Kim Jin Joo, Kim Jin You, Nam Kyung Jin, Lee Kye Young, Choo Ki Seok, Kang Taewoo, Park Heeseung, Bae Seong Hwan
Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan 49241, Republic of Korea.
Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan 50612, Republic of Korea.
Br J Radiol. 2025 Mar 1;98(1167):432-440. doi: 10.1093/bjr/tqae243.
To assess the association between multiparametric MRI features of primary tumours and axillary lymph node tumour burden in women with invasive breast cancer.
In this retrospective study, women diagnosed with invasive breast cancer who underwent 3T multiparametric MRI, including diffusion-weighted imaging (DWI) from 2019 to 2020, were evaluated. Two radiologists reviewed T2-weighted images (T2WI) for peritumoural oedema and intratumoural necrosis and measured apparent diffusion coefficient (ADC) values by manually placing regions of interest within breast tumours. We also analysed quantitative kinetic features of breast cancer using computer-aided diagnosis (CAD) and clinical-pathologic characteristics. Uni- and multivariable logistic regression analyses were conducted to identify predictors of a high axillary nodal burden (≥3 positive nodes).
In total, 301 women (mean age, 54.13 years) were evaluated. Forty-three (14.3%) had a high axillary nodal burden by surgical pathology. Multivariate analysis revealed that factors significantly associated with high axillary nodal burden included peritumoural oedema (OR: 7.970; P < .001), lower tumour ADCmax (≤1.098 × 10-3 mm2/s) (OR: 6.978; P < .001), larger tumour size (>2 cm) (OR: 2.986; P = .046), lobular histology (OR: 12.620; P < .001), and the presence of lymphovascular invasion (OR: 3.622; P = .003). CAD-derived kinetic features did not show an association with axillary nodal burden. In subgroup analysis of 238 patients with early clinically node-negative breast cancer, both peritumoural oedema (OR: 7.831; P = .002) and lower tumour ADCmax (≤1.098 × 10-3 mm2/s) (OR: 8.002; P = .002) remained significant predictors.
Our results suggest that peritumoural oedema as viewed in T2WI and the ADCmax value of breast cancer in DWI are valuable for predicting axillary nodal burden in women with invasive breast cancer.
Multiparametric MRI features of a primary tumour are useful for predicting axillary nodal burden in patients with invasive breast cancer.
评估浸润性乳腺癌女性原发肿瘤的多参数磁共振成像（MRI）特征与腋窝淋巴结肿瘤负荷之间的关联。
在这项回顾性研究中，对2019年至2020年期间接受3T多参数MRI检查（包括扩散加权成像（DWI））且被诊断为浸润性乳腺癌的女性进行了评估。两名放射科医生查看了T2加权图像（T2WI）以评估瘤周水肿和瘤内坏死情况，并通过在乳腺肿瘤内手动放置感兴趣区域来测量表观扩散系数（ADC）值。我们还使用计算机辅助诊断（CAD）分析了乳腺癌的定量动力学特征以及临床病理特征。进行单变量和多变量逻辑回归分析以确定高腋窝淋巴结负荷（≥3个阳性淋巴结）的预测因素。
总共评估了301名女性（平均年龄54.13岁）。经手术病理检查，43名（14.3%）患者存在高腋窝淋巴结负荷。多变量分析显示，与高腋窝淋巴结负荷显著相关的因素包括瘤周水肿（比值比（OR）：7.970；P <.001）、较低的肿瘤ADC最大值（≤1.098×10⁻³mm²/s）（OR：6.978；P <.001）、较大的肿瘤大小（>2 cm）（OR：2.986；P = 0.046）、小叶组织学类型（OR：12.620；P <.001）以及存在淋巴管浸润（OR：3.622；P = 0.003）。CAD得出的动力学特征与腋窝淋巴结负荷无关联。在对238例早期临床淋巴结阴性乳腺癌患者的亚组分析中，瘤周水肿（OR：7.831；P = 0.002）和较低的肿瘤ADC最大值（≤1.098×10⁻³mm²/s）（OR：8.002；P = 0.002）仍然是显著的预测因素。
我们的结果表明，T2WI上显示的瘤周水肿以及DWI中乳腺癌的ADC最大值对于预测浸润性乳腺癌女性的腋窝淋巴结负荷具有重要价值。
原发肿瘤的多参数MRI特征有助于预测浸润性乳腺癌患者的腋窝淋巴结负荷。
