br Corresponding authors at No Penglai Road Daliang District
Corresponding authors at: No. 1, Penglai Road, Daliang District, Shunde, Foshan, Guangdong, PR China.
1 These authors contributed equally to this work.
spaces (lymphatic and/or blood vessel) by tumoral cells, i.e. tumor cells spreading through the lymphatic or blood vascular networks . Peritumoral vascular invasion (VI) is considered to be an early step in the metastatic process and a key hallmark of aggressiveness tumors, therefore is very important for the progress of malignant tumors . When examined on tissue sections as a morphologic marker, the pre-sence of VI is a strong prognostic factor in many tumors, such as co-lonic, Cyclosporin H and cervical carcinomas [7–9]. It has also been shown that VI is positively correlated with regional lymph node metastasis and a greater recurrence rate in such cancers [10,11]. A study also showed the presence of VI could be considered as an indicator of high biological aggressiveness, which may be a strong prognostic factor in breast cancer . Accurate identification of VI in breast cancer patients is crucial for prognosis and treatment strategy decisions. However, VI is only available postoperatively. Preoperative knowledge of VI can pro-vide valuable information for determining the need for adjuvant therapy, thus aiding in clinical decision making. Therefore, from a clinical point of view, predicting VI in breast cancer before surgery would benefit further management of patients, which is valuable and urgently needed.
To predict VI in breast cancer, potential factors associated with VI in various aspects should be taken into consideration. Anatomical MRI can provide morphological information of breast tumor (e.g., size, margins, and location) and axillar lymph nodes. Diffusion-weighted imaging (DWI) in a fast time acquisition and without contrast medium gives information about cellularity of breast cancer . Perfusion can give additional information as regards vascularization of breast cancer . In addition, clinical parameters such as estrogen receptor (ER), pro-gesterone receptor (PR), human epidermal growth factor receptor (HER2), and Ki-67 proliferation could provide an insight into the functional activity of receptors and tumor proliferation.
Therefore, the present study aims to individually predict VI in breast cancer and develop a quantitative model for the assessment of VI based on clinical, multiparametric MRI and pathologic parameters before treatment, which will facilitate clinical decision-making of breast cancer.
2. Materials and methods
2.1. Basic characteristics of patients
This present study was approved by the Ethics Committee of our hospital, and the patient's informed consent was waived. We retro-spectively investigated the cases of 200 consecutive patients with single primary breast cancer admitted to our department from January 2016 to January 2018. All patients underwent a 1.5 T MRI examination be-fore 16 G or 18 G needle core biopsy and surgery. Patients with pre-viously-diagnosed breast cancer or incomplete clinical information were excluded, and male patients were excluded as well. None of the patients had received preoperative chemotherapy. In this study, we defined VI as the presence of tumor cells in the peritumoral vascular channels based on postoperative pathology. VI was recorded as being present or absent. Clinical information was collected including age, ER, PR, HER2, Ki-67 labeling index and histological type [e.g., invasive ductal carcinoma (IDC) (histological grade 1), IDC (histological grade 2), IDC (histological grade 3), ductal carcinoma in situ and neu-roendocrine carcinoma]. ER, PR, HER2, Ki-67-labeling index and his-tological type were confirmed by needle core biopsy. MR imaging features included breast density (fatty, dense or mixed), location (upper-outer quadrant, upper-inner quadrant, lower-outer quadrant, lower-inner quadrant, or central position), tumor size (maximum dia-meter), margins (well- defined or ill- defined), lobulation sign (absence or presence), spiculation sign (absence or presence), MRI- reported axillary lymph node metastasis (ALNM) (absent, single or multiple), contrast enhancement patterns (obvious enhancement or slight en-hancement), DWI appearance (marked hyperintensity or slight