Ex vivo MRI of axillary lymph nodes in breast cancer.
OBJECTIVE
To provide a strategy for precise co-localization of lymph nodes on axillary lymph-node dissection (ALND) specimens both on pathology and MR. To identify nodal features suggestive of metastatic involvement on a node-to-node basis.


METHODS
National Institutional review-board approved this prospective study of 18 patients with breast cancer referred for ALND. Ex vivo T1 and inversion recovery (IR) T2 WI of ALND specimens tightly positioned within scaled plastic cranes was performed immediately after surgery. The correspondence of MR-based or pathologically based nodes location was assessed. The MR size and morphological presentation of metastatic and normal nodes were compared (Student's t-test or Mann-Whitney test). Quantitative variables were compared using Pearson coefficient.


RESULTS
207 nodes were retrieved on pathology and 165 on MR. MR-pathological correlation of nodes location was high regarding MR-identified nodes (r=0.755). An MR short axis threshold of 4mm yielded the best predictive value for metastatic nodal involvement (Se=78.6%; Sp=62.3%). Irregular contours (Se=35.7%; Sp=96.7%), central nodal hyper-intensity on IR T2 WI (Se=57.1%; Sp=91.4%), and a cortical thickness above 3mm (Se=63.6%; Sp=83.2%) were significantly associated with metastatic involvement.


CONCLUSIONS
Ex vivo MR allows node-to-node correlation with pathology. Morphological MR criteria can suggest metastatic involvement.
Luciani
Alain
A
Department of Radiology, AP-HP, Groupe Henri Mondor-Albert Chenevier, 94010 Créteil, France. luciani@hmn.ap-hop-paris.fr
Pigneur
Frederic
F
Ghozali
Faridah
F
Dao
Thu-Ha
TH
Cunin
Patrick
P
Meyblum
Evelyne
E
De Baecque-Fontaine
Cecile
C
Alamdari
Ali
A
Maison
Patrick
P
Deux
Jean François
JF
Lagrange
Jean Léon
JL
Lantieri
Laurent
L
Rahmouni
Alain
A
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods