Preoperative MRI features associated with lymphovascular invasion in node‐negative invasive breast cancer: A propensity‐matched analysis

Cheon, Hyejin; Kim, Hye Jung; Lee, So Mi; Cho, Seung-Hyun; Shin, Kyung Min; Kim, Gab Chul; Park, Ji Young; Kim, Won Hwa

doi:10.1002/jmri.25710

Cited by 48 publications

(67 citation statements)

References 40 publications

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“…Previous studies showed inconsistent results for the correlation between breast MRI features and LVI. Conventional morphologic features, such as peritumoral edema and prepectoral edema on T 2 -weighted images (T 2 WI), were shown to be associated with the presence of LVI in a study by Cheon et al, 15 but not in another study by Mori et al 17 Instead, they found that the quantitative parameter of the peritumor-to- tumor ADC ratio assisted preoperative prediction of LVI status with a favorable performance (AUC, 0.81) in the overall group, which was similar to the combined model developed in our present study. However, when applied to premenopausal patients the performance of ADC ratio decreased significantly, because the peritumor parenchymal tissue in premenopausal patients were denser and contained more water, which might affect the peritumoral ADC value.…”

Section: Discussionmentioning

confidence: 99%

“…Percutaneous biopsy before surgery is insufficient when the biopsy specimen fails to provide enough information regarding the peritumoral tissue . Previous studies on breast magnetic resonance imaging (MRI) have demonstrated that a few MRI features, including adjacent vessel sign, peritumoral edema, tumor apparent diffusion coefficient (ADC), and peritumor‐to‐tumor ADC ratio are associated with LVI . However, the value of these MRI features has remained controversial.…”

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confidence: 99%

“…12,13 Previous studies on breast magnetic resonance imaging (MRI) have demonstrated that a few MRI features, including adjacent vessel sign, peritumoral edema, tumor apparent diffusion coefficient (ADC), and peritumor-totumor ADC ratio are associated with LVI. [14][15][16][17][18] However, the value of these MRI features has remained controversial.…”

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Preoperative prediction of lymphovascular invasion in invasive breast cancer with dynamic contrast‐enhanced‐MRI‐based radiomics

Liu

Bao

et al. 2019

Magnetic Resonance Imaging

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Background Lymphovascular invasion (LVI) status facilitates the selection of optimal therapeutic strategy for breast cancer patients, but in clinical practice LVI status is determined in pathological specimens after resection. Purpose To explore the use of dynamic contrast‐enhanced (DCE)‐magnetic resonance imaging (MRI)‐based radiomics for preoperative prediction of LVI in invasive breast cancer. Study Type Prospective. Population Ninety training cohort patients (22 LVI‐positive and 68 LVI‐negative) and 59 validation cohort patients (22 LVI‐positive and 37 LVI‐negative) were enrolled. Field Strength/Sequence 1.5 T and 3.0 T, T1‐weighted DCE‐MRI. Assessment Axillary lymph node (ALN) status for each patient was evaluated based on MR images (defined as MRI ALN status), and DCE semiquantitative parameters of lesions were calculated. Radiomic features were extracted from the first postcontrast DCE‐MRI. A radiomics signature was constructed in the training cohort with 10‐fold cross‐validation. The independent risk factors for LVI were identified and prediction models for LVI were developed. Their prediction performances and clinical usefulness were evaluated in the validation cohort. Statistical Tests Mann–Whitney U‐test, chi‐square test, kappa statistics, least absolute shrinkage and selection operator (LASSO) regression, logistic regression, receiver operating characteristic (ROC) analysis, DeLong test, and decision curve analysis (DCA). Results Two radiomic features were selected to construct the radiomics signature. MRI ALN status (odds ratio, 10.452; P < 0.001) and the radiomics signature (odds ratio, 2.895; P = 0.031) were identified as independent risk factors for LVI. The value of the area under the curve (AUC) for a model combining both (0.763) was higher than that for MRI ALN status alone (0.665; P = 0.029) and similar to that for the radiomics signature (0.752; P = 0.857). DCA showed that the combined model added more net benefit than either feature alone. Data Conclusion The DCE‐MRI‐based radiomics signature in combination with MRI ALN status was effective in predicting the LVI status of patients with invasive breast cancer before surgery. Level of Evidence: 1 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019;50:847–857.

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Section: Discussionmentioning

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Preoperative prediction of lymphovascular invasion in invasive breast cancer with dynamic contrast‐enhanced‐MRI‐based radiomics

Liu

Bao

et al. 2019

Magnetic Resonance Imaging

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“…LVI is one of the potential contributors to peritumoral edema (28). A recent study (29) showed that peritumoral edema is associated with LVI in patients with node-negative breast cancer. These plausible explanations also support our results showing the association between the presence of peritumoral edema and disease recurrence, because the phenomena of elevated hyaluronan levels, angiogenesis, and LVI are known to be associated with a worse prognosis (30-33).…”

Section: Discussionmentioning

confidence: 99%

Invasive Breast Cancer: Prognostic Value of Peritumoral Edema Identified at Preoperative MR Imaging

et al. 2018

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Purpose To determine the prognostic value of peritumoral edema identified at preoperative breast magnetic resonance (MR) imaging for disease recurrence in patients with invasive breast cancer. Materials and Methods Between January 2011 and December 2012, 353 women (median age, 49 years; range, 27-77 years) with invasive breast cancer who had undergone preoperative MR imaging and mastectomy or breast-conserving surgery were identified. Two radiologists independently reviewed peritumoral edema on the basis of the degree of the signal intensity surrounding the tumor on T2-weighted images. The association of disease recurrence with peritumoral edema and clinical-pathologic features was assessed by using the multivariate Cox proportional hazards model and the integrated discrimination improvement (IDI) and continuous net reclassification improvement (NRI) indexes. Results Twenty-four patients (6.8%) had disease recurrence after 27.2 months of median follow-up. At multivariate analysis, higher N stage (hazard ratio = 4.84, P = .002) and the presence of lymphovascular invasion (hazard ratio = 2.48, P = .044) and peritumoral edema (hazard ratio = 2.77, P = .022) were independent factors associated with disease recurrence. IDI and continuous NRI showed significant improvement in the accuracy of the association with disease recurrence when peritumoral edema was added to established clinical-pathologic features (IDI = 0.061, P < .001; continuous NRI = 0.334, P = .012). Conclusion Peritumoral edema identified at preoperative MR imaging is independently associated with disease recurrence. Peritumoral edema assessment may provide better prognostication in patients with invasive breast cancer. RSNA, 2018.

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“…The MRI appearances of LVI resemble in-situ ductal carcinoma, but these two entities could be differentiated by an immunohistochemical examination [16]. Van Goethem et al [17] claimed that perilesional findings observed in the mass lesion might arise from in-situ component positivity, although Cheon et al [18] ruled out this possibility by excluding patients with an in-situ component when creating their patient groups, and assumed that perilesional findings arose from the tumor itself, suggesting that peritumoral edema could be related to LVI in patients with lymph node-negative breast cancer. In our series, patients with in-situ component positivity were not excluded, and there were 31 patients (67.4%) with insitu cancer that accompanied invasive cancer.…”

Section: Discussionmentioning

confidence: 99%

Relation of peritumoral, prepectoral and diffuse edema with histopathologic findings of breast cancer in preoperative 3T magnetic resonance imaging

Gemici¹,

Ozal²,

Hocaoğlu³

et al. 2019

Journal of Surgery and Medicine

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Aim: Preoperative breast magnetic resonance imaging (MRI) findings can provide rich information about the prognosis of the disease. Morphologic and dynamic features are especially used for it. We aimed to compare peritumoral, prepectoral, and diffuse edema identified in MRI with histopathologic findings, and to show how prognostic information can be gathered from the identification of edema. Methods: We conducted a retrospective cohort study with forty-six women who underwent breast DCE-MRI as part of the pre-surgical evaluation between January and August 2018 were included in the study. Signal enhancements similar to water that were localized to the prepectoral or peritumoral areas or diffuse enhancements on T2A-weighted sequences were considered as edema. The presence of edema was compared with clinicopathologic parameters such as cancer type, tumor size, histologic grade, ER-PR receptor positivity, Her2 positivity, Ki-67 labelling index and lymphovascular invasion. Results: The mean age of the participants was 53.15±11.75 (range, 27-80) years. Eleven patients had diffuse edema, 27 patients had peritumoral edema, and 5 patients had prepectoral edema. Nineteen luminal A cancers, 17 luminal B, 9 triple-negative, and 1 Her2 cancer were seen. Peritumoral edema was associated with lymphovascular invasion positivity (p=0.002). Tumor size and the level of Ki-67 was associated with peritumoral edema (p=0.001, p=0.009). The odds of observing prepectoral edema showed no statistically significant difference in the presence of lymphovascular invasion positivity and other parameters. The presence of diffuse edema showed significant differences depending on tumor size measurements (p=0.026). Conclusion: Edema in breast MRI can provide information about histopathologic findings, particularly about lymphovascular invasion. The authors suggest that different edema types could be mentioned in radiology reports as a matter of routine given that such findings can provide information about the prognosis.

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Preoperative MRI features associated with lymphovascular invasion in node‐negative invasive breast cancer: A propensity‐matched analysis

Abstract: 3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1037-1044.

Cited by 48 publications

References 40 publications

Preoperative prediction of lymphovascular invasion in invasive breast cancer with dynamic contrast‐enhanced‐MRI‐based radiomics

Preoperative prediction of lymphovascular invasion in invasive breast cancer with dynamic contrast‐enhanced‐MRI‐based radiomics

Invasive Breast Cancer: Prognostic Value of Peritumoral Edema Identified at Preoperative MR Imaging

Relation of peritumoral, prepectoral and diffuse edema with histopathologic findings of breast cancer in preoperative 3T magnetic resonance imaging

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