Turan ILICA, Cem OREN, Nurcan ERCIKTI, Brian GOLDNER, İnanç GUVENC, Erkan OZTURK, Ali Fuat CİCEK, Gokhan OSMANOGLU, Semih GORGULU

Aksiller Lenf Nodu ADC Değerlerinin, Yüksek Rezolüsyonlu MR ile Metastatik Lenf Nodu Tespitinde Kullanımı

Yüksek rezolüsyonlu MR ile ölçülen aksiller lenf nodu ADC değerlerinin klinik etkinliğinin araştırılması. İnvaziv meme kanserli 18 kadına yüzeyel koiller ile aksiller MR çekimi yapıldı. İki radyolog belirlenmiş morfolojik kriterlere göre malignite açısından en şüpheli aksiller lenf nodunu konsensus ile belirleyerek en şüpheli lenf nodunda ADC ölçümü yaptılar. Patolojik sonuçlar referans kabul edilerek ADC ölçümlerinin metastatik-reaktif lenf nodu ayrımında tanısal etkinliğini belirlemede gerekli istatistik değerlendimeler yapıldı. Histopatolojik bulgular 18 hastanın 11’inde aksiller lenf nodu metastazı saptadı. Metastatik lenf nodlarının ADC değerleri olmayanlardan daha düşüktü (p=0.006, Mann Whitney U testi). ADC değerli olarak 0.967x10-3 mm2/s değeri eşik değer olarak kabul edildiğinde istatistiksel olarak duyarlılık, özgüllük, doğruluk, pozitif prediktif ve negatif prediktif değer sırasıyla 85.7, 100.0, 94.4, 91.7, 100.0 olarak belirlendi. Eğer bizim bu konudaki ilk bulgularımız daha geniş seriler ile desteklenirse yüksek rezolüsyonlu MR ile ölçülen aksiller lenf nodu ADC değerleri gelecekte sentinel lenf nodu biyopsisine iyi bir alternatif tarama metodu olabilir.

Anahtar Kelimeler:

Aksiller Lenf Nodu, Difüzyon MR, Görünüşteki Difüzyon Katsayısı, Meme Kanseri

A Targeted High-Resolution Axillary MRI to Detect Axillary Lymph Node Metastasis with ADC Values

To evaluate the clinical utility of ADC values of axillary lymph nodes using high-resolution axillary MR. 18 women with invasive breast carcinoma underwent axillary MR with surface coils. Two radiologists determined the most suspicious axillary lymph node using predefined morphologic descriptors and measured the ADC values of the most suspicious lymph node in consensus. Statistical analysis was performed to evaluate the diagnostic value of ADC measurements using the pathologic assessment as the reference study. Histopathologic findings revealed axillary nodal metastases in 11 out of 18 patients. ADC values of metastatic lymph nodes were lower than the nonmetastatic nodes (p=0.006, Mann Whitney U test). By using 0.967x10-3 mm2/s as a threshold, sensitivity, specificity, accuracy, positive predictive value, and negative predictive values based for ADC were 85.7, 100.0, 94.4, 91.7, 100.0. If our initial results are confirmed with larger series, ADC values of the axillary lymph nodes with high-resolution axillary MRI can be an alternative for sentinel lymph node biopsy.

Keywords:

Apparent Diffusion Coefficient, Axillary Lymph Node, Breast Cancer, Diffusion MRI,

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