Abstract
BackgroundAxillary nodal status is crucial for the management of cases with recently diagnosed breast cancer; usually addressed via axillary ultrasonography (US) along with tissue sampling in case of suspicion. Axillary nodal dissection and sentinel biopsy may be done, but are rather invasive, carrying a potential complication risk, which raises the need for non-invasive, reliable, pre-operative axillary imaging. We aimed at evaluating the performance of diffusion-weighted imaging (DWI) regarding preoperative axillary evaluation, using functional information derived from diffusion capacity differences between benign and malignant tissue. We included 77 axillary nodes from 77 patients (age range 20–78 years, mean 50 ± 12.6 SD) in our prospective study, presenting with variable clinical breast complaints, all scoring BIRADS 4/5 on sonomammography (SM). They underwent axillary evaluation by both US and DW-MRI where US classified nodes into benign, indeterminate, or malignant by evaluating nodal size, shape, cortical thickness, and hilar fat. Qualitative DWI classified them into either restricted or not and a cut-off apparent diffusion coefficient (ADC) value was calculated to differentiate benign and malignant nodal involvement. Results for each modality were correlated to those of final histopathology, which served as the standard of reference.ResultsThe calculated sensitivity, specificity, accuracy, PPV, and NPV for US was 100%, 36.6%, 75.3%, 71.2%, and 100%, respectively. Statistical indices for qualitative DWI were 76.6%, 63.3%, 76.6%, 63.3%, and 71.4%, respectively (P value < 0.001). The calculated cut off value for ADC between infiltrated and non-infiltrated nodes was 0.95 × 10−3 mm2/s concluding statistical indices of 76.6%, 63.3%, 76.6%, 63.3%, and 71.4%, respectively (P value < 0.001).ConclusionCombining DW-MRI to conventional US improves diagnostic specificity and overall accuracy of preoperative axillary evaluation of patients with recently discovered breast cancer.
Highlights
Axillary nodal status is crucial for the management of cases with recently diagnosed breast cancer; usually addressed via axillary ultrasonography (US) along with tissue sampling in case of suspicion
To predict infiltration by combining US and magnetic resonance imaging (MRI), logistic regression was done, considering P values less than 0.05 as statistically significant. This prospective study included 77 axillary nodes from the ipsilateral sides of suspicious breast lesions from 77 patients. These nodes were evaluated by both conventional US and DW-MRI in an attempt to evaluate the added role of DW-MRI in axillary evaluation
US axillary nodal evaluation according to nodal shape Considering an ovoid shape as a benign descriptor and a non-ovoid shape as a malignant one, 45 out of the examined 77 nodes (58.4%) were ovoid and 32 (41.6%) were non-ovoid resulting in a calculated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 61.7%, 90%, 90.6%, 60%, and 72.7%, respectively, having a significant P value of 0.009 (Table 1)
Summary
Axillary nodal status is crucial for the management of cases with recently diagnosed breast cancer; usually addressed via axillary ultrasonography (US) along with tissue sampling in case of suspicion. We included 77 axillary nodes from 77 patients (age range 20–78 years, mean 50 ± 12.6 SD) in our prospective study, presenting with variable clinical breast complaints, all scoring BIRADS 4/5 on sonomammography (SM). They underwent axillary evaluation by both US and DW-MRI where US classified nodes into benign, indeterminate, or malignant by evaluating nodal size, shape, cortical thickness, and hilar fat. Diffusion-weighted magnetic resonance imaging (DWMRI) utilizes water molecular mobility (Brownian motion) to identify differences in the capacity of diffusion (and signal differences) between malignant and benign tissues providing both functional and morphological data, where water molecule diffusivity and apparent diffusion coefficient (ADC) are markedly affected by lesion cellularity [4].
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: Egyptian Journal of Radiology and Nuclear Medicine
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
