Diagnostic Performance of Dedicated Axillary T2-and Diffusion-weighted MR Imaging for Nodal Staging in Breast Cancer
Diagnostic Performance of Dedicated Axillary T2-and Diffusion-weighted MR Imaging for Nodal Staging in Breast Cancer
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DOI：
10.1148/radiol.14141167
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发表时间：
2015-05-01
期刊：
影响因子：
19.7
通讯作者：
Lobbes, Marc B. I.
中科院分区：
文献类型：
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作者：
Schipper, Robert-Jan;Paiman, Marie-Louise;Lobbes, Marc B. I.
目的：评价MR平扫腋窝T2加权和扩散加权(DW)磁共振成像对新诊断乳腺癌腋窝淋巴结分期的诊断价值。材料和方法：获得机构评审委员会的批准和知情同意。50名女性(平均年龄60岁，范围2280岁)接受了没有脂肪抑制和DW成像的高空间分辨率腋窝3.0-T T2加权成像(b=0,500和800秒/毫米(2))，随后进行了前哨淋巴结活检(SLNB)或腋窝淋巴结清扫。两位放射科医生独立地对每个淋巴结进行评分，置信度从0(良性)到4(恶性)，首先是T2加权MR图像，然后是DW MR图像。两名研究人员独立测量了每个淋巴结的平均表观扩散系数(ADC)。结果：在逐个节点和逐个患者验证的基础上，T2加权成像的特异度分别为93%~97%和87%~95%，灵敏度分别为32%~55%和50%~67%，阴性预测值(NPV)分别为88%~91%和86%~89%，阳性预测值(PPV)分别为60%~70%和62%~75%，受试者工作特征曲线下面积分别为0.78和0.80~0.88，观察者间一致性较好(kappa=0.70)。加入DW磁共振成像后，特异度较低(59%~88%和50%~84%)，灵敏度较高(45%~%和75%~83%)，NPV可比(89%和90%~91%)，PPV较低(23%~42%和34%~60%)，AUC较低(0.68~0.73和0.70~0.86)。ADC测量的特异度分别为63%-%和61%-63%，敏感度分别为41%和67%，NPV分别为85%和85%-86%，PPV分别为18%和35%-36%，AUC分别为0.540.58和0.69-0.74，观察者间相关系数为0.83。结论：专用高空间分辨率腋窝T2加权成像在逐个结节和逐个患者验证的基础上显示出良好的特异度，观察者间具有良好的一致性。然而，在排除腋窝淋巴结转移方面，其NPV仍不足以替代SLNB。DW磁共振成像和ADC测量均无附加价值。(C)RSNA，2014年
Purpose: To evaluate the diagnostic performance of unenhanced axillary T2-weighted and diffusion-weighted (DW) magnetic resonance (MR) imaging for axillary nodal staging in patients with newly diagnosed breast cancer, with node-bynode and patient-by-patient validation.Materials and Methods: Institutional review board approval and informed consent were obtained. Fifty women (mean age, 60 years; range, 2280 years) underwent high-spatial-resolution axillary 3.0-T T2-weighted imaging without fat suppression and DW imaging (b = 0, 500, and 800 sec/mm(2)), followed by either sentinel lymph node biopsy (SLNB) or axillary lymph node dissection. Two radiologists independently scored each lymph node on a confidence level scale from 0 (benign) to 4 (malignant), first on T2-weighted MR images, then on DW MR images. Two researchers independently measured the mean apparent diffusion coefficient (ADC) of each lymph node. Diagnostic performance parameters were calculated on the basis of node-by-node and patient-by-patient validation.Results: With respective node-by-node and patient-by-patient validation, T2-weighted MR imaging had a specificity of 93%-97% and 87%-95%, sensitivity of 32%-55% and 50%-67%, negative predictive value (NPV) of 88%-91% and 86%-89%, positive predictive value (PPV) of 60%-70% and 62%-75%, and area under the receiver operating characteristic curve (AUC) of 0.78 and 0.80-0.88, with good interobserver agreement (kappa = 0.70). The addition of DW MR imaging resulted in lower specificity (59%-88% and 50%-84%), higher sensitivity (45%-64% and 75%-83%), comparable NPV (89% and 90%-91%), lower PPV (23%-42% and 34%-60%), and lower AUC (0.68-0.73 and 0.70-0.86). ADC measurement resulted in a specificity of 63%-64% and 61%-63%, sensitivity of 41% and 67%, NPV of 85% and 85%-86%, PPV of 18% and 35%-36%, and AUC of 0.540.58 and 0.69-0.74, respectively, with excellent interobserver agreement (intraclass correlation coefficient, 0.83).Conclusion: Dedicated high-spatial-resolution axillary T2-weighted MR imaging showed good specificity on the basis of node-by-node and patient-by-patient validation, with good interobserver agreement. However, its NPV is still insufficient to substitute it for SLNB for exclusion of axillary lymph node metastasis. DW MR imaging and ADC measurement were of no added value. (C) RSNA, 2014