Preoperative Breast MRI for Newly Diagnosed Ductal Carcinoma in Situ: Imaging Features and Performance in a Multicenter Setting (ECOG-ACRIN E4112 Trial).
Preoperative Breast MRI for Newly Diagnosed Ductal Carcinoma in Situ: Imaging Features and Performance in a Multicenter Setting (ECOG-ACRIN E4112 Trial).
复制标题
新诊断的原位导管癌的术前乳腺 MRI：多中心环境中的成像特征和性能（ECOG-ACRIN E4112 试验）。
DOI：
10.1148/radiol.2021219016
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发表时间：
2021
期刊：
影响因子：
19.7
通讯作者：
Snyder,Bradley
中科院分区：
文献类型：
--
作者：
Chou,Shinn-HueyS;Romanoff,Justin;Lehman,ConstanceD;Khan,SeemaA;Carlos,Ruth;Badve,SunilS;Xiao,Jennifer;Corsetti,RalphL;Javid,SaraH;Spell,DerrickW;Han,LindaK;Sabol,JenniferL;Bumberry,JohnR;Gareen,IlanaF;Snyder,Bradley
背景临床试验中描述乳腺X线检查检测到的导管原位癌（DCIS）的术前MRI特征和性能的数据有限。目的报告DCIS的定性MRI特征、MRI在识别其他疾病方面的性能以及成像特征与病理、基因组、东部肿瘤协作组-美国放射学成像网络学院（ECOG-ACRIN）E4112试验。材料和方法来自ECOG-ACRIN癌症研究组的多中心前瞻性临床试验的次要分析包括用常规成像技术诊断的DCIS妇女（乳腺X线摄影和US），通过粗针活检（CNB）确认，并在2015年3月至2016年4月期间入组，根据常规成像和临床检查结果，他们是广泛局部切除（WLE）的候选人。记录DCIS的MRI表现、CNB和手术切除的病理特征。在WLE中没有指数DCIS侵入性升级的每个妇女接受12基因DCIS评分。计算了MRI性能指标。影像学特征与侵入性升级、DCIS二分评分的相关性在单因素和多因素分析中估计了339名女性中的女性（<39 vs ≥39）和单次WLE成功率。（中位年龄60岁;四分位距，51-66岁），大多数DCIS病例在MRI扫描上显示非肿块增强（NME）（195/339 [58%]），其中值大小大于乳腺X线片（19 mm vs 12 mm;P<0.001）。MRI提示CNB的阳性预测值为32%（21/66）（95% CI：22，44），额外的癌症检出率为6.2%（21/339）（95% CI：4.1，9.3）。MRI假阳性率为14.2%（45/318）（95%CI：10.7，18.4）。无影像学特征与浸润性升级或DCIS评分相关（P= .05至P = .95）。结论术前MRI显示导管原位癌（DCIS）最常见的表现为非肿块性增强，中位宽度大于乳腺X线摄影，额外的癌检出率为6.2%。这部分DCIS的MRI特征不能预测病理或基因组结果。临床试验注册号NCT 02352883 © RSNA，2021另见Kuhl在本期的社论。这篇文章的早期错误版本出现在网上。本文已于2021年8月4日更正。
BackgroundThere are limited data from clinical trials describing preoperative MRI features and performance in the evaluation of mammographically detected ductal carcinoma in situ (DCIS).PurposeTo report qualitative MRI features of DCIS, MRI performance in the identification of additional disease, and associations of imaging features with pathologic, genomic, and surgical outcomes from the Eastern Cooperative Oncology Group–American College of Radiology Imaging Network (ECOG-ACRIN) E4112 trial.Materials and MethodsSecondary analyses of a multicenter prospective clinical trial from the ECOG-ACRIN Cancer Research Group included women with DCIS diagnosed with conventional imaging techniques (mammography and US), confirmed via core-needle biopsy (CNB), and enrolled between March 2015 and April 2016 who were candidates for wide local excision (WLE) based on conventional imaging and clinical examination results. DCIS MRI features and pathologic features from CNB and excision were recorded. Each woman without invasive upgrade of the index DCIS at WLE received a 12-gene DCIS score. MRI performance metrics were calculated. Associations of imaging features with invasive upgrade, dichotomized DCIS score (<39 vs ≥39), and single WLE success were estimated in uni- and multivariable analyses.ResultsAmong 339 women (median age, 60 years; interquartile range, 51–66 years), most DCIS cases showed nonmass enhancement (NME) (195 of 339 [58%]) on MRI scans with larger median size than on mammograms (19 mm vs 12 mm;P< .001). Positive predictive value of MRI-prompted CNBs was 32% (21 of 66) (95% CI: 22, 44), yielding an additional cancer detection rate of 6.2% (21 of 339) (95% CI: 4.1, 9.3). MRI false-positive rate was 14.2% (45 of 318) (95% CI: 10.7, 18.4). No imaging features were associated with invasive upgrade or DCIS score (P= .05 toP= .95). Smaller size and focal NME distribution at MRI were linked to single WLE success (P< .001).ConclusionPreoperative MRI depicted ductal carcinoma in situ (DCIS) diagnosed with conventional imaging most commonly as nonmass enhancement, with larger median span than mammography, and additional cancer detection rate of 6.2%. MRI features of this subset of DCIS did not enable prediction of pathologic or genomic outcomes.Clinical trial registration no. NCT02352883© RSNA, 2021See also the editorial by Kuhl in this issue.An earlier incorrect version of this article appeared online. This article was corrected on August 4, 2021.