Potential of specimen diffusion-weighted imaging to assess the intraoperative margin for ductal carcinoma in situ and invasive breast cancer
Potential of specimen diffusion-weighted imaging to assess the intraoperative margin for ductal carcinoma in situ and invasive breast cancer
复制标题
样本扩散加权成像评估导管原位癌和浸润性乳腺癌术中切缘的潜力
DOI：
10.1002/jso.27129
复制
发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Takase K.
中科院分区：
文献类型：
--
作者：
Mori N;Mugikura S;Takase K.
致编辑，我们怀着极大的兴趣阅读了Thill等人1撰写的题为“在保乳手术中使用Clear-Sight™系统进行DCIS和浸润性乳腺癌术中切缘评估的磁共振成像系统-上市后研究结果”的文章。他们使用了ClearSight™系统，这是一种基于MRI的术中器械，旨在评估切除标本的边缘，并显示边缘处T2星星值的测量可用于预测阳性边缘。他们指出，ClearSight™系统测量T2星星值，该值与组织的细胞构成呈反比关系。然而，在这方面，弥散加权成像（DWI）和表观弥散系数（ADC）对于确定手术标本中的阳性和阴性边缘，使用MR系统进行常规体内扫描的标本测量可能与使用诸如ClearSight ™的特定系统的T2星星测量一样方便或更有价值。是脑瘤2，3此外，已经报道了导管原位癌（DCIS）和浸润性导管癌（IDC）之间ADC的差异。4，5检查体内和切除标本之间ADC的变化也是有趣的。当标本从体内取出并且血流中断时，ADC可能会改变。由于血流中断引起的DWI和ADC的变化可能有助于确定切除标本DWI中的边缘是否为阳性。我们报告了一例乳腺癌患者，使用MR系统进行常规扫描（图1）。一名86岁的女性因肺炎入院，计算机断层扫描偶然发现左乳房肿块。术前体内动态增强MRI显示左乳房上内象限有一个肿块，无肿块增强（图1A）。肿块成分的ADC值低于非肿块增强成分的ADC值，这与文献报道的IDC一般表现为肿块的ADC值低于DCIS表现为非肿块增强的ADC值相一致（图1B、C）。6左侧乳房行肿块切除术，切除标本用37 ℃生理盐水保护，取出标本后20 min行MRI包括DWI。标本的定位图像显示存在肿块和非肿块增强成分（图1D，G）。DWI上的肿块和非肿块增强成分均观察到高信号强度（图1 E，H）。质量分量的ADC为0.565× 10− 3 mm 2/sec，低于非质量增强分量的ADC（0.783× 10− 3 mm 2/sec，图1F，I）。切除标本中肿块和非肿块增强成分的ADC分别低于体内DWI。我们的病例显示，在切除标本DWI中，提示IDC的肿块成分中的ADC低于提示DCIS的非肿块成分中的ADC。切除标本DWI的ADC值反映了IDC和DCIS之间的差异，这一事实可能有助于评估标本中乳腺癌的程度。此外，切除标本DWI的ADC值低于体内DWI。在脑梗塞的脑组织中，已知ADC在由血流中断引起的细胞毒性水肿中降低。7同样，在乳房中...
To the Editor, We read with great interest the article by Thill et al. 1 titled,“Magnetic resonance imaging system for intraoperative margin assessment for DCIS and invasive breast cancer using the Clear-Sight™ system in breast‐conserving surgery—Results from a postmarketing study.” They used the ClearSight™ system, an intraoperative MRI‐based device designed to assess the margins of the excised specimens, and showed that the measurement of the T2 star value at the margin was useful for predicting the positive margin. They stated that the ClearSight™ system measures the T2 star value, which has an inverse relationship with the cellularity of the tissue. However, diffusion‐weighted imaging (DWI) and apparent diffusion coefficient (ADC) measurements of specimens using an MR system for routine in vivo scans may be as or more convenient and valuable for determining positive and negative margins in surgical specimens than T2 star measurements using a specific system such as the ClearSight.™ Several studies reported the negative correlation between ADC and cellularity of the tissue in breast cancer as well as brain tumor. 2, 3 Further, differences in ADC between ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC) have been reported. 4, 5 It would also be interesting to examine the changes in ADC between in vivo and excised specimens. When the specimen is removed from the body and blood flow is interrupted, the ADC may change. The changes in DWI and ADC due to blood flow interruption may provide a benefit in determining whether the margin is positive or not in the excised specimen DWI. We report a case of breast cancer who underwent in vivo and excised specimens DWI using an MR system for routine scans (Figure 1). An 86‐year‐old woman was admitted to the hospital for pneumonia, and a computed tomography scan incidentally revealed a mass in the left breast. The preoperative in vivo dynamic contrast‐enhanced MRI showed a mass with non‐mass enhancement in the upper‐inner quadrant of the left breast (Figure 1A). The ADC of the mass component was lower than that of the non‐mass enhancement component, which was consistent with the reported literature showing that ADC of IDC generally appearing as a mass was lower than that of DCIS appearing as non‐mass enhancement (Figures 1B, C). 6 The lumpectomy was performed on the left breast and the excised specimen was protected with 37 C saline solution to undergo MRI including DWI 20min after specimen removal. The scout images of the specimen showed the presence of the mass and non‐mass enhancement components (Figures 1D, G). High signal intensity was observed both in mass and non‐mass enhancement components on DWI (Figures 1E, H). The ADC of the mass component was 0.565× 10− 3 mm2/sec, which was lower than that of the non‐mass enhancement component(0.783× 10− 3 mm2/sec, Figure 1F, I). The ADCs of the mass and non‐mass enhancement components in the excised specimen was lower than those in in vivo DWI, respectively. Our case showed that the ADC in the mass component suggesting IDC is lower than the ADC in the non‐mass component suggesting DCIS in the excised specimen DWI. The fact that the ADC in the excised specimen DWI reflects the difference between IDC and DCIS may be useful in assessing the extent of breast cancer in the specimen. Further, the ADCs of excised specimen DWI were lower than those in vivo DWI. In brain tissue of cerebral infarction, it has been known that the ADC is decreased in cytotoxic edema caused by the interruption of blood flow. 7 Similarly, in breast …