Şebnem ÖRGÜÇ, İşıl BAŞARAN, Gökhan PEKİNDİL, Teoman COŞKUN

Contribution of Kinetic Characteristics of Axillary Lymph Nodes to the Diagnosis in Breast Magnetic Resonance Imaging

Objective: To assess the contribution of kinetic characteristics in the discrimination of malignant-benign axillary lymph nodes. Material and Methods: One hundred fifty-five female patients were included in the study. Following magnetic resonance imaging (MRI) examinations post-processing applications were applied, dynamic curves were obtained from subtracted images. Types of dynamic curves were correlated with histopathological results in malignant cases or final clinical results in patients with no evidence of malignancy. Sensitivity, specificity, positive likehood ratio (+LHR), negative (-LHR) of dynamic curves characterizing the axillary lymph nodes were calculated. Results: A total of 178 lymph nodes greater than 8 mm were evaluated in 113 patients. Forty-six lymph nodes in 24 cases had malignant axillary involvement. 132 lymph nodes in 89 patients with benign diagnosis were included in the study. The sensitivity of type 3 curve as an indicator of malignancy was calculated as 89%. However the specificity, +LHR, -LHR were calculated as 14%, 1.04, 0.76 respectively. Conclusion: Since kinetic analysis of both benign and malignant axillary lymph nodes, rapid enhancement and washout (type 3) they cannot be used as a discriminator, unlike breast lesions. MRI, depending on the kinetic features of the axillary lymph nodes, is not high enough to be used in the clinical management of breast cancer patients. Turkish Anahtar Kelimeler: Aksiller lenf bezleri, kinetik karakterler, manyetik rezonans görüntüleme, meme kanseri Amaç: Çalışmamızda insan fetuslarında Oddi sfinkteri'nin fetal dönem boyunca morfometrik gelişiminin araştırılması amaçlandı. Materyal ve Metod: Çalışmaya, yaşları 14&ndash;40 gebelik haftası yaşı arasında değişen ve eksternal patolojisi veya anomalisi olmayan, toplam 113 adet insan fetusu (67 erkek, 46 kız) dahil edildi. Fetusların genel eksternal ölçümleri yapıldıktan sonra abdomen diseksiyonu ile duodenum, pankreas ve Oddi sfinkteri'nin lokalizasyonu belirlendi. Duodenum iç duvarında Oddi sfinkterinin yerleşim yerinden mikroskobik inceleme için histolojik doku örnekleri alındı. Işık mikroskobisinde; her bir fetusta Oddi sfinkterini oluşturan ductus koledocus ve ductus pankreatikus'tan total dış çap, lümen çapı, kanalların total duvar kalınlığı ve kanallar arası mesafe parametreleri ölçüldü. Her bir hafta ve trimester için ölçümlerin standart sapmaları hesaplandı. Bulgular: Ölçülen parametrelerden ductus koledocus duvar kalınlığı hariç diğer parametreler ile gestasyonel yaş arasında anlamlı korelasyon ilişkisi vardı (p&lt;0.001). Koledok duvar kalınlığı fetal dönemin ilk yarısında artarken, ikinci yarısında koledok lümeninin genişlemesinden dolayı miada doğru giderek azalıyordu. Cinsler arasında parametreler yönünden fark bulunamadı (p&gt;0.05). Sonuç: Çalışmamızda elde edilen verilerin, fetal dönemde, intrauterin olgularda Oddi sfinkter bölgesinin gelişiminin değerlendirilmesine katkıda bulunacağını düşünmekteyiz.

Keywords:

Axillary lymph nodes, breast carcinoma, kinetic characteristics, magnetic resonance imaging,

PDF

___

Kuhl CK, Mielcareck P, Klaschik S, Leutner C, Wardelmann E, Gie- seke J, et al. Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions? Radiology 1999;211:101-10.
Balu-Maestro C. Magnetic resonance imaging of the breast. J Ra- diol 2001;82:17-26.
American College of Radiology. ACR BIRADS— Magnetic Reso- nance Imaging. In: ACR Breast Imaging Reporting & Data Sys- tem, breast imaging atlas. Reston, Va: American College of Radi- ology, 2003.
De Bruhl ND, Michael D, Basset LW. Magnetic resonance imag- ing of breast tumors. In: Basset LW, Jackson VP, Fu KL, Fu YS, eds. Diagnosis of Diseases of the Breast 2nd ed. Elsevier Saunders: Philadelphia, 2005; 225-50.
Morris EA. Breast cancer imaging with MRI. Radiol Clin North Am 2002;40:443-66. [CrossRef]
Daniel BL, Ikeda DM. Magnetic resonance imaging of breast cancer and MRI-guided biopsy. In: Ikeda DM ed. The requisities: Breast Imaging. Elsevier-Mosby: Philadelphia 2004;189-224.
Boetes C, Barentsz JO, Mus RD, van der Sluis, van Erning LJ, Hendriks JH, et al. MR characterization of suspicious breast le- sions with a gadolinium- enhanced TurboFLASH subtraction technique. Radiology 1994;193:777-81.
Bartella L, Liberman L, Morris EA, Dershaw DD. Nonpalpable mammographically occult invasive breast cancers detected by MRI. AJR Am J Roentgenol 2006;186:865-70. [CrossRef]
Schnall MD, Blume J, Bluemke DA, DeAngelis GA, DeBruhl N, Harms S, et al. Diagnostic architectural and dynamic features at breast MR imaging: multicenter study. Radiology 2006;238: 42-53. [CrossRef]
Negendank W. Studies of human tumors by MRS: a review. NMR Biomed 1992;5:303-24. [CrossRef]
Luciani A, Dao TH, Lapeyre M, Schwarzinger M, Debaecque C, Lantieri L, et al. Simultaneous bilateral breast and high-resolution axillary MRI of patients with breast cancer: preliminary results. AJR Am J Roentgenol 2004;182:1059-67.
Murray AD, Staff T, Redpath TW, Gilbert FJ, Ah-See AK, Brookes JA, et al. Dynamic contrast enhanced MRI of the axilla in women with breast cancer: comparison with pathology of excised nodes. Br J Radiol 2002;75:220-8.
Memarsadeghi M, Riedl CC, Kaneider A, Galid A, Rudas M, Matzek W, et al. Axillary lymph node metastases in patients with breast carcinomas: assessment with nonenhanced versus uspio- enhanced MR imaging. Radiology 2006;241:367-77. [CrossRef]
Bahri S, Chen JH, Yu HJ, Kuzucan A, Nalcioglu O, Su MY. Can dynamic contrast-enhanced MRI (DCE-MRI) predict tumor recur- rence and lymph node status in patients with breast cancer? Ann Oncol 2008;19:822-4. [CrossRef]
Tuncbilek N, Karakas HM, Okten OO. Dynamic magnetic resonance imaging in determining histopathological prognostic factors of in- vasive breast cancers. Eur J Radiol 2005;53:199-205. [CrossRef]