Diagnostic Value of Diffusion Weighted Magnetic Resonance Imaging in Evaluation of Metastatic Axillary Lymph Nodes in a Sample of Iranian Women with Breast Cancer

Objective: To evaluate the diagnostic value of diffusion weighted magnetic resonance imaging (DW-MRI) in assessment of metastases in axillary lymph nodes (ALNs) in a sample of Iranian women with breast cancer. Methods: A total of 50 axillary lymph nodes from 30 female patients with histologically verified breast cancer were assessed by 1.5 T MRI. DWI was implemented at b-values of 50, 400 and 800 s/mm2. Short axis diameter, presence of fatty hilum and apparent diffusion coefficient (ADC) values (min, max and mean) of metastatic and non-metastatic ALNs was compared. Cutoff ADC values to discriminate between benign and malignant axillary lymph nodes were analyzed with receiver coefficient characteristic (ROC) curves. Result: The final histopathological examination revealed 46% (n=23) metastatic and 54% (n=27) non-metastatic ALNs. There was no statistically significant difference in short axis diameter between the two groups (p = 0.537). However there was significantly correlation between loss of fatty hilum and presence of metastases (p < 0.001) and ADC values (0.255 ± 0.19×10-3 mm2/s vs 0.616 ±0.3×10-3 mm2/s (ADC min), 1.088 ± 0.22×10-3 mm2/s vs 1.497 ± 0.24×10-3 mm2/s (ADC max) and 0.824 ± 0.103 ×10-3 mm2/s vs 1.098 ± 0.23 ×10-3 mm2/s (ADC mean)) of metastatic ALNs were significantly lower than those of non-metastatic ALNs (p < 0.001). The optimal mean ADC cut-off value for differentiation between metastatic and non-metastatic ALNs was 0.904×10-3 mm2/s which had a higher specificity (88.9%) and accuracy (91.8%) as compared with ADC min and ADC max. Conclusion: DWI-MRI and ADC values are promising imaging methods which can assess metastatic ALNs in breast cancer with high sensitivity, specificity and accuracy.