Sensitivity and Specificity of Unilateral Edema on T2w-TSE Sequences in MR-Mammography Considering 974 Histologically Verified Lesions

Abstract

The objective of this investigation was to determine the diagnostic value of unilateral edema in differentiating benign from malignant breast disease on T2w-TSE images in MR-Mammography (MRM). All patients from a 10-year period undergoing surgery in the same institution after having received MRM in our department were included in this prospective analysis of previous acquired examinations. To eliminate bias caused by prior procedures, all patients having had biopsy, operation, radiation therapy, or chemotherapy before MRM were excluded. T2w-TSE images were acquired after a dynamic contrast-enhanced series of T1-weighted images in a standardized examination protocol (1.5 T). Edema was defined as a high-signal intensity on T2w-TSE images and it was categorized as absent, perifocal, or diffuse. Examinations were rated by two experienced observers blinded to all procedures and results following MRM. In cases of disconcordance, the opinion of a third radiologist decided. Statistical testing included Pearson's Chi-squared test and Fisher's exact testing. A total of 1,010 patients with a mean age of 55 years (SD: 11.6 years, range: 16-87 years) with 1,129 histologically verified lesions were included in this investigation. After removing all patients with prior procedures from the patient collective, 974 lesions were left for statistical analysis. Perifocal edema was highly significantly (p < 0.001) associated with malignant disease, leading to a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 33.5%, 93.9%, 89.6, and 57.1%, respectively. Unilateral edema in general showed the following diagnostic parameters: sensitivity 53.0%, specificity 80.5%, PPV 80.9%, and NPV 52.3%. Edema seems to be associated with malignancy in the majority of cases. Especially, specificity and PPV were found to be high. These findings may be helpful in diagnostic decisions on otherwise equivocal cases.

Quantitative Maximum Shear-Wave Stiffness of Breast Masses as a Predictor of Histopathologic Severity

“…Peritumoral edema has been reported in association with invasive carcinomas on MRI [26] and is one of the causes of an echogenic rim surrounding breast masses on sonography. Nests of tumor cells invading the surrounding fat can also cause an echogenic rim [27].…”

Is evaluation of the presence of prepectoral edema on T2-weighted with fat-suppression 3 T breast MRI a simple and readily available noninvasive technique for estimation of prognosis in patients with breast cancer?

“…The specificity of 3 T breast MRI is only moderate, ranging from 72 to 94 % [1][2][3][4]. Recently, the unsatisfactory specificity of breast MRI has prompted evaluation of high signal intensity (SI) on T2-weighted imaging (T2WI) [6][7][8][9][10][11][12][13][14].…”

Potential of MR Mammography to Predict Tumor Grading of Invasive Breast Cancer

“…A recent investigation reported edema as a useful diagnostic adjunct for the differential diagnosis of breast lesions. In this investigation the high prevalence of perifocal edema within advanced lesions was explained by the higher permeability of vessels caused by various cytokines [21]. Furthermore, multivariate analysis identified traditional MRM descriptors as less important for the assessment of tumor grading.…”

“…These included "basic descriptors" addressing dynamic (wash-in; wash-out, continued increase, plateau) and morphological characteristics of the lesion (shape, margin, internal structure, internal septation; e. g. [16,18,19]). To further assess the lesion composition, "additional descriptors" were used including "blooming sign" [20], "edema" [21], "hook sign" [22], "destruction of nipple line" [12,23], "root sign" [12], "necrosis sign" [17,24], "skin thickening" [12] and tumor vasculature [25]. Detailed definition and examples of such "additional descriptors" can be found in the literature and "supplemental materials".…”