title: Dynamic contrast enhanced MRI of the axilla in women with breast cancer: comparison with pathology of excised nodes.
abstract: Axillary lymph node status is the most important prognostic factor in breast cancer patients and is currently determined by surgical dissection. This study was performed to assess whether dynamic gadopentetate dimeglumine (Gd) enhanced MRI is an accurate method for non-invasive staging of the axilla. 47 women with a new primary breast cancer underwent pre-operative dynamic Gd enhanced MRI of the ipsilateral axilla. Lymph node enhancement was quantitatively analysed using a region of interest method. Enhancement indices and nodal area were compared with histopathology of excised nodes using a receiver operating characteristic (ROC) curve approach. 10 patients had axillary metastases pathologically and all had > or =1 lymph node with an enhancement index of >21% and a nodal area of >0.4 cm(2). 37 patients had negative axillary nodes pathologically. 20 of these had enhancement indices <21% and nodal areas <0.4 cm(2). Using this method, a sensitivity of 100%, a specificity of 56%, a positive predictive value of 38% and a negative predictive value of 100% could be achieved. Using this method of quantitative assessment, dynamic Gd enhanced MRI may be a reliable method of predicting absence of axillary nodal metastases in women with breast cancer, thereby avoiding axillary surgery in women with a negative MRI study.
authors.affiliation: Department of Radiology, University of Aberdeen and Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Murray
authors.forename: R T
authors.initials: RT
authors.lastname: Staff
authors.forename: T W
authors.initials: TW
authors.lastname: Redpath
authors.forename: F J
authors.initials: FJ
authors.lastname: Gilbert
authors.forename: A K
authors.initials: AK
authors.lastname: Ah-See
authors.forename: J A
authors.initials: JA
authors.lastname: Brookes
authors.forename: I D
authors.initials: ID
authors.lastname: Miller
authors.forename: S
authors.initials: S
authors.lastname: Payne
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology*; D002277:Carcinoma / Q000175:diagnosis* / Q000556:secondary*; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008207:Lymphatic Metastasis / Q000175:diagnosis / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA