Frontiers in medicine · 2026
SPIO-enhanced MRI for differentiating metastatic from reactive hyperplastic lymph nodes in breast cancer: diagnostic performance and association with VEGF-C expression.
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Wu Tao, Wu Angela, Xiong Hui, Deng Jiaying, Zhang Zhewen, Gong Dan, Luo Jun, Wu Dan
Аннотация
BACKGROUND: Accurate assessment of lymph node status is essential for staging and treatment planning in breast cancer. Conventional morphological imaging criteria have limited sensitivity and specificity. Superparamagnetic Iron Oxide (SPIO)-enhanced MRI offers a functional imaging alternative exploiting macrophage-mediated iron uptake. This study evaluated the diagnostic performance of SPIO-enhanced MRI in differentiating metastatic from reactive hyperplastic lymph nodes and explored the association between MRI signal characteristics and Vascular Endothelial Growth Factor C (VEGF-C) expression.
METHODS: Sixty female breast cancer patients (January-May 2024) underwent preoperative plain and SPIO-enhanced MRI (Resovist, 0.2 mL/kg, 12-h delay). Among 112 harvested lymph nodes, Hematoxylin and Eosin staining, Prussian Blue staining, and VEGF-C immunohistochemistry were performed. The Percentage of Signal Intensity Loss (PSIL) was calculated on T2*-weighted images. The primary diagnostic analysis was patient-level using mean PSIL with receiver operating characteristic analysis.
RESULTS: Of 112 lymph nodes from 60 patients, 47 were metastatic and 65 reactive hyperplastic. Reactive nodes showed marked signal attenuation (mean PSIL 64.7 ± 12.0%) compared with metastatic nodes (11.6 ± 7.8%; p < 0.001). Patient-level ROC analysis yielded an area under the curve of 0.84 (95% CI: 0.73-0.95). At a data-derived optimal cutoff of 42% (Youden index), sensitivity was 83%, specificity 85%, positive predictive value 80.0%, negative predictive value 87.2%, and overall diagnostic accuracy 84.0%. Histopathological Prussian Blue grading supported differential iron uptake patterns between groups. High VEGF-C expression (≥++) was more prevalent in metastatic than hyperplastic nodes (85.1% vs. 12.3%; p < 0.001). PSIL showed a moderate inverse correlation with VEGF-C grade (Spearman r = -0.67; p < 0.001).
CONCLUSION: SPIO-enhanced MRI demonstrated favorable diagnostic performance for differentiating metastatic from reactive hyperplastic lymph nodes at the patient level. The imaging characteristics were associated with supportive histopathological findings and VEGF-C expression patterns. These findings warrant validation in larger, multicenter studies using currently available iron oxide agents.
METHODS: Sixty female breast cancer patients (January-May 2024) underwent preoperative plain and SPIO-enhanced MRI (Resovist, 0.2 mL/kg, 12-h delay). Among 112 harvested lymph nodes, Hematoxylin and Eosin staining, Prussian Blue staining, and VEGF-C immunohistochemistry were performed. The Percentage of Signal Intensity Loss (PSIL) was calculated on T2*-weighted images. The primary diagnostic analysis was patient-level using mean PSIL with receiver operating characteristic analysis.
RESULTS: Of 112 lymph nodes from 60 patients, 47 were metastatic and 65 reactive hyperplastic. Reactive nodes showed marked signal attenuation (mean PSIL 64.7 ± 12.0%) compared with metastatic nodes (11.6 ± 7.8%; p < 0.001). Patient-level ROC analysis yielded an area under the curve of 0.84 (95% CI: 0.73-0.95). At a data-derived optimal cutoff of 42% (Youden index), sensitivity was 83%, specificity 85%, positive predictive value 80.0%, negative predictive value 87.2%, and overall diagnostic accuracy 84.0%. Histopathological Prussian Blue grading supported differential iron uptake patterns between groups. High VEGF-C expression (≥++) was more prevalent in metastatic than hyperplastic nodes (85.1% vs. 12.3%; p < 0.001). PSIL showed a moderate inverse correlation with VEGF-C grade (Spearman r = -0.67; p < 0.001).
CONCLUSION: SPIO-enhanced MRI demonstrated favorable diagnostic performance for differentiating metastatic from reactive hyperplastic lymph nodes at the patient level. The imaging characteristics were associated with supportive histopathological findings and VEGF-C expression patterns. These findings warrant validation in larger, multicenter studies using currently available iron oxide agents.