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Effects of iron oxide particles on MRI and mammography in breast cancer patients after a sentinel lymph node biopsy with paramagnetic tracers

Published:December 26, 2020DOI:https://doi.org/10.1016/j.clinimag.2020.12.011

      Highlights

      • SLNB performed with iron oxide particles may accumulate in the breast and cause troublesome artifacts in follow-up MRI examinations
      • Accumulating iron oxide particles that are administered in SLNB may cause artifacts in mammography mimicking malignant lesions
      • Breast cancer patients must be questioned for the usage of iron oxide particles in SLNB before a follow-up mammogram or MRI

      Abstract

      Objective

      The aim of this study is to evaluate the effect of iron oxide particle deposition on follow-up mammograms and MRI examinations of patients who underwent sentinel lymph node detection with iron oxide particles.

      Materials and methods

      Two hundred and eighteen patients who had sentinel lymph node biopsy (SLNB) with iron oxide particles were evaluated. Follow-up MRI and mammography were available in 36 and 69 cases respectively. MRI examinations were evaluated for ferromagnetic artifacts that were graded as follows: 0 = No artifact, 1 = Focal area, 2 = Segmental and 3 = Regional signal void artifact. Mammography artifacts were evaluated for the presence of dense particles. Pearson's chi-square test was used for statistical analyses and P < 0.05 was accepted as significant.

      Results

      MRI artifact grading was as follows: Grade 0: 11 (30.6%), Grade 1: 14 (38.9%), Grade 2: 3 (8.3%), and Grade 3: 8 (22.2%). The grade of artifacts differed across surgery types (P = 0.019). Grade 3 artifacts were higher in breast conserving cases whereas Grade 0 was more frequent in subcutaneous mastectomy cases. Three out of 69 (4.4%) cases who had follow-up mammography had artifacts due to iron oxide particle accumulation which presented as Grade 3 MRI artifact in all.

      Conclusion

      Accumulation of iron oxide particles after SLNB with paramagnetic tracers causes artifacts on follow-up MRI examinations in half of the cases but it is significantly low in mammograms. These artifacts may be confusing in the evaluation of the images. Radiologists must be aware of these tracers and their artifacts whereas patients should be questioned for the type of SLNB before a follow-up examination.

      Keywords

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