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Open Access Research article

Correlation between the area of high-signal intensity on SPIO-enhanced MR imaging and the pathologic size of sentinel node metastases in breast cancer patients with positive sentinel nodes

Kazuyoshi Motomura1*, Tetsuta Izumi2, Souichirou Tateishi2, Hiroshi Sumino2, Atsushi Noguchi2, Takashi Horinouchi2 and Katsuyuki Nakanishi2

Author Affiliations

1 Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka 537-8511, Japan

2 Department of Radiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan

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BMC Medical Imaging 2013, 13:32  doi:10.1186/1471-2342-13-32

Published: 13 September 2013

Abstract

Background

We previously demonstrated that superparamagnetic iron oxide (SPIO)-enhanced MR imaging is promising for the detection of metastases in sentinel nodes localized by CT-lymphography in patients with breast cancer. The purpose of this study was to determine the predictive criteria of the size of nodal metastases with SPIO-enhanced MR imaging in breast cancer, with histopathologic findings as reference standard.

Methods

This study included 150 patients with breast cancer. The patterns of SPIO uptake for positive sentinel nodes were classified into three; uniform high-signal intensity, partial high-signal intensity involving ≥50% of the node, and partial high-signal intensity involving <50% of the node. Imaging results were correlated with histopathologic findings.

Results

Thirty-three pathologically positive sentinel nodes from 30 patients were evaluated. High-signal intensity patterns that were uniform or involved ≥50% of the node were observed in 23 nodes that contained macro-metastases and no node that contained micro-metastases, while high-signal intensity patterns involving <50% of the node were observed in 2 nodes that contained macro-metastases and 8 nodes that contained micro-metastases. When the area of high-signal intensity was compared with the pathological size of the metastases, a pathologic >2 mm sentinel node metastases correlated with the area of high-signal intensity, however, a pathologic ≤2 mm sentinel node metastases did not.

Conclusions

High-signal intensity patterns that are uniform or involve ≥50% of the node are features of nodes with macro-metastases. The area of high-signal intensity correlated with the pathological size of metastases for nodes with metastases >2 mm in this series.

Keywords:
Sentinel node; Breast cancer; Magnetic resonance imaging; Computed tomography; Superparamagnetic iron oxide; Nodal enhancement pattern; Lymph node metastasis