title: Dynamic enhanced computed tomography values of locally advanced breast cancers predicting axilla nodal metastasis after neoadjuvant chemotherapy.
abstract: OBJECTIVE
  We investigated the differences of dynamic enhanced values between the locally advanced breast cancers with and without axillary nodal metastasis on computed tomography (CT) after neoadjuvant chemotherapy.
  
  
  METHODS
  The patients with locally advanced breast cancer (greatest diameter >5 cm before chemotherapy) who completed the preoperative neoadjuvant chemotherapy and ready to undertake subsequent surgery received dynamic CT. The CT enhancement values were measured on the main breast cancers in the greatest diameter, and the means of enhancement were compared between the categories with nonmetastasized and metastasized nodal axilla.
  
  
  RESULTS
  Thirty-nine patients with locally advanced breast cancers, 15 patients without and 24 with metastasized nodal axilla, were enrolled in this study. The patients with metastasized axilla nodes had significantly higher net maximal enhancement (NME) than that of patients without metastasis (mean, 52.9 +/- 23.6 vs 33.6 +/- 22.5, respectively; P = 0.02). Using the receiver operating characteristic curve, the cutoff NME in differentiating the nonmetastasized and metastasized axilla nodal status was optimally chosen at 40 Hounsfield, with sensitivity of 88.24%, specificity of 50%, positive predictive value of 71.4%, negative predictive value of 75%, and accuracy of 72.4% after chemotherapy.
  
  
  CONCLUSIONS
  Additional information of dynamic CT in our results reveals statistically distinguishable NME between those advanced breast cancers with or without axilla nodal metastasis after chemotherapy.
authors.affiliation: Department of Imaging and Interventional Radiology, Chang Gung Memorial Hospital, Tao Yuan Hsien, Taiwan. alex2143@adm.cgmh.org.tw
authors.forename: Yun-Chung
authors.initials: YC
authors.lastname: Cheung
authors.forename: Shin-Cheh
authors.initials: SC
authors.lastname: Chen
authors.forename: Shir-Hwa
authors.initials: SH
authors.lastname: Ueng
authors.forename: Sheung-Fat
authors.initials: SF
authors.lastname: Ko
authors.forename: Yung-Liang
authors.initials: YL
authors.lastname: Wan
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001365:Axilla; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000556:secondary*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008207:Lymphatic Metastasis; D008297:Male; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents