Added Value of MRI for Invasive Breast Cancer including the Entire Axilla for Evaluation of High-Level or Advanced Axillary Lymph Node Metastasis in the Post–ACOSOG Z0011 Trial Era

Jung Hee Byon, Youngjean Vivian Park, Jung Hyun Yoon, Hee Jung Moon, Eunkyung Kim, Min Jung Kim, Jai Kyung You

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Background: In the post–American College of Surgeons Oncology Group Z0011 trial era, radiologists have increasingly focused on excluding high-level or advanced axillary lymph node metastasis (ALNM) by using an additional MRI scan positioned higher than lower axillae; however, the value of these additional scans remains undetermined. Purpose: To evaluate whether a standard MRI protocol is sufficient to exclude high-level or advanced ALNM in breast cancer or additional MRI of entire axilla is needed. Materials and Methods: This retrospective study evaluated women with invasive breast cancer who underwent breast MRI from April 2015 to December 2016. Some underwent neoadjuvant chemotherapy (NAC) and others underwent upfront surgery. Standard (routine axial scans including the lower axillae) and combined (routine axial scans plus additional scans including the entire axilla) MRI protocols were compared for high-level or advanced ALNM detection. Clinical-pathologic characteristics were analyzed. Uni- and multivariable logistic regression was performed to identify predictors of high-level or advanced ALNM. Results: A total of 435 women (mean age 6 standard deviation, 52 years 6 11) were evaluated (65 in the NAC group, 370 in the non-NAC group). With the standard MRI protocol, predictors of high-level ALNM were peritumoral edema (odds ratio [OR], 12.3; 95% CI: 3.9, 39.4; P , .001) and positive axilla (OR, 5.9; 95% CI: 2.0, 15.2; P , .001). Only three of 289 women with negative axillae without peritumoral edema had high-level ALNM. Predictors of advanced ALNM were positive axillae (OR, 8.9; 95% CI: 3.7, 21.5; P , .001) and peritumoral edema (OR, 2.8; 95% CI: 1.1, 6.9; P = .03). Only six of 310 women who had negative axillae without peritumoral edema had advanced ALNM. Conclusion: The performance of standard MRI was satisfactory in excluding high-level and advanced axillary lymph node metastasis in most patients with breast cancer. However, the presence of peritumoral edema or positive axillae in the MRI findings emphasizes the benefits of a combined MRI protocol.

Original languageEnglish
Pages (from-to)46-54
Number of pages9
JournalRadiology
Volume300
Issue number1
DOIs
Publication statusPublished - 2021 Jul

Bibliographical note

Funding Information:
Supported by a Basic Science Research Program grant through the National Research Foundation of Korea funded by the Ministry of Science ICT and Future Planning (NRF-2017R1A2B4010407) and by Samsung Medison.

Publisher Copyright:
© RSNA, 2021

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

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