Rationale and Objectives
This study aimed to determine if there were differences in the imaging features of normal lymph nodes between white and black women using magnetic resonance imaging.
Materials and Methods
Following institutional review board approval, we identified white and black women who underwent breast magnetic resonance imaging from November 1, 2008 to December 31, 2013 at our institution. To identify normal lymph nodes for measurement, patients with any benign or malignant causes for lymph node enlargement and patients with any subsequent breast cancer in the following 2 years were excluded. Black and white women were age matched at a 1:2 ratio. The largest lymph node in each axilla was measured for the long-axis length and maximal cortical thickness. Comparisons were made between white and black women using a conditional logistic regression to control for matching.
Results
There were 55 black women and 110 white women for analysis. The mean lymph node long-axis length was 14.7 ± 5.3 mm for black women and 14.4 ± 6.4 mm for white women ( P = .678). The mean maximum cortical thickness was 3.3 ± 1.6 mm for black women and 2.6 ± 1.4 mm for Caucasian women ( P < .001). A significantly higher percentage of black than white women had cortical thicknesses greater than threshold values of 3, 4, 5, 6, and 7 mm ( P < .01 for all).
Conclusions
The normal lymph node cortical thickness in black women is significantly greater than in white women, which should be considered when deciding to recommend a lymph node biopsy.
Introduction
As part of the routine interpretation of breast magnetic resonance imaging (MRI), lymph node size and morphology in both axilla are assessed by the radiologist to determine if additional workup and possible biopsy should be recommended to assess for malignancy. This may occur in patients with known breast cancer for whom there has been regional metastatic spread, but abnormal lymph node morphology may be the presenting sign of a new otherwise unknown cancer from either the breast or another primary source . Although axillary lymph node biopsies are generally safe procedures, the proximity to major arteries and nerves increases the risk of complications compared to breast biopsies and thus should be avoided if unnecessary . Furthermore, patients may experience undue anxiety in the setting of a false-positive biopsy recommendation. Finally, the Z11 trial demonstrated that some patients with a low axillary burden (ie, no lymph node involvement or micrometastatic disease) do not benefit from axillary lymph node dissection when treated with whole-breast radiotherapy and systemic therapy . As a result, it is less important to biopsy cases with borderline abnormal lymph nodes, which at worst have micrometastatic disease. In current practice, radiologists will recommend biopsy of an axillary lymph node based on imaging features, including nodal size and cortical thickness.
Although lymph nodes may become completely replaced by cancer and grow very large, the first sign of malignant involvement is an increase in the cortical thickness . Several authors have proposed various cortical thickness thresholds to predict malignancy, aimed at maximizing sensitivity at the cost of specificity . These thresholds range from 2.3 mm to 3 mm, which typically achieve a sensitivity of greater than 90% . However, none of these published series included any information on the race and ethnicity of their study population. Imaging features of normal axillary lymph nodes, such as cortical thickness, may differ between women of different race and ethnicity, which could impact measurement thresholds used by radiologists to decide if biopsy should be recommended. Therefore, the purpose of this study was to determine if imaging features of normal axillary lymph nodes differ between black and white women.
Materials and Methods
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Results
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Discussion
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