title: 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?
abstract: BACKGROUND
  The specificity of breast MRI is only moderate. The unsatisfactory specificity of breast MRI has prompted evaluation of high signal intensity (SI) on T2-weighted imaging (T2WI). The purpose of the study was to investigate the prevalence of prepectoral edema determined using high SI on T2WI with fat-suppression 3 T MRI and to correlate its presence with prognostic factors of breast cancer.
  
  
  METHODS
  The retrospective study comprised 589 consecutive histopathologically confirmed lesions, 460 malignant and 129 benign, identified by 3 T MRI. Presence of prepectoral edema was evaluated on T2WI with fat suppression, and its diagnostic value for malignancies and correlation with clinicopathological findings in histopathologically confirmed breast cancer were assessed.
  
  
  RESULTS
  Prepectoral edema was present in 54 of the 460 breast cancers (9 % of the total 589) and none of the 129 benign lesions. Its sensitivity and specificity were 12 and 100 %, respectively. The positive predictive value was 100 %. Young age (p = 0.01), large tumor size (p < 0.0001), high histological grade (p < 0.0001), invasive ductal carcinoma (p < 0.0001), high lymphovascular invasion degree (p < 0.0001), high axillary lymph node positivity (p < 0.0001), high inflammatory breast cancer rate (p < 0.0001), high neoadjuvant chemotherapy rate (p < 0.0001), and chemoresistant breast cancers (p < 0.0001) were significantly associated with prepectoral edema. There was no association of the morphological lesion type on MRI and dynamic enhancement imaging pattern with the presence of prepectoral edema.
  
  
  CONCLUSIONS
  Prepectoral edema has low prevalence but is specific for breast cancer and correlated with prognostic factors.
authors: Breast Imaging and Breast Intervention Section, Shizuoka Cancer Center Hospital, Naga-izumi, Shizuoka, 411-8777, Japan, t.uematsu@scchr.jp.
authors: Takayoshi
authors: T
authors: Uematsu
authors: Masako
authors: M
authors: Kasami
authors: Junichiro
authors: J
authors: Watanabe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001941:Breast Diseases / Q000188:drug therapy / Q000473:pathology*; D001943:Breast Neoplasms / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy / Q000473:pathology; D019008:Drug Resistance, Neoplasm / Q000187:drug effects; D004487:Edema / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006801:Humans; D058922:Inflammatory Breast Neoplasms / Q000188:drug therapy / Q000473:pathology; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography