Dissected sentinel lymph nodes of breast cancer patients: Characterization with high-spatial-resolution 7-T MR imaging

Mies A. Korteweg, Jaco J M Zwanenburg, Johannes M. Hoogduin, Maurice A A J Van Den Bosch, Paul J. Van Diest, Richard Van Hillegersberg, Marinus J C Eijkemans, Willem P T M Mali, Peter R. Luijten, Wouter B. Veldhuis

Research output: Contribution to journalArticle

Abstract

Purpose: To investigate the association of 7-T magnetic resonance (MR) imaging characteristics with metastatic nodal invasion, determined with histopathologic assessment in dissected sentinel lymph nodes of breast cancer patients. Materials and Methods: Institutional review board approval and informed consent were obtained. From November 2008 to July 2010, 114 dissected lymph nodes from 33 women (mean age, 57 years; range, 31-80 years) with breast cancer were included. For morphological analysis, three-dimensional (3D) T1-weighted fat-suppressed fast field- (gradient-) echo (isotropic resolution, 180 μm) MR was performed; 3D nodal dimensions, maximum cortical thickness, and presence of fatty hilum were noted. For quantitative parametric analysis, two-dimensional T1-weighted and 3D T2-, T2*-, and diffusion-weighted images were acquired. Statistical analysis included generalized estimating equations (GEEs), forward and backward stepwise regression analyses, and calculation of positive predictive value (PPV) and negative predictive value (NPV). Results: Of 114 nodes, 26 (23%) were malignant. Morphological criteria showed weak discriminatory power: A fatty center was absent in 35% of malignant nodes and 30% of benign nodes(P = .9). Nodal volume and length-width ratio were not significantly different(P = .11 and.75, respectively). Cortical thickness (threshold level, 3 mm; P =. 02) showed 91% NPV for malignancy and 95% NPV for presence of macrometastases. Quantitative parametric analyses showed comparable mean T1, T2, and T2*relaxation time constants and apparent diffusion coefficient for metastatic and benign nodes: 991 msec, 30 msec, and 18 msec and 0.17 mm2/sec versus 1035 msec (P = .14), 31 msec (P = .001; not significant after GEE), and 15 msec(P = .002) and 0.20 mm2/sec(P = .38), respectively. Mean T2*alone offered an additive discriminatory effect for identification of metastatic nodes. Consistent with the notion of pannodal changes accompanying tumor infiltration, mean T2*differed significantly even if only micrometastases were present. The interindividual differences were small, precluding easy clinical implementation. Conclusion: Morphological criteria showed poor discriminatory power, even with very-high-spatial-resolution imaging. T2*quantification allowed identification of metastatic nodal invasion.

Original languageEnglish (US)
Pages (from-to)127-135
Number of pages9
JournalRadiology
Volume261
Issue number1
DOIs
StatePublished - Oct 2011
Externally publishedYes

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Magnetic Resonance Imaging
Breast Neoplasms
Neoplasm Micrometastasis
Research Ethics Committees
Informed Consent
Neoplasms
Magnetic Resonance Spectroscopy
Lymph Nodes
Fats
Regression Analysis
Sentinel Lymph Node
P 11

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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Korteweg, M. A., Zwanenburg, J. J. M., Hoogduin, J. M., Van Den Bosch, M. A. A. J., Van Diest, P. J., Van Hillegersberg, R., ... Veldhuis, W. B. (2011). Dissected sentinel lymph nodes of breast cancer patients: Characterization with high-spatial-resolution 7-T MR imaging. Radiology, 261(1), 127-135. https://doi.org/10.1148/radiol.11103535

Dissected sentinel lymph nodes of breast cancer patients : Characterization with high-spatial-resolution 7-T MR imaging. / Korteweg, Mies A.; Zwanenburg, Jaco J M; Hoogduin, Johannes M.; Van Den Bosch, Maurice A A J; Van Diest, Paul J.; Van Hillegersberg, Richard; Eijkemans, Marinus J C; Mali, Willem P T M; Luijten, Peter R.; Veldhuis, Wouter B.

In: Radiology, Vol. 261, No. 1, 10.2011, p. 127-135.

Research output: Contribution to journalArticle

Korteweg, MA, Zwanenburg, JJM, Hoogduin, JM, Van Den Bosch, MAAJ, Van Diest, PJ, Van Hillegersberg, R, Eijkemans, MJC, Mali, WPTM, Luijten, PR & Veldhuis, WB 2011, 'Dissected sentinel lymph nodes of breast cancer patients: Characterization with high-spatial-resolution 7-T MR imaging', Radiology, vol. 261, no. 1, pp. 127-135. https://doi.org/10.1148/radiol.11103535
Korteweg MA, Zwanenburg JJM, Hoogduin JM, Van Den Bosch MAAJ, Van Diest PJ, Van Hillegersberg R et al. Dissected sentinel lymph nodes of breast cancer patients: Characterization with high-spatial-resolution 7-T MR imaging. Radiology. 2011 Oct;261(1):127-135. https://doi.org/10.1148/radiol.11103535
Korteweg, Mies A. ; Zwanenburg, Jaco J M ; Hoogduin, Johannes M. ; Van Den Bosch, Maurice A A J ; Van Diest, Paul J. ; Van Hillegersberg, Richard ; Eijkemans, Marinus J C ; Mali, Willem P T M ; Luijten, Peter R. ; Veldhuis, Wouter B. / Dissected sentinel lymph nodes of breast cancer patients : Characterization with high-spatial-resolution 7-T MR imaging. In: Radiology. 2011 ; Vol. 261, No. 1. pp. 127-135.
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abstract = "Purpose: To investigate the association of 7-T magnetic resonance (MR) imaging characteristics with metastatic nodal invasion, determined with histopathologic assessment in dissected sentinel lymph nodes of breast cancer patients. Materials and Methods: Institutional review board approval and informed consent were obtained. From November 2008 to July 2010, 114 dissected lymph nodes from 33 women (mean age, 57 years; range, 31-80 years) with breast cancer were included. For morphological analysis, three-dimensional (3D) T1-weighted fat-suppressed fast field- (gradient-) echo (isotropic resolution, 180 μm) MR was performed; 3D nodal dimensions, maximum cortical thickness, and presence of fatty hilum were noted. For quantitative parametric analysis, two-dimensional T1-weighted and 3D T2-, T2*-, and diffusion-weighted images were acquired. Statistical analysis included generalized estimating equations (GEEs), forward and backward stepwise regression analyses, and calculation of positive predictive value (PPV) and negative predictive value (NPV). Results: Of 114 nodes, 26 (23{\%}) were malignant. Morphological criteria showed weak discriminatory power: A fatty center was absent in 35{\%} of malignant nodes and 30{\%} of benign nodes(P = .9). Nodal volume and length-width ratio were not significantly different(P = .11 and.75, respectively). Cortical thickness (threshold level, 3 mm; P =. 02) showed 91{\%} NPV for malignancy and 95{\%} NPV for presence of macrometastases. Quantitative parametric analyses showed comparable mean T1, T2, and T2*relaxation time constants and apparent diffusion coefficient for metastatic and benign nodes: 991 msec, 30 msec, and 18 msec and 0.17 mm2/sec versus 1035 msec (P = .14), 31 msec (P = .001; not significant after GEE), and 15 msec(P = .002) and 0.20 mm2/sec(P = .38), respectively. Mean T2*alone offered an additive discriminatory effect for identification of metastatic nodes. Consistent with the notion of pannodal changes accompanying tumor infiltration, mean T2*differed significantly even if only micrometastases were present. The interindividual differences were small, precluding easy clinical implementation. Conclusion: Morphological criteria showed poor discriminatory power, even with very-high-spatial-resolution imaging. T2*quantification allowed identification of metastatic nodal invasion.",
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T1 - Dissected sentinel lymph nodes of breast cancer patients

T2 - Characterization with high-spatial-resolution 7-T MR imaging

AU - Korteweg, Mies A.

AU - Zwanenburg, Jaco J M

AU - Hoogduin, Johannes M.

AU - Van Den Bosch, Maurice A A J

AU - Van Diest, Paul J.

AU - Van Hillegersberg, Richard

AU - Eijkemans, Marinus J C

AU - Mali, Willem P T M

AU - Luijten, Peter R.

AU - Veldhuis, Wouter B.

PY - 2011/10

Y1 - 2011/10

N2 - Purpose: To investigate the association of 7-T magnetic resonance (MR) imaging characteristics with metastatic nodal invasion, determined with histopathologic assessment in dissected sentinel lymph nodes of breast cancer patients. Materials and Methods: Institutional review board approval and informed consent were obtained. From November 2008 to July 2010, 114 dissected lymph nodes from 33 women (mean age, 57 years; range, 31-80 years) with breast cancer were included. For morphological analysis, three-dimensional (3D) T1-weighted fat-suppressed fast field- (gradient-) echo (isotropic resolution, 180 μm) MR was performed; 3D nodal dimensions, maximum cortical thickness, and presence of fatty hilum were noted. For quantitative parametric analysis, two-dimensional T1-weighted and 3D T2-, T2*-, and diffusion-weighted images were acquired. Statistical analysis included generalized estimating equations (GEEs), forward and backward stepwise regression analyses, and calculation of positive predictive value (PPV) and negative predictive value (NPV). Results: Of 114 nodes, 26 (23%) were malignant. Morphological criteria showed weak discriminatory power: A fatty center was absent in 35% of malignant nodes and 30% of benign nodes(P = .9). Nodal volume and length-width ratio were not significantly different(P = .11 and.75, respectively). Cortical thickness (threshold level, 3 mm; P =. 02) showed 91% NPV for malignancy and 95% NPV for presence of macrometastases. Quantitative parametric analyses showed comparable mean T1, T2, and T2*relaxation time constants and apparent diffusion coefficient for metastatic and benign nodes: 991 msec, 30 msec, and 18 msec and 0.17 mm2/sec versus 1035 msec (P = .14), 31 msec (P = .001; not significant after GEE), and 15 msec(P = .002) and 0.20 mm2/sec(P = .38), respectively. Mean T2*alone offered an additive discriminatory effect for identification of metastatic nodes. Consistent with the notion of pannodal changes accompanying tumor infiltration, mean T2*differed significantly even if only micrometastases were present. The interindividual differences were small, precluding easy clinical implementation. Conclusion: Morphological criteria showed poor discriminatory power, even with very-high-spatial-resolution imaging. T2*quantification allowed identification of metastatic nodal invasion.

AB - Purpose: To investigate the association of 7-T magnetic resonance (MR) imaging characteristics with metastatic nodal invasion, determined with histopathologic assessment in dissected sentinel lymph nodes of breast cancer patients. Materials and Methods: Institutional review board approval and informed consent were obtained. From November 2008 to July 2010, 114 dissected lymph nodes from 33 women (mean age, 57 years; range, 31-80 years) with breast cancer were included. For morphological analysis, three-dimensional (3D) T1-weighted fat-suppressed fast field- (gradient-) echo (isotropic resolution, 180 μm) MR was performed; 3D nodal dimensions, maximum cortical thickness, and presence of fatty hilum were noted. For quantitative parametric analysis, two-dimensional T1-weighted and 3D T2-, T2*-, and diffusion-weighted images were acquired. Statistical analysis included generalized estimating equations (GEEs), forward and backward stepwise regression analyses, and calculation of positive predictive value (PPV) and negative predictive value (NPV). Results: Of 114 nodes, 26 (23%) were malignant. Morphological criteria showed weak discriminatory power: A fatty center was absent in 35% of malignant nodes and 30% of benign nodes(P = .9). Nodal volume and length-width ratio were not significantly different(P = .11 and.75, respectively). Cortical thickness (threshold level, 3 mm; P =. 02) showed 91% NPV for malignancy and 95% NPV for presence of macrometastases. Quantitative parametric analyses showed comparable mean T1, T2, and T2*relaxation time constants and apparent diffusion coefficient for metastatic and benign nodes: 991 msec, 30 msec, and 18 msec and 0.17 mm2/sec versus 1035 msec (P = .14), 31 msec (P = .001; not significant after GEE), and 15 msec(P = .002) and 0.20 mm2/sec(P = .38), respectively. Mean T2*alone offered an additive discriminatory effect for identification of metastatic nodes. Consistent with the notion of pannodal changes accompanying tumor infiltration, mean T2*differed significantly even if only micrometastases were present. The interindividual differences were small, precluding easy clinical implementation. Conclusion: Morphological criteria showed poor discriminatory power, even with very-high-spatial-resolution imaging. T2*quantification allowed identification of metastatic nodal invasion.

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