title: Magnetic Resonance Imaging for Axillary Breast Cancer Metastasis in the Neoadjuvant Setting: A Prospective Study.
abstract: Breast magnetic resonance imaging (MRI) for assessment of regional breast cancer metastasis is controversial owing to the variable specificity. We evaluated breast MRI for axillary metastasis in neoadjuvant chemotherapy patients.
  
  
  
  A single-institution, institutional review board-approved prospective trial enrolled female breast cancer patients receiving neoadjuvant chemotherapy from 2008 to 2012 and collected the pre- and post-treatment MRI, pretreatment axillary ultrasound, axillary biopsy, and surgical pathologic findings. The kappa coefficient was used to evaluate the strength of the agreement between the 2 modalities and Fisher's exact test was used to evaluate the association.
  
  
  
  A total of 43 patients were included. Of these 45 patients, 35 had stage N1-N2 before treatment. Comparing the abnormal results on the pretreatment MRI scans and axillary biopsy examinations, a consistent diagnosis was found for 92%, with a moderate strength of agreement (kappa coefficient, 0.54). The pretreatment MRI findings were significantly associated with the axillary biopsy results (P = .014). The false-positive rate, false-negative rate, sensitivity, and specificity were 50%, 3%, 97%, 50%, respectively. Comparing the post-treatment MRI and surgical pathologic findings revealed a consistent diagnosis rate of, with a slight strength of agreement (kappa, 0.16). The false-positive rate, false-negative rate, sensitivity, and specificity were 38%, 46%, 55%, and 63%, respectively. The post-treatment MRI findings were not associated with the pathologic lymph node results (P = .342).
  
  
  
  Pretreatment breast MRI was more specific for axillary metastasis than was axillary ultrasonography. However, post-treatment breast MRI was not predictive of residual axillary disease and should be used cautiously when altering treatment plans.
authors.affiliation: Department of Breast Oncology, H. Lee Moffitt Cancer Center, Tampa, FL.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Mattingly
authors.affiliation: Department of Diagnostic Imaging, H. Lee Moffitt Cancer Center, Tampa, FL.
authors.forename: Blaise
authors.initials: B
authors.lastname: Mooney
authors.affiliation: Biostatistic Department, Louisiana State University Health Sciences Center, School of Public Health, New Orleans, LA.
authors.forename: Hui-Yi
authors.initials: HY
authors.lastname: Lin
authors.affiliation: Department of Breast Oncology, H. Lee Moffitt Cancer Center, Tampa, FL.
authors.forename: John V
authors.initials: JV
authors.lastname: Kiluk
authors.affiliation: Department of Breast Oncology, H. Lee Moffitt Cancer Center, Tampa, FL.
authors.forename: Nazanin
authors.initials: N
authors.lastname: Khakpour
authors.affiliation: Department of Breast Oncology, H. Lee Moffitt Cancer Center, Tampa, FL.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Hoover
authors.affiliation: Department of Breast Oncology, H. Lee Moffitt Cancer Center, Tampa, FL.
authors.forename: Christine
authors.initials: C
authors.lastname: Laronga
authors.affiliation: Department of Breast Oncology, H. Lee Moffitt Cancer Center, Tampa, FL. Electronic address: M.Catherine.Lee@moffitt.org.
authors.forename: M Catherine
authors.initials: MC
authors.lastname: Lee
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001365:Axilla; D001943:Breast Neoplasms / Q000188:drug therapy / Q000556:secondary*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D055815:Young Adult
keywords: Breast neoplasms; MRI; Neoadjuvant therapy; Predictive value of MRI; Preoperative imaging