Prospective evaluation of Ultrafast Dynamic Contrast-Enhanced MRI for axillary lymph node metastases in invasive breast cancer

Ultrafast Dynamic Contrast-Enhanced (UF-DCE MRI) can sensitively detect tumor neovascularization, tumor microcirculation related changes and increased vascular permeability in the early stage through the new kinetic parameters derived from ultra-high time resolution. Therefore, this study aimed to provide the dynamic parameters of Ultrafast dynamic contrast-enhanced MRI to identify axillary lymph node metastasis of breast cancer. A total of 173 consecutive female participants who were suspected of having breast mass is identified. And all participants were well-informed and signed an consent form between September 2022 and February 2023. Clinical information and immunohistochemical information were performed in all subjects, MRI data was a prospective collection with retrospective analysis. Intra-class correlation coefficient (ICC), independent sample t test or Mann–Whitney U test, the number of cases and percentages and χ2 or Fisher’s exact test were conducted to compare different groups. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive performance for axillary lymph node metastasis (ALNM) and the optimal threshold was determined using the Youden index. The Delong test was used to compare differences among AUCs. For one hundred and fourteen patients of sixty-four ALNM group and fifty non-ALNM group, among the tumor types, invasive carcinoma ( p < 0.05) was significantly associated with ALNM. For morphological and dynamic parameters of axillary lymph nodes (ALN), there were significant differences in short diameter, long diameter, hilum, Max slope(MS) and Time-to-enhancement (TTE) between the two groups ( p < 0.001). At multivariate analysis, short diameter (OR, 5.705[95% CI:1.252,25.992]; p = 0.024), TTE (OR, 0.201[95% CI:0.051,0.794]; p = 0.022), and MS (OR, 9.584 [95% CI:2.714,33.843]; p < 0.001) have independent predictive significance for ALNM. The combination parameter showed an AUC of 0.916 than that of using TTE, MS, or the short diameter alone ( p < 0.05). Ultrafast Dynamic Contrast-Enhanced MRI kinetic parameters TTE and MS are more sensitive to identify axillary lymph node metastasis of breast cancer. It has shown great clinical value in the diagnosis, screening, treatment and prognosis evaluation of breast cancer.