The impact of preoperative MRI on breast-conserving surgery of invasive cancer: a comparative cohort study
The impact of preoperative MRI on breast-conserving surgery of invasive cancer: a comparative cohort study
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DOI：
10.1007/s10549-008-0182-3
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发表时间：
2009-07-01
影响因子：
3.8
通讯作者：
Gilhuijs, K. G. A.
中科院分区：
文献类型：
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作者：
Pengel, K. E.;Loo, C. E.;Gilhuijs, K. G. A.
目的评价乳腺术前增强磁共振成像(MRI)对肿瘤不完全切除率的影响。方法在349例浸润性乳腺癌患者中，176例仅根据常规影像和触诊进行保乳治疗(BCT)的患者(N=176例)与173例有额外MRI检查的患者(N=173例)进行比较。应用多变量分析探讨肿瘤切除不全的相关性。结果MRI检出较大范围乳腺癌19例(11.0%)，导致治疗方式改变：乳房切除(8.7%)或扩大切除(2.3%)。MRI组肿瘤切除不完全22/159(13.8%)，非MRI组35/180(19.4%)(P=0.17)。按肿瘤类型分层，未完全切除的浸润性导管癌(IDC)与MRI阴性显著相关：11/136(8.1%)对2/126(1.6%)(MRI存在)(P=0.02)。没有显著的因素可以解释其他肿瘤类型的不完全切除。结论术前MRI对肿瘤不完全切除率无显著影响，但可显著降低IDC的不完全切除率。MRI后不完全切除的减少比MRI引起的先前治疗改变的比率要小。
Aim To assess whether preoperative contrast-enhanced magnetic resonance imaging (MRI) of the breast influences the rate of incomplete tumor excision. Methods In a cohort of 349 women with invasive breast cancer, patients eligible for breast-conserving therapy (BCT) on the basis of conventional imaging and palpation only (N = 176) were compared to those who had an additional preoperative MRI (N = 173). Multivariate analysis was applied to explore associations with incomplete tumor excision. Results MRI detected larger extent of breast cancer in 19 women (11.0%), leading to treatment change: mastectomy (8.7%) or wider excision (2.3%). Tumor excision was incomplete in 22/159 (13.8%) wide local excisions in the MRI group and in 35/180 (19.4%) in the non-MRI group (P = 0.17). Stratified to tumor type, incompletely excised infiltrating ductal carcinoma (IDC) was significantly associated with absence of MRI: 11/136 (8.1%) versus 2/126 (1.6%) (MRI present) (P = 0.02). No significant factors explained incomplete excision of other tumor types. Conclusion Preoperative MRI did not significantly affect the overall rate of incomplete tumor excision, but it yielded significantly lower rate of incompletely excised IDC. The reduction of incomplete excisions after MRI was smaller than the rate of a prior treatment change incurred by MRI.