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Updated: Jun 7, 2025
Tracking the Mammary Architectural Features and Detecting Breast Cancer with Magnetic Resonance Diffusion Tensor Imaging
Published on: December 15, 2014
Prospective evaluation of MRI artefacts following breast conserving surgery and sentinel lymph node dissection with
Allan Jazrawi1, Eirini Pantiora2, Shahin Abdsaleh3
1Centre for Clinical Research, County of Västmanland, Uppsala University, Västerås, Sweden; Department of Surgery, Västmanlands Hospital, Västerås, Sweden.
Introduction:
Superparamagnetic Iron Oxide (SPIO) nanoparticles serve as a promising tracer for sentinel lymph node (SLN) detection in breast cancer. Concerns exist regarding artefacts on postoperative Magnetic Resonance Imaging (MRI), especially following breast conservation (BCS).
Materials And Methods:
In this prospective observational study, 97 women with DCIS or invasive breast cancer underwent BCS and SLN detection with peritumoral SPIO injection administered up to four weeks before surgery. Postoperatively, patients were followed with MRI and mammograms, and imaging outcomes were evaluated by four, independent breast radiologists, blinded to clinical data, using a predefined, standardized questionnaire.
Results:
In 97 patients included, there was inter-rater discordance in the prevalence of "any artefact" (range: 24.1-74.4 %; weighted average: 32.4 %) and "SPIO specific artefact" (range: 12.0-49.4 %; weighted average: 20.9 %). The median area of "any artefact" was 9.24 cm2 (iqr 4.72, 15.50) and SPIO specific artefact 9.88 (iqr 5.32, 15.5). Likert scores indicated higher difficulty interpreting MRI if artefacts were present (OR: 2.295, 95 % CI 1.028, 5.123; p = 0.043), but this was reduced if intravenous contrast was administered (OR: 0.177, 95 % CI 0.091, 0.342; p < 0.001). Multivariable analysis identified free-hand SPIO administration as a risk factor (OR 8.929, 95 % CI 2.849, 27.778; p < 0.001). All six patients with local recurrence were successfully diagnosed on MRI by all raters.
Conclusion:
This prospective cohort study suggests that a targeted peritumoral SPIO injection can result in the removal of SPIO during lumpectomy and address the concerns for artefacts on postoperative MRI follow-up, in the selected patients that MRI may be warranted.
Insights
Superparamagnetic Iron Oxide (SPIO) nanoparticles aid sentinel lymph node detection in breast cancer. Targeted SPIO injection before surgery can minimize MRI artifacts, improving postoperative imaging accuracy for selected patients.
Area of Science:
- Oncology
- Radiology
- Nanotechnology
Background:
- Superparamagnetic Iron Oxide (SPIO) nanoparticles are utilized for sentinel lymph node (SLN) detection in breast cancer patients.
- Concerns regarding Magnetic Resonance Imaging (MRI) artifacts post-breast conservation surgery (BCS) persist, particularly with SPIO use.
Purpose of the Study:
- To evaluate the impact of targeted peritumoral SPIO injection on postoperative MRI artifacts after BCS.
- To assess the influence of SPIO-related artifacts on MRI interpretation and diagnostic accuracy.
Main Methods:
- A prospective observational study included 97 women undergoing BCS and SLN detection with SPIO injection.
- Postoperative MRI and mammograms were independently reviewed by four blinded radiologists using a standardized questionnaire.
- Statistical analysis, including multivariable analysis, was performed to identify risk factors for artifacts.
Main Results:
- Inter-rater variability was observed in the prevalence and extent of "any artifact" (32.4%) and "SPIO specific artifact" (20.9%).
- Artifacts increased MRI interpretation difficulty (OR: 2.295), but intravenous contrast administration reduced this effect (OR: 0.177).
- Free-hand SPIO administration was identified as a significant risk factor for artifacts (OR: 8.929).
Conclusions:
- Targeted peritumoral SPIO injection can lead to SPIO removal during lumpectomy, mitigating postoperative MRI artifacts.
- This approach may make MRI a viable follow-up tool for selected breast cancer patients.
- Accurate diagnosis of local recurrence was achieved by all radiologists on postoperative MRI.
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