Predictive Value Of Multi-Parameter MRI In Axillary Lymph Node Metastasis Of Stage T1/2 Invasive Breast Cancer

Objective: Assessment of Axillary Lymph Node(ALN)status has important implications for tumor staging and treatment planning in patients with invasive breast cancer.The purpose of this study was to evaluate the predictive value of preoperative Multi-parameter Magnetic Resonance Imaging(mp MRI)for ALN metastasis in patients with stage T1/2 invasive breast cancer.Methods: 128 patients with stage T1/2 invasive breast cancer who underwent preoperative mp MRI examination in our hospital were collected.The morphological parameters of the primary lesion and ALN,the Apparent Diffusion Coefficient(ADC)of DWI and the Dynamic Contrast Enhanced MRI(DCE-MRI) parameters of the primary lesion of invasive breast cancer were retrospectively analyzed.To evaluate the predictive value of mp MRI for ALN metastasis,the sentinel lymph node biopsy and/or axillary lymph node dissection were used to distinguish the ALN metastatic group from the non-metastatic group.Results:Of the 128 patients,43(33.6%)had ALN metastasis,and 85(66.4%)had no metastasis.1.Analysis of the overall general data and MRI morphology and parameter characteristics of the primary lesion between the metastatic group and the non-metastatic group showed statistically significant differences in periumoral edema,lesion edge and time-signal intensity curve(TIC)(P<0.05),AUC: 0.746(95%CI:0.660-0.831,P<0.01),sensitivity: 79.1%,specificity: 56%.The difference in ADC value was statistically significant(P<0.05),the AUC was 0.685(95%CI: 0.5888-0.781,P<0.01),the optimal cutoff value was 0.897×10-3,the sensitivity was 65.1%,and the specificity was 67.9%.There were statistically significant differences in Ktrans,VP,TTP,Max Conc,AUC and Max Slope values(P<0.05),AUC: 0.816(95%CI: 0.736-0.896,P<0.01),Sensitivity: 72.1%,Specificity: 82.1%.2.Multi factor Logistic regression and ROC curve analysis of the whole group of metastatic group and non-metastatic group showed that ADC value,TIC curve,Ktrans value,VP value and Max Slope value were independent risk factors for ALN metastasis,AUC: 0.905(95%CI: 0.8544-0.956,P<0.01),Sensitivity: 88.4%,Specificity: 77.4%.3.The transfer and transfer group ALN show patients’ general information,ALN and MRI morphological characteristics analysis and parameters from the primary lesion:primary lesions and ADC values and DCE MRI morphology parameters with the differences statistically significant,the AUC,Sensitivity,Specificity: 0.720(95% CI:0.624-0.815,P < 0.01),Sensitivity: 78.6%,specificity: 52.3%;0.626(95%CI:0.520-0.732,P=0.028),Sensitivity: 81%,Specificity: 44.6%;0.829(95%CI:0.748-0.909,P<0.01),Sensitivity: 76.2%,Specificity: 80%.In addition,there were statistically significant differences in fat gate,number of ALN,ratio of ALN long diameter,short diameter and short diameter,and ALN enhancement(P<0.05),AUC:0.856(95%CI: 0.854--0.956,P<0.01),Sensitivity: 81%,Specificity: 80%.4.Multivariate Logistic regression and ROC curve analysis of lymph node in metastatic group and non-metastatic group showed that adipogate,ALN short diameter,Ktrans value,VP value and Max Slope value were independent risk factors for ALN metastasis,AUC: 0.929(95%CI: 0.8744-0.989,P<0.01),Sensitivity: 90.5%,Specificity: 88.7%.Conclusion:1.The evaluation of primary lesions and ALN by MPMRI can predict ALN metastasis in stage T1/2 invasive breast cancer.2.The diagnostic efficacy of comprehensive analysis of DCE-MRI dynamic parameters and ALN features of the primary lesion is better than that of single mp MRI features.