Learning objectives
The DWI and ADC in pre-operative breast MRI might represent a valid diagnostic tool for differentiation of benign from metastatic axillary lymph nodes in patients with newly diagnosed breast cancer.
Breast cancer is the most commonly diagnosed cancer among women throughout the world and its incidence continues to increase.
The presence of axillary lymph node metastases in patients with breast cancer helps determine surgical and postsurgical management and remains the most important prognostic factor.
The non-invasive differentiation between benign and malignant lymph nodes remains challenging;...
Background
The role of breast MRI in the assessment of axillary lymph nodes in breast cancer
The main goal for pre-operative imaging is to identify the presence of axillary metastases with a positive predictive value that is high enough to be useful to the surgeon in deciding when to proceed directly to ALND (axillary lymph node dissection).
ANATOMY OF AXILLARY REGION:
Familiarity with axillary anatomy is important,
both to be able to thoroughly examine the axilla with ultrasonography (US),
as well as to accurately identify the...
Findings and procedure details
The diagnostic accuracy of DWI and ADC in predicting axillary lymph nodes status
DWI -Diffusion weighted imaging (DWI) is a non-contrast MRI technique that can provide unique information about intercellular water motion (Figure 6).
Every change in the movement of water protons produces a variation of signal intensity on DW images and,
as a consequence,
apparent diffusion coefficient (ADC) maps,
being sensitive to certain parameters such as cell organization,
cell density,
microstructure and microcirculation.
Initial reports demonstrated that DW imaging may be a valuable tool...
Conclusion
In clinical practice,
it is still difficult to discover the early metastasis involving axillary lymph nodes in patients with breast cancer.
Given current estimates of diagnostic accuracy,
an alternative strategy,
where MRI is added to the current pathway before ALND/SLNB (sentinel lymph node biopsy),
could be considered.
This way,
women at greatest risk (positive for nodal metastases by any of ultrasound,
biopsy or USPIO-enhanced MRI) could be triaged for ALND,
whilst those who are negative would still receive SLNB and benefit from the high specificity...
References
Warwick,
Roger; Peter L.
Williams (1973) [1858].
"Angiology (Chapter 6)".Gray's anatomy.
illustrated by Richard E.
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London: Longman.
pp.588–785.
Fornasa F,
Nesotti MV, Bovo C,
Bonavina G.
Diffusion-Weighted Magnetic Resonance Imaging in the Characterization of Axillary Lymph Nodes in Patients With Breast Cancer.
Journal of magnetic resonance imaging 36:858–864 (2012).
Ecanow J S,
Abe H,
Newstead G M,
Ecanow D B,
Jeske J M.
Axillary Staging of Breast Cancer: What the Radiologist Should Know.
RadioGraphics 2013; 33:1589–1612.
Ni Hea,
Chuanmiao Xiea,
Weidong...