ECR 2015 / C-1941
Pre-operative Diffusion-weighted Imaging (DWI) and Apparent Diffusion Coefficient (ADC) ratio in assessment of axillary lymph node status in patients with breast cancer: personal experience and literature review.
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Type:
Educational Exhibit
Keywords:
Breast, MR-Functional imaging, MR, Ultrasound, Diagnostic procedure, Cancer
Authors:
I. Bednarova, S. Bednarova, A. Linda, V. Londero, C. Zuiani, M. Bazzocchi; Udine/IT
DOI:
10.1594/ecr2015/C-1941
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 of this procedure.
Fewer women would have to undergo two operations,
namely SLNB followed by ALND where positive.
- Preliminary data indicate that the ADC ratio might be a reliable and accurate parameter to detect early metastatic axillary lymph nodes in breast cancer patients.
Finally,
ADC value of metastatic lymph nodes showed up to be lower than those of benign lymph nodes in patients with breast cancer.
Furthermore,
the ADC ratio,
which is calculated between axillary lymph nodes with primary breast lesion,
was significantly lower in metastatic lymph nodes when compared with benign lymph nodes (P<0.05).
- Not only metastasis,
but also reactive hyperplasia or fibrotic proliferation,
might affect diffusion.
SLNB is currently the most accurate method to rule out small micrometastatic nodal disease in breast cancer.
In the recent studies it is believed that the micrometastases remain beyond the morphologic resolution of any clinically available MR technology.
- Lymph node-specific contrast material-enhanced MR imaging could be of potential benefit,
although there is a need for more studies and further research with standardised methods and criteria for classifying a node as positive before any changes to policy and practice should be considered.