title: Accuracy of computed tomography perfusion in assessing metastatic involvement of enlarged axillary lymph nodes in patients with breast cancer.
abstract: BACKGROUND
  The purpose of this study was to evaluate the diagnostic accuracy of computed tomography (CT) perfusion in differentiating metastatic from inflammatory enlarged axillary lymph nodes in patients with breast cancer.
  
  
  METHODS
  Twenty-five patients with 26 locally advanced breast tumors and clinically palpable axillary lymph nodes underwent dynamic multi-detector CT (LightSpeed 16; General Electric Company) at one scan per second for 150 seconds at the same table position after 40 ml intravenous contrast injection at 4.0 ml/second. Semi-automatic calculation of values of perfusion parameters - blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability surface (PS) - was performed. Results were compared with pathology and with Her-2/neu and Ki-67 levels in a surgical specimen of the primary tumor.
  
  
  RESULTS
  Examined lymph nodes were inflammatory in 8 cases and metastatic in 18. Mean values of perfusion parameters in inflammatory and metastatic nodes, respectively, were BF of 76.18 (confidence interval [CI], 31.53) and 161.60 (CI, 40.94) ml/100 mg per minute (p < 0.05), BV of 5.81 (CI, 2.50) and 9.15 (CI, 3.02) ml/100 mg (not significant [n.s.]), MTT of 6.80 (CI, 1.55) and 5.50 (CI, 1.84) seconds (p = 0.07), and PS of 25.82 (CI, 4.62) and 25.96 (CI, 7.47) ml/100 mg per minute (n.s.). Size of nodes, stage of breast cancer, Ki-67 and Her-2/neu levels in breast cancer, and expression of primary tumor activity were not correlated to any perfusion parameter in metastatic nodes.
  
  
  CONCLUSIONS
  CT perfusion might be an effective tool for studying enlarged axillary lymph nodes in patients with breast cancer. It gives information on vascularization of lymph nodes, helping to understand the changes occurring when neoplastic cells implant in lymph nodes.
authors.affiliation: Ningxia Medical College Hospital, Yinchuan, Ningxia, 75004, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Liu
authors.forename: Massimo
authors.initials: M
authors.lastname: Bellomi
authors.forename: Giovanna
authors.initials: G
authors.lastname: Gatti
authors.forename: Xuejun
authors.initials: X
authors.lastname: Ping
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000556:secondary; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000556:secondary; D003287:Contrast Media; D005260:Female; D006801:Humans; D019394:Ki-67 Antigen / Q000378:metabolism; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010477:Perfusion; D011446:Prospective Studies; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D012039:Regional Blood Flow; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D019394:Ki-67 Antigen; D018719:Erb-b2 Receptor Tyrosine Kinases; C508053:ERBB2 protein, human