Fig. 4

One example of the point-based scoring system for predicting breast cancer patients with axillary lymph node metastasis. A ~ F are MRI images of a female left breast cancer patient with invasive ductal carcinoma who was negative for human epidermal growth factor receptor-2, positive for estrogen receptor, AJCC stage II and T2 stage. An axial contrast-enhanced T₁WI image (A) shows a tumor with a maximum diameter of 3.7 cm located in the upper-outer quadrant. The mean values of K_ep, V_e, and TTP from the corresponding pseudocolor images of K_ep (B), V_e, (C), and TTP (D) were 1.130 min⁻¹, 0.310, and 0.530 min, respectively. Breast MRI diagnosed no axillary lymph node metastasis for level I nodes due to the lack of all of the following features from axial T₂WI with fat suppression imaging (E) and contrast-enhanced T₁WI imaging (F): cortical thickening, missing fatty hilum, round shape, or a long-to-short axis ratio of less than 2 (long-to-short axis ratio was 2.2 for this patient). However, the risk of axillary lymph node metastasis assessed by the scoring system was 19.5,with an axillary lymph node metastasis probability of 81.8%.The final postoperative pathology report showed that this tumor had three axillary lymph node metastases at axillary level I (white arrow)