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

Kaynakça

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