Email this article Comparative evaluation of strain ratio on sonographic elastography and T2* values on 3 Tesla magnetic resonance imaging in differentiating malignant from benign axillary lymph nodes in breast cancer
Abstract
Background: The study aimed to assess whether strain ratio and T2* values can improve the sensitivity and specificity of differentiating metastatic from benign axillary lymph nodes in breast cancer patients taking histopathology as reference standard.
Methods: The study was done on 43 patients. A multi-echo transverse T2*W MR sequence was obtained with TE = 0.9- 1.5 ms, TR=37.2 ms and flip angle = 25°. Sonographic elastography was done using high frequency linear probe (L3-16 MHz). Manual selection of the region of interest was done on suspicious lymph nodes for calculation of T2* values and strain ratio. ROC curves were obtained for various T2* and strain ratio values in comparison to histopathological findings as gold standard.
Results: Correlation with histopathology was better with T2* values than strain ratio. The sensitivity and specificity were calculated using cut off values obtained from ROC curve (31.225 ms for T2* value and 1.85 for SR) and were 70.37%, 68.75% for strain ratio and 96.29%, 93.75% for T2* value respectively. The positive predictive value and negative predictive value were also assessed, values being higher for T2* than strain ratio. Comparison of areas under ROC curve was statistically significant with p=0.018.
Conclusions: T2* can be used as a potential biomarker for differentiating metastatic from benign axillary lymph nodes owing to its high sensitivity, specificity and relative ease of performance. Quantitative assessment of changes in T2* values may allow more objective analysis of signal changes with significant differences between benign and malignant lymph nodes, even in case of partial infiltration.
Keywords
Full Text:
PDFReferences
Li C, Meng S, Yang X, Wang J, Hu J. The value of T2* in differentiating metastatic from benign axillary lymph nodes in patients with breast cancer--a preliminary in vivo study. PLoS One. 2014;9:1.
Andreea GI, Pegza R, Lascu L, Bondari S, Stoica Z, Bondari A. The Role of Imaging Techniques in Diagnosis of Breast Cancer. Curr Heal Sci J. 2011;37(2):55-61.
Arslan G, Altintoprak KM, Yirgin IK, Atasoy MM, Celik L. Diagnostic accuracy of metastatic axillary lymph nodes in breast MRI. Springerplus. 2016;5(1):735.
Choi JJ, Kang BJ, Kim SH, Lee JH, Jeong SH, Yim HW et al. Role of sonographic elastography in the differential diagnosis of axillary lymph nodes in breast cancer. J Ultrasound Med. 2011;30:429-36.
Liberman L, Cody 3rd HS, Hill AD, Rosen PP, Yeh SD, Akhurst T et al. Sentinel lymph node biopsy after percutaneous diagnosis of nonpalpable breast cancer. Radiology. 1999;211(3):835-44.
Wojcinski S, Dupont J, Schmidt W, Cassel M, Hillemanns P. Real-time ultrasound elastography in 180 axillary lymph nodes: elasticity distribution in healthy lymph nodes and prediction of breast cancer metastases. BMC Med Imaging. 2012;12(1):35.
Bedi DG, Krishnamurthy R, Krishnamurthy S, Edeiken BS, Le-Petross H, Fornage BD et al. Cortical morphologic features of axillary lymph nodes as a predictor of metastasis in breast cancer: In vitro sonographic study. Am J Roentgenol. 2008;191(3):646-52.
Bonnema J, van Geel N, Van Ooijen B, Mali SP, Tjiam SL, Henzen-Logmans SC et al. Ultrasound-guided aspiration biopsy for detection of nonpalpable axillary node metastases in breast cancer patients: new diagnostic method. World J Surg. 1997;21(3):270-4.
Uematsu T, Sano M, Homma K. In vitro high-resolution helical CT of small axillary lymph nodes in patients with breast cancer: Correlation of CT and histology. Am J Roentgenol. 2001;176(4):1069-74.
Shetty SK, Harisinghani MG. Magnetic resonance techniques in lymph node imaging. Appl Radiol. 2004;33(7):34-44.
Dudea SM, Botar-Jid C, Dumitriu D, Vasilescu D, Manole S, Lenghel ML. Differentiating benign from malignant superficial lymph nodes with sonoelastography. Med Ultrasonography. 2013;15:132-9.
Lyshchik A, Higashi T, Asato R, Tanaka S, Ito J, Hiraoka M et al. Cervical lymph node metastases: Diagnosis at sonoelastography - Initial experience. Radiology. 2007;243(1):258-67.
Zhang Y, Lv Q, Yin Y, Xie M, Xiang F, Lu C, et al. The value of ultrasound elastography in differential diagnosis of superficial lymph nodes. Front Med China. 2009;3(3):368-74.
Latif MA, Shady M, Hegazy MAE, Abdo YM. B-mode ultrasound, sono-elastography and diffusion-weighted MRI in differentiation of enlarged axillary lymph nodes in patients with malignant breast disease. Egypt J Radiol Nucl Med. 2016;47(3):1137-49.
Korteweg MA, Visser F, Polders DL, Takahara T, Mali WPTM, Veldhuis WB. Gadofosveset as a negative contrast agent for detecting metastatic axillary lymph nodes in breast cancer patients on diffusion and T2* weighted images: a proof of principle. In: Proceedings of the Eighteenth Meeting of the International Society for Magnetic Resonance in Medicine. Berkeley. Calif: Int Society Magnetic Resonance Med. 2010;5837.
