Preoperative MRI Improves Prediction of Extensive Occult Axillary Lymph Node Metastases in Breast Cancer Patients with a Positive Sentinel Lymph Node Biopsy

被引:17
作者
Loiselle, Christopher [1 ,8 ]
Eby, Peter R. [6 ]
Kim, Janice N. [1 ]
Calhoun, Kristine E. [3 ]
Allison, Kimberly H. [4 ,9 ]
Gadi, Vijayakrishna K. [5 ,7 ]
Peacock, Sue
Storer, Barry E. [7 ]
Mankoff, David A. [2 ,10 ]
Partridge, Savannah C. [2 ]
Lehman, Constance D. [2 ]
机构
[1] Univ Washington, Med Ctr, Dept Radiat Oncol, Seattle, WA 98195 USA
[2] Univ Washington, Med Ctr, Dept Radiol, Seattle, WA 98195 USA
[3] Univ Washington, Med Ctr, Dept Surg, Seattle, WA 98195 USA
[4] Univ Washington, Med Ctr, Dept Pathol, Seattle, WA 98195 USA
[5] Univ Washington, Med Ctr, Dept Med, Div Med Oncol, Seattle, WA 98195 USA
[6] Virginia Mason Med Ctr, Dept Radiol, Seattle, WA 98101 USA
[7] Fred Hutchinson Canc Res Ctr, Seattle, WA 98104 USA
[8] Swedish Canc Inst, Dept Radiat Oncol, Seattle, WA USA
[9] Stanford Univ, Med Ctr, Dept Pathol, Stanford, CA 94305 USA
[10] Univ Penn, Dept Radiol, Philadelphia, PA 19104 USA
关键词
Breast cancer; radiation; MRI; sentinel lymph node; axilla; RANDOMIZED CONTROLLED-TRIAL; CONTRAST-ENHANCED MRI; TUMOR ANGIOGENESIS; FOLLOW-UP; DISSECTION; LESIONS; RADIOTHERAPY; NOMOGRAM; FEATURES; WOMEN;
D O I
10.1016/j.acra.2013.10.001
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
Rationale and Objectives: To test the ability of quantitative measures from preoperative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to predict, independently and/or with the Katz pathologic nomogram, which breast cancer patients with a positive sentinel lymph node biopsy will have four or more positive axillary lymph nodes on completion axillary dissection. Materials and Methods: A retrospective review was conducted to identify clinically node-negative invasive breast cancer patients who underwent preoperative DCE-MRI, followed by sentinel node biopsy with positive findings and complete axillary dissection (June 2005-January 2010). Clinical/pathologic factors, primary lesion size, and quantitative DCE-MRI kinetics were collected from clinical records and prospective databases. DCE-MRI parameters with univariate significance (P <.05) to predict four or more positive axillary nodes were modeled with stepwise regression and compared to the Katz nomogram alone and to a combined MRI-Katz nomogram model. Results: Ninety-eight patients with 99 positive sentinel biopsies met study criteria. Stepwise regression identified DCE-MRI total persistent enhancement and-volume adjusted peak enhancement as significant predictors of four or more metastatic nodes. Receiver operating characteristic curves demonstrated an area under the curve of 0.78 for the Katz nomogram, 0.79 for the DOE-MRI multivariate model, and 0.87 for the combined MRI-Katz model. The combined model was significantly more predictive than the Katz nomogram alone (P =.003). Conclusions: Integration of DCE-MRI primary lesion kinetics significantly improved the Katz pathologic nomogram accuracy to predict the presence of metastases in four or more nodes. DCE-MRI may help identify sentinel node-positive patients requiring further local-regional therapy.
引用
收藏
页码:92 / 98
页数:7
相关论文
共 35 条
  • [1] Proton MR spectroscopy with choline peak as malignancy marker improves positive predictive value for breast cancer diagnosis: Preliminary study
    Bartella, L
    Morris, EA
    Dershaw, DD
    Liberman, L
    Thakur, SB
    Moskowitz, C
    Guido, J
    Huang, W
    [J]. RADIOLOGY, 2006, 239 (03) : 686 - 692
  • [2] Breast lesions: Correlation of contrast medium enhancement patterns on MR images with histopathologic findings and tumor angiogenesis
    Buadu, LD
    Murakami, J
    Murayama, S
    Hashiguchi, N
    Sakai, S
    Masuda, K
    Toyoshima, S
    Kuroki, S
    Ohno, S
    [J]. RADIOLOGY, 1996, 200 (03) : 639 - 649
  • [3] Metabolic and vascular features of dynamic contrast-enhanced breast magnetic resonance imaging and 15O-water positron emission tomography blood flow in breast cancer
    Eby, Peter R.
    Partridge, Savannah C.
    White, Steven W.
    Doot, Robert K.
    Dunnwald, Lisa K.
    Schubert, Erin K.
    Kurland, Brenda F.
    Lehman, Constance D.
    Mankoff, David A.
    [J]. ACADEMIC RADIOLOGY, 2008, 15 (10) : 1246 - 1254
  • [4] Characteristics of Probably Benign Breast MRI Lesions
    Eby, Peter R.
    DeMartini, Wendy B.
    Gutierrez, Robert L.
    Saini, Monica H.
    Peacock, Sue
    Lehman, Constance D.
    [J]. AMERICAN JOURNAL OF ROENTGENOLOGY, 2009, 193 (03) : 861 - 867
  • [5] Esserman Laura, 1999, Breast J, V5, P13, DOI 10.1046/j.1524-4741.1999.005001013.x
  • [6] Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer
    Fisher, B
    Anderson, S
    Bryant, J
    Margolese, RG
    Deutsch, M
    Fisher, ER
    Jeong, J
    Wolmark, N
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 2002, 347 (16) : 1233 - 1241
  • [7] IDENTIFICATION OF A SUBGROUP OF PATIENTS WITH BREAST-CANCER AND HISTOLOGICALLY POSITIVE AXILLARY NODES RECEIVING ADJUVANT CHEMOTHERAPY WHO MAY BENEFIT FROM POSTOPERATIVE RADIOTHERAPY
    FOWBLE, B
    GRAY, R
    GILCHRIST, K
    GOODMAN, RL
    TAYLOR, S
    TORMEY, DC
    [J]. JOURNAL OF CLINICAL ONCOLOGY, 1988, 6 (07) : 1107 - 1117
  • [8] Locoregional Recurrence After Sentinel Lymph Node Dissection With or Without Axillary Dissection in Patients With Sentinel Lymph Node Metastases
    Giuliano, Armando E.
    McCall, Linda
    Beitsch, Peter
    Whitworth, Pat W.
    Blumencranz, Peter
    Leitch, A. Marilyn
    Saha, Sukamal
    Hunt, Kelly K.
    Morrow, Monica
    Ballman, Karla
    [J]. ANNALS OF SURGERY, 2010, 252 (03) : 426 - 433
  • [9] Axillary Dissection vs No Axillary Dissection in Women With Invasive Breast Cancer and Sentinel Node Metastasis A Randomized Clinical Trial
    Giuliano, Armando E.
    Hunt, Kelly K.
    Ballman, Karla V.
    Beitsch, Peter D.
    Whitworth, Pat W.
    Blumencranz, Peter W.
    Leitch, A. Marilyn
    Saha, Sukamal
    McCall, Linda M.
    Morrow, Monica
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2011, 305 (06): : 569 - 575
  • [10] Long-Term Follow-Up Confirms the Oncologic Safety of Sentinel Node Biopsy Without Axillary Dissection in Node-Negative Breast Cancer Patients
    Giuliano, Armando E.
    Chung, Alice P.
    [J]. ANNALS OF SURGERY, 2010, 251 (04) : 601 - 603