title: Preoperative axillary staging with 3.0-T breast MRI: clinical value of diffusion imaging and apparent diffusion coefficient.
abstract: The axillary staging in newly diagnosed breast cancer is under major evolution. The aims of this study were to define the diagnostic performance of 3.0-T diffusion-weighted imaging (DWI) in the detection of axillary metastases in newly diagnosed breast cancer, to assess apparent diffusion coefficients (ADCs) for histopathologically confirmed metastatic lymph nodes in a clinical setting. Altogether 52 consecutive breast cancer patients underwent magnetic resonance imaging and DWI in addition to axillary ultrasound. ADCs of axillary lymph nodes were analysed by two breast radiologists and ultrasound-guided core biopsies were taken. In a separate reading by one radiologist two types of region of interests were used for a smaller group of patients. Altogether 56 axillae (121 lymph nodes) were included in the statistical analysis. Metastatic axillae (51.8%) had significantly lower ADCs (p<0.001). Mean ADCs were 0.663-0.676 x 10(-3) mm2/s for the histologically confirmed metastatic LNs and 1.100-1.225 x 10(-3) mm2/s for the benign. The sensitivity, specificity, and accuracy of DWI were 72.4%, 79.6%, and 75.9%, respectively with threshold ADC 0.812 x 10(-3) mm2/s. Region of interest with information on the minimum value increased the diagnostic performance (area under the curve 0.794 vs. 0.619). Even though ADCs are significantly associated with histopathologically confirmed axillary metastases the diagnostic performance of axillary DWI remains moderate and ultrasound-guided core biopsies or sentinel lymph node biopsies cannot be omitted.
authors.affiliation: Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland.
authors.forename: Suvi
authors.initials: S
authors.lastname: Rautiainen
authors.affiliation: Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Mervi
authors.initials: M
authors.lastname: Könönen
authors.affiliation: Department of Clinical Pathology, Kuopio University Hospital, Kuopio, Finland; Unit of Pathology and Forensic Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland.
authors.forename: Reijo
authors.initials: R
authors.lastname: Sironen
authors.affiliation: Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Amro
authors.initials: A
authors.lastname: Masarwah
authors.affiliation: Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Mazen
authors.initials: M
authors.lastname: Sudah
authors.affiliation: Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Juhana
authors.initials: J
authors.lastname: Hakumäki
authors.affiliation: Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland; Unit of Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland.
authors.forename: Ritva
authors.initials: R
authors.lastname: Vanninen
authors.affiliation: Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Anna
authors.initials: A
authors.lastname: Sutela
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology* / Q000601:surgery; D004058:Diffusion; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D057234:Preoperative Period; D012372:ROC Curve
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