MRI characteristics of breast edema for assessing axillary lymph node burden in early-stage breast cancer: a retrospective bicentric study

作者：Xu, Zeyan; Ding, Yingying; Zhao, Ke; Han, Chu; Shi, Zhenwei; Cui, Yanfen; Liu, Chunling; Lin, Huan; Pan, Xipeng; Li, Pinxiong; Chen, Minglei; Wang, Huihui; Deng, Xiaohui; Liang, Changhong; Xie, Yu^*; Liu, Zaiyi^*

来源：European Radiology, 2022, 32(12): 8213-8225.

DOI：10.1007/s00330-022-08896-z

• Breast neoplasms
• Magnetic resonance imaging
• Edema
• Lymph nodes

Objectives To investigate whether breast edema characteristics at preoperative T2-weighted imaging (T2WI) could help evaluate axillary lymph node (ALN) burden in patients with early-stage breast cancer. Methods This retrospective study included women with clinical T1 and T2 stage breast cancer and preoperative MRI examination in two independent cohorts from May 2014 to December 2020. Low (< 3 LNs+) and high (>= 3 LNs+) pathological ALN (pALN) burden were recorded as endpoint. Breast edema score (BES) was evaluated at T2WI. Univariable and multivariable analyses were performed by the logistic regression model. The added predictive value of BES was examined utilizing the area under the curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Results A total of 1092 patients were included in this study. BES was identified as the independent predictor of pALN burden in primary (n = 677) and validation (n = 415) cohorts. The analysis using MRI-ALN status showed that BES significantly improved the predictive performance of pALN burden (AUC: 0.65 vs 0.71, p < 0.001; IDI = 0.045, p < 0.001; continuous NRI = 0.159, p = 0.050). These results were confirmed in the validation cohort (AUC: 0.64 vs 0.69, p = 0.009; IDI = 0.050, p < 0.001; continuous NRI = 0.213, p = 0.047). Furthermore, BES was positively correlated with biologically invasive clinicopathological factors (p < 0.05). Conclusions In individuals with early-stage breast cancer, preoperative MRI characteristics of breast edema could be a promising predictor for pALN burden, which may aid in treatment planning.

• 单位
  y; 广东省人民医院; 汕头大学; 广东省心血管病研究所; 南方医科大学