Abstract
BACKGROUND: Breast magnetic resonance imaging (MRI) provides valuable information for tumor detection, as well as potential applications in molecular characterization and prognostication. A key feature detectable on MRI is the presence of breast edema, which has been associated with tumor aggressiveness and poorer clinical outcomes. AIM: To determine the correlation between intramammary edema patterns as observed on breast MRI and the histopathological and molecular characteristics of the tumor. METHODS: In this retrospective single-center study, 123 women with biopsy-proven breast cancer underwent preoperative breast MRI from June 2022 to June 2025. The classification of edema was determined on T2-weighted images, divided into four breast edema score (BES) categories: BES-1 (no edema), BES-2 (peritumoral edema), BES-3 (prepectoral edema), and BES-4 (subcutaneous edema). The MRI findings were correlated with histological type, molecular subtype, receptor status, Ki67 index, and lymph node involvement. Data analysis was conducted using IBM SPSS Statistics for Windows, version 28. RESULTS: Edema was observed in 45.5% of patients. Statistically significant correlation was observed between BES and molecular subtypes (P < 0.001), hormone receptor status (P < 0.001), and human epidermal growth factor receptor 2 expression (P < 0.001). Higher BES categories (BES 2-4) exhibited a higher prevalence in human epidermal growth factor receptor 2-positive and triple-negative tumors, while the absence of edema (BES-1) demonstrated a predominance in hormone receptor-positive subtypes. CONCLUSION: The presence and severity of MRI-based breast edema score have been found to correlate with aggressive molecular subtypes, underscoring the potential role of BES in prognostic stratification and guiding tailored treatment strategies.