MRI-based breast edema typing for evaluating neoadjuvant chemotherapy efficacy in breast cancer and its predictive factors

ZHANG Ting; ZHOU Linghui; LIN Zhijun; CHEN Sijie; ZHAO Xin

doi:10.20258/j.cnki.1006-9011.2025.10.018

Abstract：Objective To evaluate the predictive value of different types of breast edema on the efficacy of neoadjuvant che-motherapy(NAC)in breast cancer patients based on MRI.Methods A total of 66 patients with pathologically confirmed breast cancer were enrolled.All patients underwent breast MRI prior to NAC.Edema in the affected breast was classified based on im-ages from T2-weighted sequences into four types:Type 1(no edema),Type 2(peritumoral edema),Type 3(prepectoral edema),and Type 4(subcutaneous edema).Therapeutic efficacy was evaluated after NAC completion,and patients were di-vided into a pathological complete response(PCR)group and a non-PCR group.The clinicopathological and imaging character-istics were compared among patients with different edema types and different therapeutic responses.Logistic regression analysis was used to examine the relationship between breast edema types and NAC efficacy.The Spearman correlation analysis was em-ployed to assess the correlations between breast edema types and imaging characteristics.The predictive performance of the edema typing for NAC response was analyzed using ROC curves.Results Among the 66 patients,the distribution of edema types was as follows:13 with Type 1,17 with Type 2,15 with Type 3,and 21 with Type 4.Significant differences were ob-served in maximum tumor diameter,peritumoral ADC value,and the ratio of peritumoral ADC to normal glandular ADC be-tween patients with Type 1 and Type 3 edema,and between those with Type 1 and Type 4 edema(all P<0.05).Twenty-two pa-tients achieved PCR,while 44 were in the non-PCR group.The proportion of patients with Type 4 edema was significantly higher in the non-PCR group than in the PCR group(P<0.01).Logistic regression analysis revealed that breast edema type was significantly associated with NAC efficacy(P<0.01).Correlation analysis showed positive correlations between breast edema type and maximum tumor diameter(r=0.498,P<0.01),peritumoral ADC(r=0.448,P<0.01),and the peritumoral ADC/normal gland ADC ratio(r=0.395,P<0.05).No significant correlation was found between edema type and intratumoral ADC(r=-0.254,P=0.04).ROC curve analysis indicated that the edema typing system predicted PCR with an AUC of 0.823(95%CI:0.717～0.930,P<0.01),a sensitivity of 68.2%,and a specificity of 81.8%.Conclusion The types of breast edema in breast cancer are associated with specific MRI characteristics and may provide valuable information for assessing the efficacy of NAC.