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Association of peritumoral region features assessed on breast MRI and prognosis of breast cancer: a systematic review and meta-analysis

  • Breast
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Abstract

Background

Increasing attention has been given to the peritumoral region. However, conflicting findings have been reported regarding the relationship between peritumoral region features on MRI and the prognosis of breast cancer.

Purpose

To evaluate the relationship between peritumoral region features on MRI and prognosis of breast cancer.

Materials and methods

A retrospective meta-analysis of observational studies comparing either qualitative or quantitative assessments of peritumoral MRI features on breast cancer with poor prognosis and control subjects was performed for studies published till October 2022. Pooled odds ratios (ORs) or standardized mean differences and 95% confidence intervals (CIs) were estimated by using random-effects models. The heterogeneity across the studies was measured using the statistic I2. Sensitivity analyses were conducted to test this association according to different study characteristics.

Results

Twenty-four studies comprising 1853 breast cancers of poor prognosis and 2590 control participants were included in the analysis. Peritumoral edema was associated with non-luminal breast cancers (OR=3.56; 95%CI: 2.17, 5.83; p=.000), high expression of the Ki-67 index (OR=3.70; 95%CI: 2.41, 5.70; p =.000), high histological grade (OR=5.85; 95%CI: 3.89, 8.80; p=.000), lymph node metastasis (OR=2.83; 95%CI: 1.71, 4.67; p=.000), negative expression of HR (OR=3.15; 95%CI: 2.03, 4.88; p=.000), and lymphovascular invasion (OR=1.72; 95%CI: 1.28, 2.30; p=.000). The adjacent vessel sign was associated with greater odds of breast cancer with poor prognosis (OR=2.02; 95%CI: 1.68, 2.44; p=.000). Additionally, breast cancers with poor prognosis had higher peritumor-tumor ADC ratio (SMD=0.67; 95%CI: 0.54, 0.79; p=.000) and peritumoral ADCmean (SMD=0.29; 95%CI: 0.15, 0.42; p=.000). A peritumoral region of 2–20 mm away from the margin of the tumor is recommended.

Conclusion

The presence of peritumoral edema and adjacent vessel signs, higher peritumor-tumor ADC ratio, and peritumoral ADCmean were significantly correlated with poor prognosis of breast cancer.

Clinical relevance statement

MRI features of the peritumoral region can be used as a non-invasive index for the prognostic evaluation of invasive breast cancer.

Key Points

• Peritumoral edema was positively associated with non-luminal breast cancer, high expression of the Ki-67 index, high histological grade, lymph node metastasis, negative expression of HR, and lymphovascular invasion.

• The adjacent vessel sign was associated with greater odds of breast cancers with poor prognosis.

• Breast cancers with poor prognosis had higher peritumor-tumor ADC ratio and peritumoral ADCmean.

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Abbreviations

ADC ratio :

Peritumoral maximum ADC value/tumor mean ADC value

ADCmean:

Average ADC value

CI:

Confidence interval

ER:

Estrogen receptors

HER-2:

Human epidermal growth factor receptor 2

HR:

Hormone receptors

OR:

Odds ratio

SMD:

Standardized mean difference

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Acknowledgements

All authors read and approved the final manuscript. The authors thank Lizhi Xie from GE Healthcare for the statistical and technical support.

Funding

This study was supported by the 2022 Teaching Reform of Continuing Education of Liaoning Adult Education Society (LCYJGZXYB22100); University-level teaching reform research general project of Dalian Medical University (DYLX21036); the 2022 General Project of the “Peak Climbing Plan” of Dalian city key specialty of medicine(2022DF042); National Natural Science Foundation of China (82271975); and the Natural Science Foundation of Liaoning Province (2020-MS-266).

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Authors and Affiliations

  1. Department of Radiology, First Affiliated Hospital of Dalian Medical University, No 222 Zhongshan Road, Xigang District, Dalian, Liaoning, 116011, People’s Republic of China

    Siqi Zhao, Yuanfei Li, Ning Ning, Hongbing Liang, Yueqi Wu, Qi Wu, Zhuo Wang, Ailian Liu, Qingwei Song & Lina Zhang

  2. Zhongshan College of Dalian Medical University, No28 Aixian Road, Gaoxin District, Dalian, Liaoning, 116085, People’s Republic of China

    Jiahe Tian

  3. School of Public Health, Dalian Medical University, Dalian, Liaoning Province, No. 9W. Lvshun South Road, Dalian, 116044, People’s Republic of China

    Jie Yang

  4. Department of Pathology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, Liaoning, 116011, People’s Republic of China

    Xue Gao

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  1. Siqi Zhao
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Corresponding author

Correspondence to Lina Zhang.

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Guarantor

The scientific guarantor of this publication is Lina Zhang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Siqi Zhao, Yuanfei Li, and Jie Yang kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was not required for this study because the study is a meta-analysis, and outcome data was published previously.

Ethical approval

The study was approved by the Ethics Committee of the First Hospital of Dalian Medical University (IRB number: PJ- KS-KY-2022-50).

Study subjects or cohorts overlap

All study subjects or cohorts have been previously reported, as this is a meta-analysis study.

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• retrospective

• diagnostic or prognostic study

• performed at one institution

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Zhao, S., Li, Y., Ning, N. et al. Association of peritumoral region features assessed on breast MRI and prognosis of breast cancer: a systematic review and meta-analysis. Eur Radiol (2024). https://doi.org/10.1007/s00330-024-10612-y

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