OBJECTIVETo evaluate the diagnostic value of mammography, computed tomography (CT), and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for axillary lymph node staging in breast cancer patients.

METHODSFrom February, 2014 to October, 2015, 109 women with breast cancer received examinations with preoperative mamography, CT, and DCE-MRI. The diagnostic sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the 3 modalities were evaluated using histopathologic assessments as the gold standard.

RESULTSIn total, 39.4% (43/109) of the patients had axillary lymph node metastasis. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of mamography for determining lymph node metastasis were 14.0%, 84.8%, 56.9%, 37.5% and 60.0%, respectively; those of CT were 93.0%, 57.6%, 71.6%,58.8% and 92.7%, and those of DCE-MRI were 95.3%, 65.2%, 77.1%, 64.1% and 95.6%, respectively. Compared with the histopathologic result, the Kappa coefficients of mamography, CT, and DCE-MRI were -0.13, 0.459 and 0.558, respectively. The specificity of mamography was significantly higher (P<0.05), but its sensitivity, accuracy, positive predictive value, and negative predictive value were significantly lower than those of CT and DCE-MRI (P<0.05). Compared with CT, DCE-MRI had significantly higher sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for diagnosis of lymph node metastasis (P<0.05).

CONCLUSIONDCE-MRI has a greater diagnostic power than CT and mammography, and CT has a greater diagnostic power than mammography for axillary lymph node metastasis in breast cancer patients. Mamography alone should be used cautiously for the diagnosis of lymph node metastasis.