Conservative Approach to Regional Node Dissection Possible With Breast MRI: Presented at ASBD

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Title: Conservative Approach to Regional Node Dissection Possible With Breast MRI: Presented at ASBD
URL: http://www.pslgroup.com/dg/21F81A.htm
Doctor's Guide
April 15, 2008

By Kristina Rebelo

SAN DIEGO -- April 15, 2008 -- Magnetic resonance imaging (MRI) can be a valuable tool in the workup of breast cancer for surgical planning with regard to lymph node dissection, according to results of a study presented here at the 32nd Annual Symposium of the American Society of Breast Disease (ASBD).

The study was a retrospective review of reports from patients who underwent lumpectomy with concurrent lymphoscintigraphic and dye-directed sentinel node dissection and those who underwent breast MRI. Patients selected included those who underwent breast MRI less than 6 months prior to surgery for biopsy-proven cancer.

The researchers identified 4 patients as having both abnormal lymph nodes on MRI and disease in sample sentinel nodes; 2 patients had disease present in sentinel nodes with no abnormal lymph nodes identified on MRI; 7 had abnormal lymph nodes on MRI and no disease in dissected sentinel nodes; 13 had no disease identified in the sampled lymph nodes and no abnormal lymph nodes seen on MRI. The results gave researchers a negative predictive value of 87% for identifying absence of nodal disease with MRI.

"Basically, we can look at staging for breast cancer by looking at primary mass," said the presenter, second author Jessica Yuen, MD, Radiologist, Pennsylvania Hospital, Philadelphia, Pennsylvania. "If we can determine if there is lymph node metastasis prior to initial surgery, the surgeons can better plan their surgery." Co-authors were radiologists Jason Kosove, MD, and Brian Englander, MD, Director of Women's Imaging Center, Pennsylvania Hospital, Philadelphia, Pennsylvania.

Reports were evaluated for identification of abnormal lymph nodes on MRI based on lymph node size and morphology, and then on pathology from sentinel node dissection confirming presence or absence of disease in the sampled lymph node.

Breast MRI that does not identify abnormal lymph nodes suggests that there has been no nodal spread of cancer and, therefore, the surgeon can plan a more conservative dissection of regional nodes.

The researchers predict that future improvement in MRI coils will further improve the ability to detect abnormal lymph nodes in the breast and axilla, adding even more value to breast MRI when assessing and treating breast cancer patients, including the possibility of identifying abnormal lymph nodes with image-guided biopsy.

[Presentation title: Utility of Breast MRI in Evaluation of Abnormal Lymph Nodes. Poster T2]

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