Prepectoral Edema Suggests Malignant Breast Tumor

By Reuters Staff

NEW YORK (Reuters Health) - Prepectoral edema on magnetic resonance mammography (MRM) strongly suggests the presence of malignant breast tumors, researchers from Germany report.

MRM is currently used primarily for evaluation of women after operation or radiation, preoperative breast cancer staging, examination of cancers of unknown primary, and to aid in decision making with women who are genetically predisposed to breast cancer.

While using MRM for these reasons, Dr. Clemens G. Kaiser from Medical Faculty Mannheim-University of Heidelberg, Mannheim, Germany and colleagues discovered prepectoral edema (i.e., increased amounts of T2-weighted hyperintense fluid spatters and liquid layers in the prepectoral region) accompanying some lesions.

This prompted them to undertake a retrospective study of 162 women with 180 histopathologically correlated lesions to evaluate the diagnostic value of prepectoral edema in the female breast.

Twenty-six lesions (14.4%) were associated with prepectoral edema - including 24 of 93 (25.8%) histologically invasive cancers, compared with only 2 of 76 (2.6%) histologically benign lesions.

This yielded a specificity of 97.3% and a positive predictive value of 92.3% for prepectoral edema as an indicator for malignancy, according to the March 15 Academic Radiology online report.

The overall accuracy of prepectoral edema for indicating malignancy was 57.7%.

In contrast, the sensitivity of prepectoral edema for indicating malignancy was only 19.3%, and its moderate negative predictive value (48%) in the face of low prevalence limits its ability to rule out malignancy.

Prepectoral edema was present in similar fractions of ductal invasive (19/73, 26%) and other invasive (5/20, 25%) tumors, and it was much more common in tumors up to 2 cm diameter (13.8%) than in larger tumors (48.5%).

"If present, prepectoral edema represents a helpful tool in the differential diagnosis of breast lesions," the researchers conclude. "However, it cannot replace other morphologic and kinetic signs, which all have to be respected in forming the final diagnosis."

Dr. Kaiser did not respond to a request for comments.

SOURCE: https://bit.ly/1DbKrtv

Academic Radiol 2015.

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