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Magnetic resonance lymphography of sentinel lymph nodes in patients with breast cancer using superparamagnetic iron oxide: a feasibility study

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The sentinel lymph node (SLN) biopsy technique using superparamagnetic iron oxide (SPIO) as a tracer instead of radioisotopes has been described. To further advance this technique, we evaluated preoperative SPIO-MR sentinel lymphography to facilitate the accurate identification of the lymphatic pathways and primary SLN.


A prospective study was performed in ten patients with breast cancer and clinically negative axillary lymph nodes. None of the patients received preoperative chemotherapy. After 1.6 ml of SPIO (ferucarbotran) was injected in the subareolar breast tissue, sentinel axillary lymph nodes were detected by MRI in T2*-weighted gradient echo images and resected using the serial SPIO-SLN biopsy procedure with a handheld magnetometer.


In one patient, gadolinium-enhanced MR imaging was performed at the same time as SPIO-MR lymphography, and this patient was excluded from further analysis. In all patients (9/9) SLNs were detected by SPIO-MR sentinel lymphography and successfully identified at surgery. The number of SLNs detected by lymphography (mean 2.7) significantly correlated with SLNs identified at surgery (mean 2.2). One patient had nodal metastases. In one patient, skin color changed to brown at the injection site and resolved spontaneously. There were no severe reactions to the procedure or complications in any patient.


This is the first study to evaluate SPIO both as a contrast material in MR sentinel lymphography and as a tracer in SLN biopsy using an integrated method. The acquired three-dimensional imaging demonstrated excellent image quality and usefulness to identify SLN in conjunction with SLN biopsy.

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  1. Giuliano AE, Kirgan DM, Guenther JM, Morton DL. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg. 1994;220:391–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Cody HS. Sentinel lymph node mapping in breast cancer. Breast Cancer. 1999;6:13–22.

    Article  CAS  PubMed  Google Scholar 

  3. Ferrucci JT, Stark DD. Iron oxide-enhanced MR imaging of the liver and spleen: review of the first 5 years. AJR Am J Roentgenol. 1990;155:943–50.

    Article  CAS  PubMed  Google Scholar 

  4. Motomura K, Ishitobi M, Komoike Y, Koyama H, Noguchi A, Sumino H, et al. SPIO-enhanced magnetic resonance imaging for the detection of metastases in sentinel nodes localized by computed tomography lymphography in patients with breast cancer. Ann Surg Oncol. 2011;18:3422–9.

    Article  PubMed  Google Scholar 

  5. Shiozawa M, Lefor AT, Hozumi Y, Kurihara K, Sata N, Yasuda Y, et al. Sentinel lymph node biopsy in patients with breast cancer using superparamagnetic iron oxide and a magnetometer. Breast Cancer. 2012. doi:10.1007/s12282-011-0327-9.

  6. Yamashiro N, Tozaki M, Ogawa T, Kawano N, Suzuki T, Ozaki S, et al. Preoperative MRI marking technique for the planning of breast-conserving surgery. Breast Cancer. 2009;16:223–8.

    Article  PubMed  Google Scholar 

  7. Bellin MF, Beigelman C, Precetti-Morel S. Iron oxide-enhanced MR lymphography: initial experience. Eur J Radiol. 2000;34:257–64.

    Article  CAS  PubMed  Google Scholar 

  8. Houssami N, Ciatto S, Macaskill P, Lord SJ, Warren RM, Dixon JM, et al. Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer. J Clin Oncol. 2008;26:3248–58.

    Article  PubMed  Google Scholar 

  9. Harisinghani MG, Barentsz J, Hahn PF, Deserno WM, Tabata-baei S, van de Kaa CH, et al. Noninvasive detection of clinically occult lymph-node metastases in prostate cancer. N Engl J Med. 2003;348:2491–9.

    Article  PubMed  Google Scholar 

  10. Rockall AG, Sohaib SA, Harisinghani MG, Babar SA, Singh N, Jeyarajah AR, et al. Diagnostic performance of nanoparticle-enhanced magnetic resonance imaging in the diagnosis of lymph node metastases in patients with endometrial and cervical cancer. J Clin Oncol. 2005;23:2813–21.

    Article  PubMed  Google Scholar 

  11. Stets C, Brandt S, Wallis F, Buchmann J, Gilbert FJ, Heywang-Kobrunner SH. Axillary lymph node metastases: a statistical analysis of various parameters in MRI with USPIO. J Magn Reson Imaging. 2002;16:60–8.

    Article  PubMed  Google Scholar 

  12. Suga K, Yamamoto S, Tangoku A, Oka M, Kawakami Y, Matsunaga N. Breast sentinel lymph node navigation with three-dimensional interstitial multidetector-row computed tomographic lymphography. Invest Radiol. 2005;40:336–42.

    Article  PubMed  Google Scholar 

  13. Nakamura R, Nagashima T, Sakakibara M, Sangai T, Fujimoto H, Arai M, et al. Breast-conserving surgery using supine magnetic resonance imaging in breast cancer patients receiving neoadjuvant chemotherapy. Breast. 2008;17:245–51.

    Article  PubMed  Google Scholar 

  14. Ishiyama K, Sashi R, Katayose Y, Tomura N, Watarai J, Narita K. Sentinel lymph node after intramammary injection of superparamagnetic iron oxide (in Japanese with English abstract). Nippon Igaku Hoshasen Gakkai Zasshi. 2002;62:744–6.

    PubMed  Google Scholar 

  15. Suga K, Yuan Y, Ogasawara N, Okada M, Matsunaga N. Localization of breast sentinel lymph nodes by MR lymphography with a conventional gadolinium contrast agent. Preliminary observations in dogs and humans. Acta Radiol. 2003;44:35–42.

    CAS  PubMed  Google Scholar 

  16. Mariani G, Moresco L, Viale G, Villa G, Bagnasco M, Canavese G, et al. Radioguided sentinel lymph node biopsy in breast cancer surgery. J Nucl Med. 2001;42:1198–215.

    CAS  PubMed  Google Scholar 

  17. Lawaczeck R, Bauer H, Frenzel T, Hasegawa M, Ito Y, Kito K, et al. Magnetic iron oxide particles coated with carboxydextran for parenteral administration and liver contrasting. Pre-clinical profile of SH U555A. Acta Radiol. 1997;38:584–97.

    CAS  PubMed  Google Scholar 

  18. March DE, Wechsler RJ, Kurtz AB, Rosenberg AL, Needleman L. CT-pathologic correlation of axillary lymph nodes in breast carcinoma. J Comput Assist Tomogr. 1991;15:440–4.

    Article  CAS  PubMed  Google Scholar 

  19. Fazel R, Krumholz HM, Wang Y, Ross JS, Chen J, Ting HH, et al. Exposure to low-dose ionizing radiation from medical imaging procedures. N Engl J Med. 2009;27(361):849–57.

    Article  Google Scholar 

  20. Anderson LJ, Holden S, Davis B, Prescott E, Charrier CC, Bunce NH, et al. Cardiovascular T2-star (T2*) magnetic resonance for the early diagnosis of myocardial iron overload. Eur Heart J. 2001;22:2171–9.

    Article  CAS  PubMed  Google Scholar 

  21. Takada S, Inoue T, Niizuma K, Shimizu H, Tominaga T. Hemosiderin detected by T2*-weighted magnetic resonance imaging in patients with unruptured cerebral aneurysms: indication of previous bleeding? Neurol Med Chir. 2011;51:275–81.

    Article  Google Scholar 

  22. Kimura K, Tanigawa N, Matsuki M, Nohara T, Iwamoto M, Sumiyoshi K, et al. High-resolution MR lymphography using ultrasmall superparamagnetic iron oxide (USPIO) in the evaluation of axillary lymph nodes in patients with early stage breast cancer: preliminary results. Breast Cancer. 2010;17:241–6.

    Article  PubMed  Google Scholar 

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This work was partially supported by a Jichi Medical University Young Investigator Award.

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Correspondence to Mikio Shiozawa.

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Shiozawa, M., Kobayashi, S., Sato, Y. et al. Magnetic resonance lymphography of sentinel lymph nodes in patients with breast cancer using superparamagnetic iron oxide: a feasibility study. Breast Cancer 21, 394–401 (2014).

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