Preoperatif 3T manyetik rezonans görüntülemede tümör çevresi, pektoral kas önü ve yaygın ödemin meme kanserinin histopatolojik bulguları ile ilişkisi

Öz

Amaç: Preoperatif meme manyetik rezonans görüntüleme (MRG), meme kanserinin prognozu konusunda zengin bilgiler sağlar. Bunun için özellikle morfolojik ve dinamik özellikler kullanılır. Çalışmamızda meme MRG’de peritümöral, prepektoral, diffüz ödemin meme kanserinin histopatolojik prognostic parametreler ile ilişkisin araştırmayı ve meme MRG’den prognoz ile ilgili edinilen bilgileri değerlendirmeyi amaçladık.

Yöntemler: Ocak-Ağustos 2018 tarihleri arasında hastanemizde meme kanseri tanısı almış ve ameliyat öncesi değerlendirmede kontrastlı dinamik meme MRG çekilen 46 hasta çalışmaya dahil edildi. T2A sekansta tümör çevresinde, pektoral kas önünde ya da tüm memede izlenen su ile benzer sinyal ödem lehine değerlendirildi. Her bir ödem tipi; kanser tipi, tümör boyutu, histolojik evre, ER-PR reseptör pozitifliği, Her2 reseptör pozitifliği, Ki67 proliferasyon indeksi ve lenfovasküler invazyon gibi klinikopatolojik parametreler ile değerlendirildi.

Bulgular: Ortalama yaş 53.15±11.75 (aralık 27-80) idi. Meme MRG’de 11 hastada diffüz, 27 hastada peritümöral, 5 hastada prepektoral ödem bulgusu izlenmekteydi. 19 lüminal A, 17 lüminal B, 9 üçlü negatif, 1 Her2 kanser mevcuttu.Peritümöral ödem LVI pozitifliği ile ilişkili bulundu (p=0.002). Tümör boyutu ve Ki-67 indexi peritümöral ödemle ilişkilidir (p=0.001, p=0.009).Prepektoral ödem ile değerlendirilen parametreler arasında ilişkili görülmedi. Diffüz ödem tümör boyutuna göre farklılık gösterir (p=0.026).

Sonuç: Meme MRG’de görülen peritümöral ödem LVI pozitifliği açısından bilgi vericidir. Farklı ödem tipleri prognoz açısından bilgiler taşıdığından rutin raporlamalarda belirtilmelidir.

Anahtar Kelimeler

• Meme kanseri,Ödem,Magnetik rezonans görüntüleme,Lenfovasküler invazyon

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

Abstract

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.

Keywords

• Breast cancer,Edema,Magnetic resonance imaging,Lymphovascular invasion

References

1. 1. Kim KW, Kuzmiak CM, Kim YJ, Seo JY, Jung HK, Lee MS. Diagnostic Usefulness of Combination of Diffusion-weighted Imaging and T2WI, Including Apparent Diffusion Coefficient in Breast Lesions: Assessment of Histologic Grade. Acad Radiol. 2018 Jan 12. pii: S1076-6332(17)30489-0. doi: 10.1016/j.acra.2017.11.011.
2. 2. Mazurowski MA. Radiogenomics: What it is and why it is important. J Am Coll Radiol. 2015 Aug;12(8):862-6. doi: 10.1016/j.jacr.2015.04.019.
3. 3. Cheon H, Kim HJ, Kim TH, Ryeom HK, Lee J, Kim GC, et al. Invasive breast cancer: Prognostic value of peritumoral edema identified at preoperative MR imaging. Radiology. 2018 Jan 9:171157. doi: 10.1148/radiol.2017171157.
4. 4. Schmitz AM, Loo CE, Wesseling J, Pijnappel RM, Gilhuijs KG. Association between rim enhancement of breast cancer on dynamic contrast-enhanced MRI and patient outcome: impact of subtype. Breast Cancer Res Treat. 2014.148(3):541–51.
5. 5. Choi JS, Ko ES, Ko EY, Han BK, Nam SJ. Background parenchymal enhancement on preoperative magnetic resonance imaging: association with recurrence-free survival in breast cancer patients treated with neoadjuvant chemotherapy. Medicine (Baltimore). 2016 Mar;95(9):e3000.
6. 6. Li SP, Makris A, Beresford MJ, Taylor NH, Ah-See ML, Stirling JJ, et al. Use of dynamic contrast-enhanced MR imaging to predict survival in patients with primary breast cancer undergoing neoadjuvant chemotherapy. Radiology. 2011 Jul;260(1):68-78. doi: 10.1148/radiol.11102493.
7. 7. Youk JH, Son EJ, Chung J, Kim JA, Kim EK. Triple-negative invasive breast cancer on dynamic contrast-enhanced and diffusion-weighted MR imaging: comparison with other breast cancer subtypes. Eur Radiol. 2012 Aug;22(8):1724-34. doi: 10.1007/s00330-012-2425-2.
8. 8. Uematsu T. Focal breast edema associated with malignancy on T2-weighted images of breast MRI: peritumoral edema, prepectoral edema, and subcutaneous edema. Breast Cancer. 2015 Jan;22(1):66-70. doi: 10.1007/s12282-014-0572-9.

9. 9. Allred DC, Harvey JM, Berardo M, Clark GM. Prognostic and predictive factors in breast cancer by immunohistochemical analysis. Mod Pathol. 1998;11(2):155–168.
10. 10. Wolff AC, Hammond ME, Hicks DG, Dowsett M, McShane LM, Allison KH, et al; American Society of Clinical Oncology; College of American Pathologists. Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/ College of American Pathologists clinical practice guideline update. Arch Pathol Lab Med. 2014 Feb;138(2):241-56
11. 11. Cheang MC, Chia SK, Voduc D, Gao D, Leung S, Snider J et al. Ki67 index, HER2 status, and prognosis of patients with luminal B breast cancer. J Natl Cancer Inst. 2009;101(10):736–750.
12. 12. Baltzer PA, Yang F, Dietzel M, Herzog A, Simon A, Vag T, et al. Sensitivity and specificity of unilateral edema on T2w-TSE sequences in MR-mammography considering 974 histologically verified lesions. Breast J. 2010;16:233–9.
13. 13. Auvinen P, Tammi R, Parkkinen J, Tammi M, Agren U, Johansson R, et al. Hyaluronan in peritumoral stroma and malignant cells associates with breast cancer spreading and predicts survival. Am J Pathol. 2000; 156(2):529–36.
14. 14. Mori N, Mugikura S, Takasawa C, Miyashita M, Shimauchi A, Ota H, et al. Peritumoral apparent diffusion coefficients for prediction of lymphovascular invasion in clinically node-negative invasive breast cancer. Eur Radiol. 2016 Feb;26(2):331-9. doi: 10.1007/s00330-015-3847-4.
15. 15. Rosen PP. Tumor emboli in intramammary lymphatics in breast carcinoma: pathologic criteria for diagnosis and clinical significance. Pathol Annu. 1983;18(Pt 2):215–32.
16. 16. Sanders LM, Dardik M, Modi L, Sanders AE, Schaefer SS, Litvak A. Macroscopic lymphovascular invasion visualized on mammogram and magnetic resonance imaging: Initially misidentified as ductal carcinoma in situ but properly diagnosed by immunohistochemistry. SAGE Open Med Case Rep. 2017 Apr 21;5:2050313X17705803. doi: 10.1177/2050313X17705803.
17. 17. Van Goethem M, Schelfout K, Kersschot E, Colpaert C, Verslegers I, Biltjes I, et al. Enhancing area surrounding breast carcinoma on MR mammography: comparison with pathological examination. Eur Radiol. 2004;14:1363–70.
18. 18. Cheon H, Kim HJ, Lee SM, Cho SH, Shin KM, Kim GC, et al. Preoperative MRI features associated with lymphovascular invasion in node-negative invasive breast cancer: A propensity-matched analysis. J Magn Reson Imaging. 2017 Oct;46(4):1037-44. doi: 10.1002/jmri.25710.
19. 19. Bae MS, Shin SU, Ryu HS, Han W, Im SA, Park IA, et al. Pretreatment MR imaging features of triple-negative breast cancer: association with response to neoadjuvant chemotherapy and recurrence-free survival. Radiology. 2016;281: 392–400.
20. 20. Dietzel M, Baltzer PA, Vag T, Gröschel T, Gajda M, Camara O, et al. Magnetic resonance mammography of invasive lobular versus ductal carcinoma: systematic comparison of 811 patients reveals high diagnostic accuracy irrespective of typing. J Comput Assist Tomogr. 2010;34:587–95.
21. 21. Kawashima H, Kobayashi-Yoshida M, Matsui O, Zen Y, Suzuki M, Inokuchi M. Peripheral hyperintense pattern on T2-weighted magnetic resonance imaging (MRI) in breast carcinoma: correlation with early peripheral enhancement on dynamic MRI and histopathologic findings. J Magn Reson Imaging. 2010 Nov;32(5):1117-23. doi: 10.1002/jmri.22279.