Determination of Metastatic Axillary Lymph Node in Breast Cancer: Differentiation with Dynamic MRI Examination by Signal Intensity-Time Curves

Duzgun Yildirim, Baki Ekci, Bengi Gurses, Ahmet Kaur

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DOI: 10.4236/jct.2011.24076                

Abstract

Purpose: We aimed to evaluate the role of dynamic magnetic resonance imaging (MRI) in the detection of axillary lymph node metastasis based on the signal intensity-time curves. Materials and Methods: The data of 120 patients (benign patients, n = 91; malignant patients, n = 29) who underwent dynamic breast MRI were reviewed. The lymph nodes with the strongest criteria for malignancy (morphological-dynamic properties) were included in the analysis. Signal intensity-time curves were plotted by the software. Results: Of 29 patients with breast cancer, axillary lymph nodes were involved in 21 and not involved in the remaining 8. There was no significant difference between benign and malignant cases in terms of the distributions of Type Ia, Type Ib and Type IV curves (p = 0.12), whereas a significant difference was found between benign and malignant cases in terms of the distributions of Type II and III curves (p < 0.01). Benign lymph nodes dominantly displayed Type III curves (66.2%), whereas malignant ones dominantly displayed Type II curves (57.2%). Conclusion: On dynamic MRI studies, benign and metastatic lymph nodes display different signal intensity-time curves.

Keywords

Dynamic Magnetic Resonance Imaging, Breast Neoplasms, Axillary Lymph Nodes, Lymphatic Metastasis, Sensitivity-Specificity

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	L. P. Adler, J. P. Crowe, N. K. al-Kaisi and J. L. Sunshine, “Evaluation of Breast Masses and Axillary Lymph Nodes with [F-18] 2-Deoxy-2-fluoro-D-glucose PET,” Radiology, Vol. 187, 1993, pp. 743-750.
[2]	U. Veronesi, G. Paganelli, G. Viale G, et al., “Sentinel Lymph Node Biopsy and Axillary Dissection in Breast Cancer: Results in a Large Series,” Journal of National Cancer Institute, Vol. 91, No. 4, 1999, pp. 368-373. doi:10.1093/jnci/91.4.368
[3]	B. Cady, “The Need to Reexamine Axillary Lymph Node Dissection in Invasive Breast Cancer,” Cancer, Vol. 73, 1994, pp. 505-508.
[4]	W. K. Ruffin, A. Stacey-Clear, J. Younger and H. C. Hoover, “Rationale for Routine Axillary Dissection in Carcinoma of the Breast,” Journal of the American College of Surgeons, Vol. 180, 1995, pp. 245-251.
[5]	A. Recht and M. J. Houlihan, “Axillary Lymph Nodes and Breast Cancer: A Review,” Cancer, Vol. 76, No. 9, 1995, pp. 1491-1512.
[6]	B. Fowble, R. Gray, K. Gilchrist, et al., “Identification of a Subgroup of Patients with Breast Cancer and Histologically Positive Axillary Nodes Receiving Adjuvant Chemotherapy Who may Benefit from Postoperative Radiotherapy,” Journal of Clinical Oncology, Vol. 6, 1988, pp. 1107-1117.
[7]	R. G. McLean and G. N. Ege, “Prognostic Value of Axillary Lymphoscintigraphy in Breast Carcinoma Patients,” Journal of Nuclear Medicine, Vol. 27, 1986, pp. 1116-1124.
[8]	S. E. Harms, D. P. Flamig, K. L. Hesley, et al., “MR Imaging of the Breast with Rotating Delivery of Excitation off Resonance: Clinical Experience with Pathologic Correlation,” Radiology, Vol. 187, 1993, pp. 493-501.
[9]	A. D. Murray, R. T. Staff, T. W. Redpath, et al., “Dynamic Contrast Enhanced MRI of the Axilla in Women with Breast Cancer: Comparison with Pathology of Excised Nodes,” The British Journal of Radiology, Vol. 75, 2002, pp. 220-228.
[10]	B. Cady, “Dilemmas in Breast Disease,” The Breast Journal, Vol. 1, No. 2, 1995, pp. 121-124. doi:10.1111/j.1524-4741.1995.tb00230.x
[11]	D. E. March, R. J. Wechsler, A. F. Kurtz, A. L. Rosenberg and L. Needleman, “CT-Pathologic Correlation of Axillary Lymph Nodes in Breast Carcinoma,” Journal of Computer Assisted Tomography, Vol. 15, No. 3, 1991, pp. 440-444. doi:10.1097/00004728-199105000-00017
[12]	L. Kalisher, A. M. Chu and R. G. Peyster, “Clinicopathological Correlation of Xeroradiography in Determining Involvement of Metastatic Axillary Nodes in Female Breast Cancer,” Radiology, Vol. 121, 1976, pp. 333-335.
[13]	S. Alvarez, E. Anorbe, P. Alcorta, F. Lopez, I. Alonso and J. Cortes, “Role of Sonography in the Diagnosis of Axillary Lymph Node Metastases in Breast Cancer: A Systematic Review,” American Journal of Roentgenology, Vol. 186, 2006, pp. 1342-1348.
[14]	W. T. Yang, C. Metreweli, P. K. Lam and J. Chang, “Benign and Malignant Breast Masses and Axillary Nodes: Evaluation with Echo-Enhanced Color Power Doppler US,” Radiology, Vol. 220, 2001, pp. 795-802. doi:10.1148/radiol.2203001545
[15]	W. T. Yang, J. Chang and C. Metreweli, “Patients with Breast Cancer: Differences in Color Doppler Flow and Gray-Scale US Features of Benign and Malignant Axillary Lymph Nodes,” Radiology, Vol. 215, 2000, pp. 568-573.
[16]	H. J. Steinkamp, U. K. Teichgraber, M. Mueffelmann, N. Hosten and P. Kenzel, “Felix. Differential Diagnosis of Lymph Node Lesions. A Semiquantitative Approach with Power Doppler Sonography,” Investigative Radiology, Vol. 34, No. 8, pp. 509-515. doi:10.1097/00004424-199908000-00003
[17]	H. J. Steinkamp, C. Wissgott, J. Rademaker and R. Felix, “Current Status of Power Doppler and Color Doppler Sonography in the Differential Diagnosis of Lymph Node Lesions,” European Radiology, Vol. 12, 2002, pp. 1785-1793.
[18]	M. Y. Choi, J. W. Lee and K. J. Jang, “Distinction between Benign and Malignant Causes of Cervical, Axillary, and Inguinal Lymphadenopathy: Value of Doppler Spectral Wave-Form Analysis,” American Journal of Roentgenology, Vol. 165, 1995, pp. 981-984.
[19]	A. R. Sever, P. Mills, S. E. Jones, K. Cox, J. Weeks, D. Fish and P. A. Jones, “Preoperative Sentinel Node Identification with Ultrasound Using Microbubbles in Patients with Breast Cancer,” American Journal of Roentgenology, Vol. 196, No. 2, 2011, pp. 251-256.
[20]	J. J. Choi, B. J. Kang, S. H. Kim, et al., “Role of Sonographic Elastography in the Differential Diagnosis of Axillary Lymph Nodes in Breast Cancer,” Journal of Ultrasound in Medicine, Vol. 30, 2011, pp. 429-436.
[21]	P. Vassallo, G. Edel, N. Roos, A. Naguib and P. E. Peters, “In-Vitro High-Resolution Ultrasonography of Benign and Malignant Lymph Nodes: A Sonographic-Histopathologic Correlation,” Investigative Radiology, Vol. 28, No. 8, 1993, pp. 698-705. doi:10.1097/00004424-199308000-00009
[22]	M. Memarsadeghi, C. C. Riedl, A. Kaneider, A. Galid, M. Rudas, W. Matzek and T. H. Helbich, “Axillary Lymph Node Metastases in Patients with Breast Carcinomas: Assessment with Nonenhanced versus USPIO-Enhanced MR Imaging,” Radiology, Vol. 241, 2006, pp. 367-377.
[23]	E. R. Horak, R. Leek, N. Klenk, et al., “Angiogenesis, Assessed by Platelet/Endothelial Cell Adhesion Molecule Antibodies, as Indicator of Node Metastases and Survival in Breast Cancer,” Lancet, Vol. 340, 1992, pp. 1120-1124.
[24]	N. Weidner, P. Semplej, W. R. Welch and J. Folkman, “Tumor Angiogenesis and Metastasis: Correlation in Invasive Breast Carcinoma,” The New England Journal of Medicine, Vol. 324, 1991, pp. 1-8. doi:10.1056/NEJM199101033240101
[25]	S. E. Harms, D. P. Flamig, K. L. Hesley, et al., “MR Imaging of the Breast with Rotating Delivery of Excitation off Resonance: Clinical Experience with Pathologic Correlation,” Radiology, Vol. 187, 1993, pp. 493-501.
[26]	E. Furman-Haran, R. Margalit, D. Grobgeld and H. Dcgani, “Dynamic Contrast-Enhanced Magnetic Resonance Imaging Reveals Stress-Induced Angiogenesis in MCF7 Human Breast Tumors,” The Proceedings of the National Academy of Sciences, Vol. 93, No. 13, 1996, pp. 6247-6251. doi:10.1073/pnas.93.13.6247
[27]	D. K. Yeung, W. T. Yang and G. M. Tse, “Breast Cancer: In Vivo Proton MR Spectroscopy in the Characterization of Histopathologic Subtypes and Preliminary Observations in Axillary Node Metastases,” Radiology, Vol. 225, 2002, pp. 190-197. doi:10.1148/radiol.2243011519
[28]	R. L. Wahl, R. L. Cody, G. D. Hutchins and E. E. Mudgett, “Primary and Metastatic Breast Carcinoma: Initial Clinical Evaluation with Pet with the Radiolabeled Glucose Analogue 2-[F-18]-Fluoro-2-deoxy-O-glucose,” Radiology, Vol. 179, 1991, pp. 765-770.
[29]	H. Minn and I. Soini, “[l8F]Fluorodeoxyglucose Scintigraphy in Diagnosis and Follow up of Treatment in Advanced Breast Cancer,” European Journal of Nuclear Medicine, Vol. 15, No. 2, 1989, pp. 61-66. doi:10.1007/BF00702620
[30]	M. R. Keshtgar and M. Baum, “Axillary Dissection over the Years: Where to from Here?” World Journal of Surgery, Vol. 25, No. 6, pp. 761-766. doi:10.1007/s00268-001-0002-y
[31]	B. J. Grube and A. E. Giuliano, “The Current Role of Sentinel Node Biopsy in the Treatment of Breast Cancer,” Advences in Surgery, Vol. 38, 2004, pp. 121-166.
[32]	J. S. Jeruss, D. J. Winchester, S. F. Sener, et al., “Axillary Recurrence after Sentinel Node Biopsy,” Annals of Surgical Oncology, Vol. 12, No. 1, 2005, pp. 34-40. doi:10.1007/s10434-004-1164-2
[33]	M. L. Smidt, C. M. Janssen, D. M. Kuster, E. D. Bruggink and L. J. Strobbe, “Axillary Recurrence after a Negative Sentinel Node Biopsy for Breast Cancer: Incidence and Clinical Significance,” Annals of Surgical Oncology, Vol. 12, 2005, pp. 29-33.
[34]	S. Krishnamurthy, N. Sneige, D. G. Bedi, et al., “Role of Ultrasound-Guided Fine-Needle Aspiration of Indeterminate and Suspicious Axillary Lymph Nodes in the Initial Staging of Breast Carcinoma,” Cancer, Vol. 95, No. 5, 2002, pp. 982-988. doi:10.1002/cncr.10786
[35]	A. Sapino, P. Cassoni, F. Zanon, et al., “Ultrasonographically-Guided Fine-Needle Aspiration of Axillary Lymph Nodes: Role in Breast Cancer Management,” British Journal of Cancer, Vol. 88, 2003, pp. 702-706. doi:10.1038/sj.bjc.6600744
[36]	J. U. Oruwari, M. A. Chung, S. Koelliker, M. M. Steinhoff and B. Cady, “Axillary Staging Using Ultrasoundguided Fine Needle Aspiration Biopsy in Locally Advanced Breast Cancer,” The American Journal of Surgery, Vol. 184, 2002, pp. 307-309.
[37]	M. Pamilo, M. Soiva and E. M. Lavast, “Real-Time Ultrasound, Axillary Mammography, and Dynamical Examination in the Detection of Axillary Lymph Node Metastases in Breast Cancer Patients,” Journal of Ultrasound in Medicine, Vol. 8, 1989, pp. 115-120.
[38]	J. J. Tjandra, N. P. M. Sacks, C. H. Thompson, et al., “The Detection of Axillary Lymph Node Metastases from Breast Cancer by Radiolabelled Monoclonal Antibodies: A Prospective Study,” British Journal of Cancer, Vol. 59, 1989, pp. 296-302. doi:10.1038/bjc.1989.61
[39]	S. S. Jeffrey, S. B. Jones and K. Smith, “Controversies in Sentinel Lymph Node Biopsy for Breast Cancer,” Cancer Biotherapy and Radiopharmaceuticals, Vol. 15, No. 3, 2000, pp. 223-233. doi:10.1089/108497800414310
[40]	D. E. March, R. J. Wechsler, A. F. Kurtz, A. L. Rosenberg and L. Needleman, “CT-Pathologic Correlation of Axillary Lymph Nodes in Breast Carcinoma,” Journal of Computer Assisted Tomography, Vol. 15, No. 3, 1991, pp. 440-444. doi:10.1097/00004728-199105000-00017
[41]	M. J. Silverstein, E. D. Gierson, J. R. Waisman, G. M. Senofsky, W. J. Colbum and P. Gamagani, “Axillary Lymph Node Dissection for Tla Breast Carcinoma,” Cancer, Vol. 73, 1994, pp. 664-667.
[42]	M. Fraile, M. Rull, F. J. Julian, et al., “Sentinel Node Biopsy as a Practical Alternative to Axillary Lymph Node Dissection in Breast Cancer Patients: An Approach to Its Validity,” Annals of Oncology, Vol. 11, 2000, pp. 701-705.
[43]	H. Fujii, K. Enomoto, T. Ikeda, et al., “Lymph Node Metastasis from Breast Cancer Diagnosed by F-18 FDG Whole-Body PET,” Breast Cancer, Vol. 7, No. 2, 2000, pp. 165-168. doi:10.1007/BF02967451
[44]	N. Y. Tse, C. K. Hoh, R. A. Hawkins, et al., “The Application of Positron Emission Tomographic Imaging with Fluorodeoxyglucose to the Evaluation of Breast Disease,” Annals of Surgery, Vol. 216, No. 1, 1992, pp. 27-34.
[45]	R. H. El Khouli, K. J. Macura, M. A. Jacobs, et al., “Dynamic Contrast-Enhanced MRI of the Breast: Quantitative Method for Kinetic Curve Type Assessment,” American Journal of Roentgenology, Vol. 193, No. 4, 2009, pp. 295-300. doi:10.2214/AJR.09.2483
[46]	P. Schrenk, A. Shamiyeh and W. Wayand, “Sentinel Lymph-Node Biopsy Compared to Axillary Lymph-Node Dissection for Axillary Staging in Breast Cancer Patients,” European Journal of Surgical Oncology, Vol. 27, 2001, pp. 378-382. doi:10.1053/ejso.2001.1139
[47]	W. T. Yang, G. M. Tse, P. K. Lam, C. Metreweli and J. Chang, “Correlation between Color Power Doppler Sonographic Measurement of Breast Tumor Vasculature and Immunohistochemical Analysis of Microvessel Density for the Quantitation of Angiogenesis,” Journal of Ultrasound in Medicine, Vol. 21, 2002, pp. 1227-1235.