Is there a role for routine use of MRI in selection of patients for breast-conserving cancer therapy?
Is there a role for routine use of MRI in selection of patients for breast-conserving cancer therapy?
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DOI：
10.1016/j.jamcollsurg.2007.12.039
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发表时间：
2008-05-01
影响因子：
5.2
通讯作者：
Cance, William G.
中科院分区：
文献类型：
--
作者：
Grobmyer, Stephen R.;Mortellaro, Vincent E.;Cance, William G.
背景：术前双侧乳腺 MRI 在考虑进行保乳治疗的乳腺癌患者中的作用一直存在争议。我们假设术前 MRI 以及 MRI 引导的活组织检查的积极计划将导致考虑接受乳腺癌保乳治疗的患者的多学科治疗计划发生变化，并且与切缘阳性部分乳房切除术的发生率降低相关。 研究设计：对 2005 年 1 月至 2007 年 7 月期间在单一中心接受乳腺癌治疗的一系列连续患者进行回顾性审查。根据体检、X线摄影和超声检查，研究中的患者是保乳癌症治疗的候选者。所有患者均接受术前乳腺 MRI 评估。分析包括 MRI 引导活检的数量和结果、MRI 对治疗计划的影响以及该系列患者中切缘阳性部分乳房切除术的发生率。 结果：分析了 79 名女性患者。中位年龄为 57 岁。 MRI 对 21 名患者进行了 25 次 MRI 引导的活检，以检查之前未识别的可疑病变。 44% 的 MRI 引导活检呈癌症阳性。 MRI 与 15 名患者 (19%) 的多中心同侧癌症 (n = 7)、更广泛的原发灶大小 (n = 6) 或对侧乳腺癌 (n = 2) 的治疗变化相关。在该系列中，需要额外切除手术的切缘阳性部分乳房切除术的发生率非常低（10%）。 结论：双侧乳腺 MRI 与 MRI 引导的活检程序结合使用时，有助于规划保乳癌症治疗候选人的多学科治疗。通过对肿瘤进行更准确的局部分期，MRI 是一种工具，可用于帮助降低切缘阳性部分乳房切除术的高再切除率。
BACKGROUND: The role of preoperative bilateral breast MRI in breast cancer patients being considered for breast-conserving therapy has been controversial. We hypothesized that preoperative MRI, along with an active program in MRI-directed biopsies, would lead to a change in multidisciplinary treatment planning for patients being considered for breast-conserving cancer therapy, and it would be associated with reduced rates of margin-positive partial mastectomies.STUDY DESIGN: A retrospective review of a consecutive series of patients who were treated for breast cancer at a single center between January 2005 and July 2007 was conducted. Patients in the study were candidates for breast-conserving cancer therapy based on physical examination, niammography, and ultrasonography All patients were evaluated by a preoperative breast MRI. Analysis included number and result of MRI-directed biopsies, impact of MRI on treatment planning, and incidence of margin-positive partial mastectomy within the series of patients.RESULTS: Seventy-nine female patients were analyzed. Median age was 57 years. MRI led to the performance of 25 MRI-directed biopsies for previously unrecognized suspicious lesions in 21 patients. Forty-four percent of MRI-directed biopsies were positive for cancer. MRI was associated with a change in management in 15 patients (19%) for multicentric ipsilateral cancer (n = 7), a more extensive primary lesion size (n = 6), or contralateral breast cancer (n = 2). Incidence of margin-positive partial mastectomy requiring additional resective operation was very low in this series (10%).CONCLUSIONS: Bilateral breast MRI, when used in conjunction with MRI-directed biopsy procedures, can be helpful in planning multidisciplinary treatment of candidates for breast-conserving cancer therapy. By allowing more accurate local staging Of tumors, MRI is a tool that can be used to help reduce high reexcision rates for margin-positive partial mastectornies.