Korean J Radiol.  2024 Sep;25(9):788-797. 10.3348/kjr.2024.0196.

Preoperative MRI Features Associated With Axillary Nodal Burden and Disease-Free Survival in Patients With Early-Stage Breast Cancer

• Zhang J
• Yin Z
• Zhang J
• Song R
• Cui Y
• Yang X

• KMID: 2558924
• DOI: http://doi.org/10.3348/kjr.2024.0196

Abstract

Objective
To investigate the potential association among preoperative breast MRI features, axillary nodal burden (ANB), and disease-free survival (DFS) in patients with early-stage breast cancer.
Materials and Methods
We retrospectively reviewed 297 patients with early-stage breast cancer (cT1-2N0M0) who underwent preoperative MRI between December 2016 and December 2018. Based on the number of positive axillary lymph nodes (LNs) determined by postoperative pathology, the patients were divided into high nodal burden (HNB; ≥3 positive LNs) and non-HNB (<3 positive LNs) groups. Univariable and multivariable logistic regression analyses were performed to identify independent risk factors associated with ANB. Predictive efficacy was evaluated using the receiver operating characteristic (ROC) curve and area under the curve (AUC). Univariable and multivariable Cox proportional hazards regression analyses were performed to determine preoperative features associated with DFS.
Results
We included 47 and 250 patients in the HNB and non-HNB groups, respectively. Multivariable logistic regression analysis revealed that multifocality/multicentricity (adjusted odds ratio [OR] = 3.905, 95% confidence interval [CI]: 1.685– 9.051, P= 0.001) and peritumoral edema (adjusted OR = 3.734, 95% CI: 1.644–8.479, P = 0.002) were independent risk factors for HNB. Combined peritumoral edema and multifocality/multicentricity achieved an AUC of 0.760 (95% CI: 0.707– 0.807) for predicting HNB, with a sensitivity and specificity of 83.0% and 63.2%, respectively. During the median follow-up period of 45 months (range, 5–61 months), 26 cases (8.75%) of breast cancer recurrence were observed. Multivariable Cox proportional hazards regression analysis indicated that younger age (adjusted hazard ratio [HR] = 3.166, 95% CI: 1.200–8.352, P= 0.021), larger tumor size (adjusted HR = 4.370, 95% CI: 1.671–11.428, P= 0.002), and multifocality/multicentricity (adjusted HR = 5.059, 95% CI: 2.166–11.818, P< 0.001) were independently associated with DFS.
Conclusion
Preoperative breast MRI features may be associated with ANB and DFS in patients with early-stage breast cancer.

Keyword

Breast neoplasms; Magnetic resonance imaging; Axilla; Lymph nodes; Survival