Relevant Imaging Features Of Breast MRI And Computed Tomography Lymphography In Predicting Axillary Lymph Node Metastasis In Breast Cancer

Part Ⅰ:Imaging Features of Sentinel Lymph Node Mapped by Computed Tomography Lymphography in Predicting Axillary Lymph Node Metastasis in Brest CancerPurpose:To evaluate the predictive value of sentinel lymph node(SLN)mapped by computed tomography lymphography(CT-LG)for ALN metastasis in breast cancer patients.Methods:A total of 153 patients with breast cancer who underwent preoperative CT-LG examination in our hospital from January 2018 to June 2021 were retrospectively included in the study.This retrospective study has been approved by our institutional Review Committee.The inclusion criteria were:(1)Women aged 18 years or older;(2)Images can clearly locate sentinel lymph nodes;(3)First diagnosis of breast cancer;(4)Breast cancer was pathologically confirmed by surgery or biopsy;The exclusion criteria included:(1)patients with incomplete or missing pathological results;(2)patients were diagnosed or considered with distant metastasis;(3)patients who had undergone tumor resection or neoadjuvant chemotherapy prior to CT-LG;(4)Lactation patient.Long-axis diameter,short-axis diameter,ratio of long-/short-axis and cortical thickness were measured.Logistic regression analysis was performed to evaluate independent predictors associated with ALN metastasis.The prediction of ALN metastasis was determined with related variables of SLN using Receiver operating characteristic(ROC)analysis.Clinical and imaging data of eligible patients were reviewed and collected.Sentinel lymph nodes were then identified on the Philips IntelliSpace Portal 3D reconstruction workstation,and the long-axis diameter,short-axis diameter and cortical thickness of selected sentinel lymph node were measured and recorded.For patients with two or more SLN,the largest one was selected for measurement.Continuous variables were analyzed with two independent sample t tests.Logistic regression analysis(stepwise)was performed to evaluate the variables associated with ALN metastasis,so that significant or marginal significant factors(P<0.05)could be identified.Receiver operating characteristic(ROC)curve analysis was performed to evaluate the MDCT variates and post-combination factor for predicting ALN metastasis.Area under the curve(AUC)was evaluated for diagnostic ability.Results:Among the 153 cases,50(32.7%)cases had ALN metastasis,and 103(67.3%)without ALN metastasis.The long-axis diameter(P<0.001),short-axis diameter(P<0.001),ratio of long-/short-axis(P=0.002)and cortical thickness(P<0.001)were significantly correlated with axillary lymph node metastasis.cortical thickness was an independent predictor,and its cut-off value was 3.5mm(OR:4.177,95%CI:1.724-10.120,P=0.002).Its sensitivity,specificity,AUC,positive predictive value(PPV)and negative predictive value(NPV)was 72.97%,92.50%,0.858,81.81%and 88.10%,respectively.After all the four indicators combined,the sensitivity,specificity and AUC were 72.97%,95.00%and 0.870,respectively.Conclusion:ALN status can be predicted using the imaging features of SLN which was mapped on CT-LG in breast cancer patients.Besides,it may be helpful to select true negative lymph nodes in patients with early breast cancer,and when the associated indicators of the mapped SLN supported negative results and this SLN was the largest lymph nodes of the axillary,it was possible to prevent the patient from being isolated from the lymph node biopsy.Part Ⅱ:Breast MRI and Ipsilateral Axillary Lymph Node Imaging Features for Prediction of Axillary Lymph Node Metastasis in Breast CancerPurpose:To investigate the value of qualitative features of breast cancer Magnetic resonance imaging(MRI)and the quantitative features of the largest lymph node of ipsilateral axilla in predicting of axillary lymph node(ALN)status.Methods:This retrospective study involved 92 patients with invasive breast cancer who underwent 3.0T breast MRI examinations prior to surgery and other treatment in our hospital from January 2017 to November 2021.This retrospective study has been approved by our institutional Review Committee.The inclusion criteria were:(1)Women aged 18 years or older;(2)First diagnosis of breast cancer;(3)Breast cancer was pathologically confirmed by surgery or biopsy;(4)Patients who underwent sentinel lymph node biopsy(SLNB)or axillary lymph node dissection(ALND);The exclusion criteria included:(1)patients with incomplete or missing pathological results;(2)patients were diagnosed or considered with distant metastasis;(3)patients who had undergone tumor resection or neoadjuvant chemotherapy prior to MRI;(4)Lactation patient;(5)Obvious bleeding in and around the primary tumor;(6)Patients whose tumors are too small to be placed in the Region of interest(ROI);(7)Non-mass breast cancer or poor image quality.The features of breast cancer MRI,the largest lymph node of ipsilateral axilla and postoperative pathology results were measured and collected.Continuous and categorical variables were analyzed with two independent sample t tests and χ2-test respectively.Logistic regression analysis(stepwise)was performed to evaluate the variables associated with ALN metastasis,so that significant or marginal significant factors(P<0.05)could be identified.Receiver operating curve(ROC)and area under the curve(AUC)was performed to evaluate the relevant single and combined variables for predicting ALN metastasis.The AUC was evaluated for diagnostic ability.Results:Among the 92 cases,39(42.4%)cases had ALN metastasis.Qualitative characteristics of breast MRI including tumor size,margin,shape,T2WI signal and enhancement pattern were significantly correlated with axillary lymph node metastasis.The long-axis diameter,short-axis diameter,ratio of long-/short-axis of the largest lymph node of ipsilateral axilla were significantly correlated with axillary lymph node metastasis as well.When the qualitative index combined with quantitative index,the sensitivity and specificity were 84.91%and 84.62%,the AUC was 0.911.The specificity of quantitative index was 98.11%%and AUC was 0.832,respectively.Conclusion:Qualitative features of breast cancer and quantitative features of the largest lymph node of ipsilateral axilla can predict ALN status.The combination of qualitative features and quantitative features is more effective than qualitative features or quantitative features alone for the diagnosis of ALN metastasis,which may be helpful for clinical selection of more appropriate treatment.