Diagnostic performance of gadofosveset-enhanced axillary MRI for nodal (re)staging in breast cancer patients: results of a validation study

T. J. A. van Nijnatten*, R. J. Schipper, M. B. I. Lobbes, L. M. van Roozendaal, S. Voo, M. Moossdorff, M. -L. Paiman, B. de Vries, K. B. M. I. Keymeulen, J. E. Wildberger, M. L. Smidt, R. G. H. Beets-Tan

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

AIM: To evaluate diagnostic performance of gadofosveset ( GDF)-enhanced magnetic resonance imaging (MRI) in addition to T2-weighted (T2W) MRI for nodal (re) staging in newly diagnosed breast cancer patients. MATERIALS AND METHODS: Ninety patients underwent axillary T2W-and GDF-MRI. Two radiologists independently scored each lymph node; first on T2W-MRI, subsequently adjusting their score on GDF-MRI. Diagnostic performance parameters were calculated on node-by-node and patient-by-patient validation with histopathology as the reference standard. Furthermore, learning curve analysis for reading GDF-MRI was performed. RESULTS: In patient-by-patient validation, overall reader performances for T2W-and GDF-MRI were similar with area under the receiver operating characteristic curves (AUC) of 0.75 and 0.77 (p = 0.731) for reader 1 and 0.79 and 0.72 (p = 0.156) for reader 2. For node-by-node validation, AUC values of T2W-and GDF-MRI were 0.76 and 0.82 (p = 0.018) and 0.77 and 0.77 (p = 0.998) for reader 1 and 2. The AUC for reader 1 was 0.71 for first one-third of nodes evaluated, improving to 0.80 and 0.95 for the next and last one-third, respectively. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) improved from 38%, 89%, 56%, and 79% to 60%, 93%, 64%, and 92%. The AUC of reader 2 improved from 0.69 to 0.79. CONCLUSION: The present study confirmed that GDF-MRI, in addition to T2W-MRI, has potential as a non-invasive method for nodal (re) staging in breast cancer. (C) 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.
Original languageEnglish
Pages (from-to)168-175
Number of pages8
JournalClinical Radiology
Volume73
Issue number2
DOIs
Publication statusPublished - 1 Feb 2018

Keywords

  • LYMPH-NODES
  • NEOADJUVANT CHEMOTHERAPY
  • SYSTEMIC TREATMENT
  • ARM LYMPHEDEMA
  • DISSECTION
  • BIOPSY
  • TRIAL
  • METASTASES
  • MICROMETASTASES
  • METAANALYSIS

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