The impact of body mass index (BMI) on MRI diagnostic performance and surgical management for axillary lymph node in breast cancer

Shu-Tian Chen,Shou-Tung Chen,Chi Wei Mok,Hwa-Koon Wu,Chiung-Ying Liao,Wen-Pei Wu,Hung-Wen Lai,Dar-Ren Chen

doi:10.1186/s12957-022-02520-6

Abstract

BackgroundWe hypothesized that different BMI might have different impact on pre-operative MRI axillary lymph node (ALN) prediction accuracy and thereby subsequent surgical lymph node management. The aim of this study is to evaluate the effect of BMI on presentation, surgical treatment, and MRI performance characteristics of breast cancer with the main focus on ALN metastasis evaluation.MethodsThe medical records of patients with primary invasive breast cancer who had pre-operative breast MRI and underwent surgical resection were retrospectively reviewed. They were categorized into 3 groups in this study: underweight (BMI < 18.5), normal (BMI of 18.5 to 24), and overweight (BMI > 24). Patients’ characteristics, surgical management, and MRI performance for axillary evaluation between the 3 groups were compared.ResultsA total of 2084 invasive breast cancer patients with a mean age of 53.4 ± 11.2 years were included. Overweight women had a higher rate of breast conserving surgery (56.7% vs. 54.5% and 52.1%) and initial axillary lymph node dissection (15.9% vs. 12.2% and 8.5%) if compared to normal and underweight women. Although the post-operative ALN positive rates were similar between the 3 groups, overweight women were significantly found to have more axillary metastasis on MRI compared with normal and underweight women (50.2% vs 37.7% and 18.3%). There was lower accuracy in terms of MRI prediction in overweight women (65.1%) than in normal and underweight women (67.8% and 76.1%).ConclusionOur findings suggest that BMI may influence the diagnostic performance on MRI on ALN involvement and the surgical management of the axilla in overweight to obese women with breast cancer.

Highlights

We hypothesized that different Body mass index (BMI) might have different impact on pre-operative MRI axillary lymph node (ALN) prediction accuracy and thereby subsequent surgical lymph node management
Since axillary lymph node dissection (ALND) may not be necessary in women with metastatic axillary disease who meet the trial criteria, these studies had changed the role of pre-operative axillary imaging from identifying ALN metastasis to detecting patients with advanced or high-level axillary lymph nodes
Patient and clinicopathological characteristics According to the inclusion and exclusion criteria, a total of 2084 women with primary operable invasive breast cancer patients who received pre-operative breast MRI and surgical treatment were selected from Changhua Christian Hospital (CCH) Breast Cancer Database

Summary

Introduction

We hypothesized that different BMI might have different impact on pre-operative MRI axillary lymph node (ALN) prediction accuracy and thereby subsequent surgical lymph node management. Axillary lymph node (ALN) staging is an important part in the surgical management of breast cancer. Axillary lymph node dissection (ALND) was the gold standard in determining the status of ALNs in patients with breast cancer. Sentinel lymph node biopsy (SLNB), which was associated with less morbidity, had gradually replaced ALND for surgical ALN evaluation in patients with early breast cancer [9,10,11]. Since ALND may not be necessary in women with metastatic axillary disease who meet the trial criteria, these studies had changed the role of pre-operative axillary imaging from identifying ALN metastasis to detecting patients with advanced (more than 2 metastatic LNs) or high-level axillary lymph nodes (metastasis in level II or III LNs). Pre-operative axillary imaging plays an important role on identifying patients who are suitable for SLNB [14] or even omitting biopsy in some conditions [15, 16]

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