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Can Breast MRI Predict Axillary Lymph Node Metastasis in Women Undergoing Neoadjuvant Chemotherapy

Annals of Surgical Oncology volume 17, pages 1841–1846 (2010)Cite this article

Abstract

Background

Axillary lymph node status provides important staging information. We sought to evaluate the predictive value of breast magnetic resonance imaging (MRI) in detecting axillary lymph node metastases prior to initiation of neoadjuvant chemotherapy (NAC) and in detecting residual lymph node metastases after NAC in women found to be node positive prior to NAC.

Methods

Women underwent breast MRI with axillary evaluation prior to initiation of NAC and again after completion of NAC. Pathologic confirmation of lymph node status was confirmed by sentinel lymph node biopsy (SLNB), image-guided axillary fine-needle aspiration (FNA)/core biopsy, or axillary lymph node dissection. We evaluated the sensitivity, specificity, and negative and positive predictive values of MRI in detecting axillary node involvement.

Results

Seventy-four women completed NAC and underwent surgery. Sensitivity of MRI in detecting axillary node involvement prior to NAC was 64.7% and specificity was 100%, with positive and negative predictive values of MRI of 100% and 77.8%, respectively. Sensitivity and specificity of MRI to identify residual pathologic axillary lymph node disease following NAC were 85.7% and 89%, respectively, while the positive and negative predictive values were 92% and 80.9%, respectively.

Conclusion

Breast MRI has moderate sensitivity and high specificity for predicting axillary lymph node status prior to NAC. In patients found to be node positive prior to NAC, MRI was able to predict with moderate sensitivity and specificity whether residual nodal disease was present. The accuracy of MRI is not adequate to obviate either the need for staging by sentinel node biopsy or the need for completion axillary dissection in women determined to be node positive prior to NAC.

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Affiliations

  1. Department of Surgery, Brigham and Women’s Hospital and Dana Farber Cancer Institute, Harvard Medical School, Boston, USA

    Sara Javid, Davendra Segara & Mehra Golshan

  2. Department of Radiology, Brigham and Women’s Hospital and Faulkner Hospital, Harvard Medical School, Boston, USA

    Parisa Lotfi

  3. Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA

    Sughra Raza

Authors
  1. Sara Javid
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  2. Davendra Segara
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  3. Parisa Lotfi
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  4. Sughra Raza
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  5. Mehra Golshan
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Correspondence to Mehra Golshan.

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Javid, S., Segara, D., Lotfi, P. et al. Can Breast MRI Predict Axillary Lymph Node Metastasis in Women Undergoing Neoadjuvant Chemotherapy. Ann Surg Oncol 17, 1841–1846 (2010). https://doi.org/10.1245/s10434-010-0934-2

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  • DOI: https://doi.org/10.1245/s10434-010-0934-2

Keywords

  • Sentinel Node Biopsy
  • Axillary Node
  • Axillary Node Dissection
  • Breast Magnetic Resonance Imaging
  • Axillary Lymph Node Metastasis