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Objective:
Breast edema is defined as a high signal intensity on T2-weighted MR image. It is an essential image phenotype of breast MRI. The purpose of this study was to investigate the prognostic implication of breast edema on preoperative breast MRI in breast cancer patients.

Materials and Methods:
Data of 858 breast cancer patients at a single institution were retrospectively analyzed. Patients were divided into two groups according to the presence or absence of breast edema and edema was subdivided as peritumoral, prepectoral, or subcutaneous edema on preoperative breast MRI. We compared the clinicopathologic characteristics and survival outcomes between the two groups. Also, we further analyzed those features according to the three subtypes of breast edema.

Results:
Of 858 patients, 365 (42.5%) had breast edema on preoperative breast MRI. Patients with breast edema showed significantly higher rates of axillary lymph node metastasis (54.8% vs. 19.1%, p < 0.001) and lymphovascular invasion (LVI) (58.6% vs. 12.7%, p < 0.001) than those without breast edema. Patients with breast edema also showed significantly worse overall survival rate (log-rank p < 0.001; hazard ratio [HR]: 3.97; 95% confidence interval [CI]: 2.07-7.61) and recurrence-free survival rate (log-rank p < 0.001; HR: 2.79; 95% CI: 1.79-4.353) than those without breast edema. Among three subtypes of breast edema, subcutaneous breast edema remained a significant factor affecting overall survival rate even after adjusting for other variables.

Conclusion:
Breast edema on preoperative breast MRI implies a higher possibility of LVI and axillary lymph node metastasis that can lead to a poor prognosis. Description of breast edema and its subtype on preoperative breast MRI might provide prognosis prediction that we could consider more intensive surveillance for those with breast edema.