Classification of breast edema on T2-weighted imaging for predicting sentinel lymph node metastasis and biological behavior in breast cancer

S Xie; W Tang; C Zhang; J Wang; M Wang; Y Zhou

doi:10.1016/j.crad.2024.04.014

Classification of breast edema on T2-weighted imaging for predicting sentinel lymph node metastasis and biological behavior in breast cancer

Clin Radiol. 2024 Apr 27:S0009-9260(24)00205-8. doi: 10.1016/j.crad.2024.04.014. Online ahead of print.

Authors

S Xie¹, W Tang², C Zhang³, J Wang³, M Wang³, Y Zhou⁴

Affiliations

¹ Departments of Radiology, Yijishan Hospital of Wannan Medical College, Wuhu 241001, Anhui, China; Departments of Radiology, Fuyang Hospital of Anhui Medical University, Fuyang 236000, Anhui, China.
² Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
³ Departments of Radiology, Yijishan Hospital of Wannan Medical College, Wuhu 241001, Anhui, China.
⁴ Departments of Radiology, Yijishan Hospital of Wannan Medical College, Wuhu 241001, Anhui, China. Electronic address: zhouyunfeng808@163.com.

PMID: 38763808
DOI: 10.1016/j.crad.2024.04.014

Abstract

Objective: To determine whether preoperative classification of breast edema on T2-weighted imaging (T2WI) is useful for predicting sentinel lymph node (SLN) metastasis and biological behavior in patients with early-stage breast cancer.

Methods: This retrospective study involved 341 women with breast cancer who underwent breast MRI from January 2019 to March 2022. Breast edema was scored on a scale of 1-4 on T2WI (1, no edema; 2, peritumoral edema; 3, prepectoral edema; and 4, subcutaneous edema). A logistic regression model was employed for univariate and multivariate analyses. A clinicopathological model was established using independent influencing factors identified in the multivariate analyses, excluding breast edema score (BES). Subsequently, BES was incorporated into this model to establish a combined BES model. The AUC and Delong test were used to examine the additional predictive value of the BES.

Results: Logistic regression analysis showed that breast edema was an independent risk factor for SLN metastasis. The combined BES model significantly improved the predictive performance of SLN metastasis compared with the clinicopathological model alone (AUC, 0.77 vs. 0.71; p=0.005). In addition, the BES was significantly positively correlated with the tumor diameter (p<0.001), histologic grade (p=0.001), Ki-67 index (p<0.001), and non-luminal subtypes (p<0.001).

Conclusion: The BES on T2WI is useful for predicting SLN metastasis. A higher grade of breast edema is associated with breast cancer aggressiveness and increases the probability of SLN metastasis.