Predictive value of T2-weighted magnetic resonance imaging for the prognosis of patients with mass-type breast cancer with peritumoral edema

Abstract

The aim of the present study was to investigate the role of edema surrounding breast cancer masses in the prognostic prediction of magnetic resonance imaging (MRI) T2-weighted fat suppression sequence. For this purpose, 80 patients with mass-type breast cancer underwent conventional plain breast MRI, dynamic contrast-enhanced (DCE)-MRI or diffusion-weighted MRI scan. The associations between edema around the mass on MRI T2 fat suppression sequence plain scan and tumor stage, pathological findings, immunohistochemical findings and axillary lymph node metastasis were analyzed. The results revealed the presence of edema around the mass on the MRI T2 fat suppression sequence plain scan in 35 patients. By contrast, there was no abnormal enhancement on the DCE-MRI, and the apparent diffusion coefficient value did not decrease in these areas. Compared with the remaining 45 patients, the 35 patients with peritumoral edema exhibited a higher tumor stage and a higher rate of axillary lymph node metastasis (all P<0.05). However, there was no significant difference in pathological classification or the expression of estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 (as determined by immunohistochemistry) between the two groups. In total, 12 cases of tumor shrinkage during neoadjuvant chemotherapy were accompanied by an improvement in edema. Taken together, the findings of the present study indicated that the presence of edema around the mass on the MRI T2 fat suppression sequence may predict poor prognosis in patients with mass-type breast cancer. Furthermore, the improvement of the peritumoral edema post-neoadjuvant chemotherapy may also be a predictor of a more favorable prognosis.

Keywords: breast cancer; edema; magnetic resonance imaging; predictive value; prognosis.

Figure 1.

Magnetic resonance imaging examination of a 62-year-old woman with invasive ductal carcinoma of the left breast with metastasis to the right axillary lymph nodes confirmed by biopsy. (A) The T2-weighted fat suppression sequence revealed the presence of edema around the tumor mass and under the skin. (B) The transverse contrast-enhanced dynamic sequence revealed that there was a markedly irregular enhancement mass in the lateral quadrant at the level of the nipple.

Figure 2.

Magnetic resonance imaging examination of a 56-year-old woman with invasive ductal carcinoma in the left breast. (A) The T2-weighted fat suppression sequence revealed that the areola and breast skin were thickened and there was edema anterior to the pectoralis major muscle and under the skin. (B) The transverse contrast-enhanced dynamic sequence revealed that there was a mass with markedly irregular enhancement in the lateral quadrant at the level of the nipple.

Figure 3.

Magnetic resonance imaging examination of a 47-year-old woman with invasive ductal carcinoma in the left breast who received NAC. (A) The T2-weighted fat suppression sequence revealed the presence of edema around the tumor mass and areola, with breast skin thickening prior to NAC. (B) Transverse contrast-enhanced dynamic sequence revealed that there was a mass exhibiting markedly irregular enhancement in the lateral quadrant at the level of the nipple prior to NAC. (C and E) The T2-weighted with fat suppression sequence revealed that the presence of edema around the mass and areola, as well as the breast skin thickening had improved after (C) 2 and (E) 4 cycles of NAC. (D and F) Contrast-enhanced dynamic sequences revealed that the mass was significantly smaller compared with that prior to NAC after (D) 2 and (F) 4 cycles of NAC. NAC, neoadjuvant chemotherapy.

Figure 4.

Immunohistochemical staining of ER, PR and HER2 in breast tumor tissues at a magnification of ×200. Strong immunostaining for (A) ER, (B) PR and (C) HER2 in breast tumor tissue. ER, estrogen receptor; PR, progesterone receptor; HER2, human epidermal growth factor receptor 2.