Who may benefit from preoperative breast MRI? A single-center analysis of 1102 consecutive patients with primary breast cancer
Who may benefit from preoperative breast MRI? A single-center analysis of 1102 consecutive patients with primary breast cancer
复制标题
DOI：
10.1007/s10549-015-3556-3
复制
发表时间：
2015-10-01
影响因子：
3.8
通讯作者：
Schild, Hans H.
中科院分区：
文献类型：
--
作者：
Debald, Manuel;Abramian, Alina;Schild, Hans H.
几位作者质疑术前磁共振成像（MRI）的潜在益处，因为在新诊断的乳腺癌患者中可能存在过度诊断、假阳性结果和不必要的切除术。为了揭示一个更好的选择患者谁应该接受术前MRI后，组织学确诊的乳腺癌，目前的分析进行。我们的目的是评估术前乳腺MRI对新诊断乳腺癌患者的影响，以通过检测隐匿性恶性病灶来发现最有可能从术前MRI中获益的患者亚组。回顾性分析了2002年至2013年期间接受原发性乳腺癌治疗的1102例连续患者。所有患者均接受了乳房超声、乳房X线摄影和双侧乳房MRI的三重评估。344例（31.2%）出现常规影像学检查未发现的提示额外恶性病变的MRI表现。在223例患者（20.2%）的索引乳房和28例患者（2.5%）的对侧乳房中发现了组织学证实的恶性病灶。假阴性率分别为31例（2.8%）和62例（5.6%）。绝经前女性（p = 0.024）、小叶浸润性乳腺癌（p = 0.02）以及高乳腺密度患者[美国放射学会（ACR）3 + 4; p = 0.01]与索引乳房中的额外恶性病灶显著相关。多变量分析证实小叶组织学（p = 0.041）以及辅助因素“绝经前阶段”和“高乳腺密度（ACR 3+4）”（p = 0.044）具有独立显著性。以往的研究表明，乳腺MRI是一种可靠的工具，用于预测肿瘤的扩展，以及检测额外的同侧和对侧肿瘤病灶，在组织学证实的乳腺癌。在本研究中，我们证明，尤其是绝经前乳腺密度高的患者以及小叶组织学的患者似乎受益于术前MRI。
Several authors question the potential benefit of preoperative magnetic resonance imaging (MRI) against the background of possible overdiagnosis, false-positive findings, and unnecessary resections in patients with newly diagnosed breast cancer. In order to reveal a better selection of patients who should undergo preoperative MRI after histological confirmed breast cancer, the present analysis was implemented. We aimed to evaluate the influence of preoperative breast MRI in patients with newly diagnosed breast cancer to find subgroups of patients that are most likely to benefit from preoperative MRI by the detection of occult malignant foci. A total of 1102 consecutive patients who underwent treatment for primary breast cancer between 2002 and 2013 were retrospectively analyzed. All patients underwent triple assessment by breast ultrasound, mammography, and bilateral breast MRI. MRI findings not seen on conventional imaging that suggested additional malignant disease was found in 344 cases (31.2 %). Histological confirmed malignant foci were found in 223 patients (20.2 %) within the index breast and in 28 patients (2.5 %) in the contralateral breast. The rate of false-negative biopsies was 31 (2.8 %) and 62 (5.6 %), respectively. Premenopausal women (p = 0.024), lobular invasive breast cancer (p = 0.02) as well as patients with high breast density [American College of Radiology (ACR) 3 + 4; p = 0.01] were significantly associated with additional malignant foci in the index breast. Multivariate analysis confirmed lobular histology (p = 0.041) as well as the co-factors "premenopausal stage" and "high breast density (ACR 3+4)" (p = 0.044) to be independently significant. Previous studies revealed that breast MRI is a reliable tool for predicting tumor extension as well as for the detection of additional ipsilateral and contralateral tumor foci in histological confirmed breast cancer. In the present study, we demonstrate that especially premenopausal patients with high breast density as well as patients with lobular histology seem to profit from preoperative MRI.