Application of MR Mammography Beyond Local Staging: Is There a Potential to Accurately Assess Axillary Lymph Nodes? Evaluation of an Extended Protocol in an Initial Prospective Study

Application of MR Mammography Beyond Local Staging: Is There a Potential to Accurately Assess Axillary Lymph Nodes? Evaluation of an Extended Protocol in an Initial Prospective Study
Pascal A. T. Baltzer, Matthias Dietzel, Hartmut P. Burmeister, Ramy Zoubi, Mieczyslaw Gajda, Oumar Camara, and Werner A. Kaiser
AJR 2011; 196:641-647

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Most significant predictors (p < 0.001) of present metastasis were "irregular margin" (diagnostic OR, 14.0), "inhomogeneous cortex" (diagnostic OR, 8.4), "perifocal edema" (positive likelihood ratio, 100) and "asymmetry" (diagnostic OR, 19.5). CHAID tree identified "asymmetry" and "irregular margin" as significant predictors (adjusted-p < 0.05) for present metastasis (PPV: 100%), whereas absence of "asymmetry" and "homogeneous internal structure" were highly predictive of absent metastasis (negative predictive value, 94.3%). Combination of significant descriptors using binary logistic regression revealed an area under the receiver operating characteristic curve of 0.93 (p < 0.001). Inter-rater agreement was "almost-perfect" ( = 0.95).

Combined T-staging and locoregional staging (N-staging) was possible within one imaging session using the proposed protocol. Despite a minimal increase in examination time, high diagnostic accuracy and excellent interrater reliability were achieved