mapping and sentinel node biopsy in the patient with breast cancer.JAMA 276:1818–1822, 1996.
Veronesi U, Paganelli G, Galimberti V,et al: Sentinel node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes.Lancet 349:1864–1867, 1997.
Giuliano AE, Jones RC, Brennan M,et al: Sentinel lymphadenectomy in breast cancer.J Clin Oncol 15:2345–2350, 1997.
Krag D, Weaver D, Ashikaga T,et al: The sentinel node in breast cancer.N Engl J Med 339:941–946, 1998.
Author information
Authors and Affiliations
About this article
Cite this article
Yoshimura, G., Sakurai, T., Oura, S. et al. Evaluation of axillary lymph node status in breast cancer with MRI. Breast Cancer 6, 249–258 (1999). https://doi.org/10.1007/BF02967179
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02967179