Lobar Approach to Breast Ultrasound by Dominique Amy

Author:Dominique Amy
Language: eng
Format: epub, pdf
Publisher: Springer International Publishing, Cham

Expensive technique

Irradiation

Time-consuming

Not available outside developed countries.

Therefore the current challenge is to reduce the rate of SLNB. New developments on US and MRI [69] and cost-effective strategies in the workup of patients with early breast cancer, who are a majority of the cases in the developed countries, will decrease under 50% the proportion of patients undergoing SLNB [70].

10.3.2.5 Magnetic Resonance Imaging (MRI)

MRI has several advantages over other imaging modalities, such as the lack of ionizing radiation (compared to PET/CT) or less intra- and interobserver variation (common in ultrasound examinations). Despite its limitations (claustrophobia, accessibility, cost), MRI is increasingly used for the pre-therapeutic evaluation of breast cancer. MRI has a broad sensitivity range reported as 36–78% and 93–100% specificity for detecting axillary metastasis [49, 71–73] and allows an accurate evaluation of axillary LN, levels I–III, as well as the internal mammary nodes.

There is a large variation in the criteria for distinguishing positive from negative LN: size, short/long axis ratio, LN >4 mm, short axis diameter >5 or >10 mm, shape, irregular margins, lobulated margins, presence of fatty hilum, cortical thickening, cortical thickness >3 mm, asymmetric cortex, unclear margins, perinodular edema, anatomic location of the LN, signal intensity time curves, heterogeneous uptake of USPIO, lack of USPIO uptake, T2* values, high signal intensity on DWI, early-stage enhancement, apparent diffusion coefficient (ADC) values, visual inspection of DWI and ADC, and detectability on DWI [69]. We would point out other interesting criteria reported in recent years:When using a signal intensity increase in the LN of >100% during the first post-contrast images as a threshold for malignancy, sensitivity is 83%, specificity 90%, and accuracy 88%; these results are not improved when LN size and morphology are used as additional criteria [72].

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