Validation of In Vivo Nodal Assessment of Solid Malignancies with USPIO-Enhanced MRI: A Workflow Protocol
Driessen, Daphne A.J.J.; de Gouw, Didi J.J.M.; Stijns, Rutger C.H.; Litjens, Geke; Israël, Bas; Philips, Bart W.J.; Hermans, John J.; Dijkema, Tim; Klarenbeek, Bastiaan R.; van der Post, Rachel S.; Nagtegaal, Iris D.; van Engen-Van Grunsven, Adriana C.H.; Brosens, Lodewijk A.A.; Veltien, Andor; Zámecnik, Patrik; Scheenen, Tom W.J.
(2022) Methods and Protocols, volume 5, issue 2, pp. 1 - 13
(Article)
Abstract
Background: In various cancer types, the first step towards extended metastatic disease is the presence of lymph node metastases. Imaging methods with sufficient diagnostic accuracy are required to personalize treatment. Lymph node metastases can be detected with ultrasmall superpara-magnetic iron oxide (USPIO)-enhanced magnetic resonance imaging (MRI), but this method needs
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validation. Here, a workflow is presented, which is designed to compare MRI-visible lymph nodes on a node-to-node basis with histopathology. Methods: In patients with prostate, rectal, periampullary, esophageal, and head-and-neck cancer, in vivo USPIO-enhanced MRI was performed to detect lymph nodes suspicious of harboring metastases. After lymphadenectomy, but before histopathological assessment, a 7 Tesla preclinical ex vivo MRI of the surgical specimen was performed, and in vivo MR images were radiologically matched to ex vivo MR images. Lymph nodes were annotated on the ex vivo MRI for an MR-guided pathological examination of the specimens. Results: Matching lymph nodes of ex vivo MRI to pathology was feasible in all cancer types. The annotated ex vivo MR images enabled a comparison between USPIO-enhanced in vivo MRI and histopathology, which allowed for analyses on a nodal, or at least on a nodal station, basis. Conclusions: A workflow was developed to validate in vivo USPIO-enhanced MRI with histopathology. Guiding the pathologist towards lymph nodes in the resection specimens during histopathological work-up allowed for the analysis at a nodal basis, or at least nodal station basis, of in vivo suspicious lymph nodes with corresponding histopathology, providing direct information for validation of in vivo USPIO-enhanced, MRI-detected lymph nodes.
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Keywords: 7 Tesla, Lymph node, Magnetic resonance imaging, Nodal staging, Node-to-node correlation, Pathology, magnetic resonance imaging, pathology, lymph node, node-to-node correlation, nodal staging, Biochemistry, Genetics and Molecular Biology (miscellaneous), Structural Biology, Biotechnology, Journal Article
ISSN: 2409-9279
Publisher: MDPI AG
Note: Funding Information: Funding: The data were selected from five scientific trials that received different funding: (1) VALIN-ODE study: Radboud Oncology Fund; (2) 7TNANO1 study: KWF grant granted to the Department of Medical Imaging of the Radboudumc; (3) NANO-PANC study: anonymous funder; (4) PRECIES study: internal funding; (5) USPIO-NECK study: Radboud Institute for Health Sciences junior research grant. The funding bodies had no role in the design of the study and collection, analysis, and interpretation of data and in the writing of the manuscript. Publisher Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland.
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