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May 9, 2026Open Access

Can MRI predict lymphovascular invasion in breast cancer? A radiological-pathological observational insights

Key Points

This study aims to assess MRI characteristics of invasive breast cancer in relation to lymphovascular invasion (LVI) and their clinicopathological correlations.
Retrospective analysis of 103 breast cancer cases with preoperative MRI evaluations including conventional, dynamic contrast-enhanced, and diffusion-weighted imaging.
MRI findings were classified using the BIRADS lexicon along with specific imaging details such as tumor ADC value and peritumoral characteristics.
Histopathological assessment for LVI was performed postoperatively, along with statistical analysis to identify significant MRI findings related to LVI.
Higher T-stage, histologic grade, and HER2-positive subtypes are significantly associated with LVI (p < 0.0001).
Peritumoral ADC value (> 1.5) and peritumor/tumor ADC ratio (> 1.9) are significant predictive MRI markers for LVI (p < 0.001).
High Ki-67 proliferation index and specific MRI features like intratumoral high T2 signal also correlate strongly with LVI presence.

Abstract

Abstract Aim of study To assess MRI features of invasive breast cancer in relation to lymphovascular invasion (LVI) and its clinicopathological associations. Methods This retrospective study included 103 cases of pathologically proven breast cancer who had undergone preoperative MRI including conventional study, dynamic contrast-enhanced study (DCE) and diffusion-weighted imaging (DWI). Lesions were reviewed and described according to Breast Imaging Reporting and Data System (BIRADS) lexicon 2013 edition in addition to other MRI findings including: peritumoral edema, intratumoral high T2 signal intensity, tumor apparent diffusion coefficient (ADC) value, peritumoral ADC value, and peritumor–tumor ADC ratio. Histopathological and immunohistochemical analysis was done. Presence or absence of lymphovascular invasion (LVI) on postoperative histopathology was assessed. Statistical analyses were performed to identify significant MRI findings found with LVI as well as its clinicopathological associations. Results Higher T-stage of the tumor ( p 1.5) and peritumor/tumor ADC ratio (> 1.9) ( p < 0.001). Conclusions We found that lymphovascular invasion was more common in HER2-positive molecular subtypes and high-grade invasive tumors. T2-weighted imaging was helpful in detecting peritumoral edema and intratumoral high T2 signal which is strongly associated with lymphovascular invasion. Peritumoral ADC value and peritumor–tumor ADC ratio can be predictive MRI findings for LVI. This can impact management plans and patient prognosis especially in node-negative invasive breast cancer cases.

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