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

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 I 2 . 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.