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Added Value of MRI for Invasive Breast Cancer including the Entire Axilla for Evaluation of High-Level or Advanced Axillary Lymph Node Metastasis in the Post-ACOSOG Z0011 Trial Era.

  • Byon, Jung Hee1
  • Park, Youngjean Vivian1
  • Yoon, Jung Hyun1
  • Moon, Hee Jung1
  • Kim, Eun-Kyung1
  • Kim, Min Jung1
  • You, Jai Kyung1
  • 1 From the Department of Radiology, Yonsei University College of Medicine, Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea (J.H.B., Y.V.P., J.H.Y., H.J.M., E.K.K., M.J.K.); Department of Radiology and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Republic of Korea (J.H.B.); Department of Radiology, Yonsei University College of Medicine, Yongin Severance Hospital, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yongin, Gyeonggi-do, Republic of Korea (E.K.K.); and Department of Radiology, NHIS Ilsan Hospital, Goyang, Republic of Korea (J.K.Y.). , (North Korea)
Published Article
Radiological Society of North America
Publication Date
Jul 01, 2021
DOI: 10.1148/radiol.2021202683
PMID: 33904772


Background In the post-American College of Surgeons Oncology Group Z0011 trial era, radiologists have increasingly focused on excluding high-level or advanced axillary lymph node metastasis (ALNM) by using an additional MRI scan positioned higher than lower axillae; however, the value of these additional scans remains undetermined. Purpose To evaluate whether a standard MRI protocol is sufficient to exclude high-level or advanced ALNM in breast cancer or additional MRI of entire axilla is needed. Materials and Methods This retrospective study evaluated women with invasive breast cancer who underwent breast MRI from April 2015 to December 2016. Some underwent neoadjuvant chemotherapy (NAC) and others underwent upfront surgery. Standard (routine axial scans including the lower axillae) and combined (routine axial scans plus additional scans including the entire axilla) MRI protocols were compared for high-level or advanced ALNM detection. Clinical-pathologic characteristics were analyzed. Uni- and multivariable logistic regression was performed to identify predictors of high-level or advanced ALNM. Results A total of 435 women (mean age ± standard deviation, 52 years ± 11) were evaluated (65 in the NAC group, 370 in the non-NAC group). With the standard MRI protocol, predictors of high-level ALNM were peritumoral edema (odds ratio [OR], 12.3; 95% CI: 3.9, 39.4; P < .001) and positive axilla (OR, 5.9; 95% CI: 2.0, 15.2; P < .001). Only three of 289 women with negative axillae without peritumoral edema had high-level ALNM. Predictors of advanced ALNM were positive axillae (OR, 8.9; 95% CI: 3.7, 21.5; P < .001) and peritumoral edema (OR, 2.8; 95% CI: 1.1, 6.9; P = .03). Only six of 310 women who had negative axillae without peritumoral edema had advanced ALNM. Conclusion The performance of standard MRI was satisfactory in excluding high-level and advanced axillary lymph node metastasis in most patients with breast cancer. However, the presence of peritumoral edema or positive axillae in the MRI findings emphasizes the benefits of a combined MRI protocol. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Abe in this issue.

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