Abstract
Background: In various cancer types, the first step towards extended metastatic disease is the presence of lymph node metastases. Imaging methods with sufficient diagnostic accuracy are required to personalize treatment. Lymph node metastases can be detected with ultrasmall superparamagnetic iron oxide (USPIO)-enhanced magnetic resonance imaging (MRI), but this method needs validation. Here, a workflow is presented, which is designed to compare MRI-visible lymph nodes on a node-to-node basis with histopathology. Methods: In patients with prostate, rectal, periampullary, esophageal, and head-and-neck cancer, in vivo USPIO-enhanced MRI was performed to detect lymph nodes suspicious of harboring metastases. After lymphadenectomy, but before histopathological assessment, a 7 Tesla preclinical ex vivo MRI of the surgical specimen was performed, and in vivo MR images were radiologically matched to ex vivo MR images. Lymph nodes were annotated on the ex vivo MRI for an MR-guided pathological examination of the specimens. Results: Matching lymph nodes of ex vivo MRI to pathology was feasible in all cancer types. The annotated ex vivo MR images enabled a comparison between USPIO-enhanced in vivo MRI and histopathology, which allowed for analyses on a nodal, or at least on a nodal station, basis. Conclusions: A workflow was developed to validate in vivo USPIO-enhanced MRI with histopathology. Guiding the pathologist towards lymph nodes in the resection specimens during histopathological work-up allowed for the analysis at a nodal basis, or at least nodal station basis, of in vivo suspicious lymph nodes with corresponding histopathology, providing direct information for validation of in vivo USPIO-enhanced, MRI-detected lymph nodes.
Highlights
Many different types of solid cancers have a high propensity to metastasize to locoregional and distant lymph nodes, which is one of the most important prognostic factors for 4.0/).survival [1,2]
Visualizing ultrasmall superparamagnetic iron oxide (USPIO) accumulation in ex vivo magnetic resonance imaging (MRI) is not a prerequisite in the workflow we propose here, as the ex vivo MRI is used as an intermediate step to match any lymph node from in vivo MRI to the dissection specimen and to histopathology
In vivo USPIO-enhanced MRI and ex vivo MRI of resected specimens was technically feasible in all five patients
Summary
Many different types of solid cancers have a high propensity to metastasize to locoregional and distant lymph nodes, which is one of the most important prognostic factors for 4.0/).survival [1,2]. Many different types of solid cancers have a high propensity to metastasize to locoregional and distant lymph nodes, which is one of the most important prognostic factors for 4.0/). With continuously improving opportunities for selective treatment of individual metastatic deposits with surgery or radiotherapy, assessment and exact localization of lymph node metastases is crucial. Highly sensitive detection of small lymph node metastases is urgently needed [3]. The first step towards extended metastatic disease is the presence of lymph node metastases. Lymph node metastases can be detected with ultrasmall superparamagnetic iron oxide (USPIO)-enhanced magnetic resonance imaging (MRI), but this method needs validation. Methods: In patients with prostate, rectal, periampullary, esophageal, and head-and-neck cancer, in vivo USPIO-enhanced MRI was performed to detect lymph nodes suspicious of harboring metastases. But before histopathological assessment, a 7 Tesla preclinical ex vivo MRI of the surgical specimen was performed, and in vivo
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