Breast cancer: in vivo proton MR spectroscopy in the characterization of histopathologic subtypes and preliminary observations in axillary node metastases.

PURPOSE To assess the relationship between breast cancer subtypes and choline detection by using in vivo proton magnetic resonance (MR) spectroscopy and to assess the feasibility of proton MR spectroscopy in the study of axillary lymph node metastases. MATERIALS AND METHODS Breast and lymph node MR spectroscopy of lesions identified at contrast material-enhanced MR imaging was performed in 39 patients with breast cancer. Spectroscopic and histopathologic findings were determined and compared. The sensitivity, specificity, and accuracy of the MR spectroscopic technique in the detection of axillary lymph node metastases were determined. RESULTS There were four cases of ductal carcinoma in situ (DCIS) and 34 invasive carcinomas, including three with an extensive in situ component. Twenty-six breast lesions were positive for choline at MR spectroscopy; nine, negative; and three, failed cases (ie, determination of positive or negative for choline could not be made). No data were available for one lesion. Four of the nine negative findings were DCIS; three, infiltrating ductal carcinoma (IDC) with an extensive in situ component; and two, IDC. Fourteen axillary lymph nodes were positive for choline; 17, negative; and four, failed cases. No data were available for four nodes. Comparison of the preliminary diagnostic indexes of the MR spectroscopic technique with the ultrasonographically guided fine-needle aspiration biopsy findings in lymph nodes revealed a sensitivity of 82%, specificity of 100%, and accuracy of 90%. CONCLUSION Choline is consistently detected in IDC. DCIS and IDC with an extensive in situ component are likely to be negative for choline at MR spectroscopy. In vivo proton MR spectroscopy of axillary lymph nodes in patients with breast cancer is feasible and has encouraging preliminary results.

[1]  I. Gribbestad,et al.  Characterization of neoplastic and normal human breast tissues with in vivo 1H MR spectroscopy , 1999, Journal of magnetic resonance imaging : JMRI.

[2]  A Horsman,et al.  Prediction of axillary lymph node status in invasive breast cancer with dynamic contrast-enhanced MR imaging. , 1997, Radiology.

[3]  S. Heywang,et al.  MR imaging of the breast with Gd-DTPA: use and limitations. , 1989, Radiology.

[4]  I. Gribbestad,et al.  In vivo 1H MRS of normal breast and breast tumors using a dedicated double breast coil , 1998, Journal of magnetic resonance imaging : JMRI.

[5]  A. Ketcham,et al.  Total axillary lymphadenectomy in the management of breast cancer. , 1991, Archives of surgery.

[6]  Vanhamme,et al.  Improved method for accurate and efficient quantification of MRS data with use of prior knowledge , 1997, Journal of magnetic resonance.

[7]  S E Harms,et al.  MR imaging of the breast with rotating delivery of excitation off resonance: clinical experience with pathologic correlation. , 1993, Radiology.

[8]  Barbara L. Smith,et al.  Evaluating human breast ductal carcinomas with high-resolution magic-angle spinning proton magnetic resonance spectroscopy. , 1998, Journal of magnetic resonance.

[9]  J. A. den Boer,et al.  Pharmacokinetic Analysis of Gd‐DTPA Enhancement in dynamic three‐dimensional MRI of breast lesions , 1997, Journal of magnetic resonance imaging : JMRI.

[10]  S. Edge,et al.  Suspect breast lesions: findings at dynamic gadolinium-enhanced MR imaging correlated with mammographic and pathologic features. , 1995, Radiology.

[11]  W. Mackinnon,et al.  Fine-needle biopsy specimens of benign breast lesions distinguished from invasive cancer ex vivo with proton MR spectroscopy. , 1997, Radiology.

[12]  D. Yeung,et al.  Human breast lesions: characterization with contrast-enhanced in vivo proton MR spectroscopy--initial results. , 2001, Radiology.

[13]  S. Dwivedi,et al.  Evaluation of total choline from in-vivo volume localized proton MR spectroscopy and its response to neoadjuvant chemotherapy in locally advanced breast cancer , 2001, British Journal of Cancer.

[14]  S E Harms,et al.  MR imaging of the breast , 1993, Journal of magnetic resonance imaging : JMRI.

[15]  C. Kuhl,et al.  Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions? , 1999, Radiology.

[16]  M D Schnall,et al.  Breast MR imaging: interpretation model. , 1997, Radiology.

[17]  F. Howe,et al.  In vivo 31p mrs: absolute concentrations, signal‐to‐noise and prior knowledge , 1995, NMR in biomedicine.

[18]  W. Negendank,et al.  Studies of human tumors by MRS: A review , 1992, NMR in biomedicine.

[19]  Scott Fields,et al.  Mapping pathophysiological features of breast tumors by MRI at high spatial resolution , 1997, Nature Medicine.

[20]  J L Ackerman,et al.  Enhanced resolution of proton NMR spectra of malignant lymph nodes using magic‐angle spinning , 1996, Magnetic resonance in medicine.

[21]  W. Mackinnon,et al.  Magnetic resonance spectroscopy detects cancer in draining lymph nodes. , 1993, Invasion & metastasis.

[22]  M D Schnall,et al.  Suspicious breast lesions: MR imaging with radiologic-pathologic correlation. , 1994, Radiology.

[23]  I. Gribbestad,et al.  Comparative signal intensity measurements in dynamic gadolinium‐enhanced MR mammography , 1994, Journal of magnetic resonance imaging : JMRI.

[24]  R. Lenkinski,et al.  Human breast lesions: characterization with proton MR spectroscopy. , 1998, Radiology.

[25]  E Adalsteinsson,et al.  Motion correction and lipid suppression for 1H magnetic resonance spectroscopy , 2000, Magnetic resonance in medicine.