Abstract
BACKGROUND: Breast cancer (BC) is the most prevalent malignant tumor among women worldwide, significantly impacting women's health and lives. The accurate assessment of axillary lymph node (ALN) status is critical for BC staging, treatment planning, and the evaluation of overall survival outcomes. This study aimed to explore the relationship between preoperative ultrafast dynamic contrast-enhanced magnetic resonance imaging (UF-DCE MRI) parameters and ALN metastasis in patients with mass-type invasive ductal carcinoma (IDC) of the breast, and to construct a nomogram model for predicting ALN metastasis. METHODS: Preoperative UF-DCE MRI images and medical records of 96 breast IDC patients (38 with ALN metastasis, 58 without) confirmed by pathology were retrospectively analyzed. Conventional MRI features, UF-DCE MRI parameters, DCE parameters, and clinical features were evaluated. Receiver operating characteristic (ROC) curves and nomograms for univariate parameters and combined diagnostic efficiency were constructed. RESULTS: Time-to-enhancement (TTE), time-to-peak (TTP) after enhancement, and time to center of maximum slope (TTMS) were significantly lower in the ALN metastasis group (10.05±4.91 vs. 15.59±15.04 s, 85.89±33.93 vs. 208.27±102.28 s, 19.05±22.25 vs. 19.81±9.29 s; all P<0.05), whereas tumor size was significantly smaller in the non-ALN metastasis group (2.2±1.1 vs. 3.0±1.5 cm, P<0.001). No other clinical or imaging parameters showed significant differences between groups. TTP had the best diagnostic efficacy for ALN metastasis, with an area under the curve (AUC) of 0.865 [95% confidence interval (CI): 0.794-0.937]. The combined parameter prediction model improved the diagnostic efficacy, with an AUC of 0.919 (95% CI: 0.864-0.974). The nomogram indicated that TTP had the greatest impact on lymph node metastasis, followed by tumor size and apparent diffusion coefficient (ADC). The nomogram indicated that metastasis probability = e(score)/1 + e(score), with score = 0.70 * tumor size - 2.49 * ADC - 0.03 * TTP + 3.78. CONCLUSIONS: Multiple UF-DCE MRI parameters can predict ALN metastasis in patients with mass-like breast IDC before operation. The nomogram model combined with clinical and UF-DCE MRI parameters can better assist clinicians in making personalized treatment plans for patients.