School of Medicine, South China University of Technology, Guangzhou, 510006, China.
Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
Eur Radiol. 2022 Dec;32(12):8213-8225. doi: 10.1007/s00330-022-08896-z. Epub 2022 Jun 15.
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.
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).
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).
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.
• In this retrospective study of 1092 patients with early-stage breast cancer from two cohorts, the MRI characteristic of breast edema has independent and additive predictive value for assessing axillary lymph node burden. • Breast edema characteristics at T2WI positively correlated with biologically invasive clinicopathological factors, which may be useful for preoperative diagnosis and treatment planning for individual patients with breast cancer.
探讨术前 T2 加权成像（T2WI）中乳房水肿特征是否有助于评估早期乳腺癌患者腋窝淋巴结（ALN）负担。
本回顾性研究纳入了 2014 年 5 月至 2020 年 12 月期间来自两个独立队列的临床 T1 和 T2 期乳腺癌患者及术前 MRI 检查患者。记录低（<3 个淋巴结+）和高（≥3 个淋巴结）病理性 ALN（pALN）负担作为终点。在 T2WI 上评估乳房水肿评分（BES）。采用 logistic 回归模型进行单变量和多变量分析。利用曲线下面积（AUC）、净重新分类改善（NRI）和综合判别改善（IDI）评估 BES 的附加预测价值。
本研究共纳入 1092 例患者。在原发（n=677）和验证（n=415）队列中，BES 被确定为 pALN 负担的独立预测因子。利用 MRI-ALN 状态进行分析显示，BES 显著提高了 pALN 负担的预测性能（AUC：0.65 与 0.71，p<0.001；IDI=0.045，p<0.001；连续 NRI=0.159，p=0.050）。这些结果在验证队列中得到了证实（AUC：0.64 与 0.69，p=0.009；IDI=0.050，p<0.001；连续 NRI=0.213，p=0.047）。此外，BES 与生物学侵袭性临床病理因素呈正相关（p<0.05）。
在早期乳腺癌患者中，术前 MRI 乳房水肿特征可能是预测 pALN 负担的有前途的指标，有助于治疗计划的制定。
在来自两个队列的 1092 例早期乳腺癌患者的回顾性研究中，T2WI 上的乳房水肿特征对评估腋窝淋巴结负担具有独立且附加的预测价值。
T2WI 上的乳房水肿特征与生物学侵袭性临床病理因素呈正相关，这可能有助于乳腺癌患者的术前诊断和治疗计划制定。
