Evaluating the impact of preoperative breast magnetic resonance imaging on the surgical management of newly diagnosed breast cancers
Evaluating the impact of preoperative breast magnetic resonance imaging on the surgical management of newly diagnosed breast cancers
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DOI：
10.1001/archsurg.142.5.441
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发表时间：
2007-05-01
影响因子：
--
通讯作者：
Bethke, Kevin P.
中科院分区：
文献类型：
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作者：
Bilimoria, Karl Y.;Cambic, Angela;Bethke, Kevin P.
假设：新诊断为乳腺癌的女性可能有其他同侧或对侧乳腺恶性肿瘤，未被乳房x光检查和超声检查发现。磁共振成像（MRI）在检测乳腺癌方面表现出极好的敏感性。然而，常规MRI对新发活检证实的乳腺癌手术治疗的影响尚不清楚。设计：前瞻性数据库的回顾性分析。设置：一个大城市地区的学术三级医疗中心。患者：在1年内，在单一机构、单一外科医生的环境下，共有155名新诊断为乳腺癌的女性通过乳房x光检查、超声检查和针活检进行了术前双侧乳房MRI。主要观察指标：基于乳房MRI结果的手术治疗改变。结果：73例患者MRI显示124个可疑病灶。65例患者需要mri后随访乳房x光检查或超声检查，41例患者接受了额外的图像引导活检。在36例患者中，基于影像学-病理相关性，MRI发现了其他未被发现的恶性肿瘤，手术治疗发生了变化。10例患者（8例有益）将乳房肿瘤切除术转为乳房切除术，21例患者（10例有益）进行了更广泛的切除，5例患者（2例有益）进行了对侧手术。较大的肿瘤大小是手术治疗有益改变的独立预测因子（优势比1.66；95%可信区间1.04-2.66）。结论：乳房MRI对9.7%的新诊断乳腺癌的手术治疗有有益的改变。MRI检测到其他未被发现的同侧和对侧乳腺恶性肿瘤表明，乳腺MRI可能在评估新发乳腺癌方面发挥作用。
Hypothesis: Women with newly diagnosed breast cancers may harbor additional ipsilateral or contralateral breast malignancies that are undetected by mammography and ultrasonography. Magnetic resonance imaging (MRI) has demonstrated excellent sensitivity in the detection of breast cancers. However, the impact of routine MRI on the surgical management of new, biopsy-proven breast cancers remains unclear.Design: Retrospective analysis of a prospective databaseSetting: An academic, tertiary care center in a large metropolitan area.Patients: A total of 155 women with breast cancer newly diagnosed by mammography, uhrasonography, and needle biopsy underwent preoperative bilateral breast MRI in a single-institution, single-surgeon setting during I year.Main Outcome Measures: Change in surgical management based on breast MRI findings.Results: The MRI demonstrated 124 additional suspicious lesions in 73 patients. Post-MRI follow-up mammograms or ultrasonograms were required in 65 patients, and 41 patients under-went additional image-guided biopsies. There was a change in surgical management as MRI discovered additional, otherwise undetected malignancies in 36 patients based on radiographic-pathologic correlation. Lumpectomy was converted to mastectomy in 10 patients (8 beneficial), wider excision was performed in 21 patients (10 beneficial), and 5 patients (2 beneficial) underwent contralateral surgery. Larger tumor size was an independent predictor of a beneficial change in surgical management (odds ratio, 1.66; 95% confidence interval, 1.04-2.66).Conclusions: Breast MRI results in a beneficial change in surgical management in 9.7% of newly diagnosed breast cancers. The detection of additional, otherwise undetected ipsilateral and contralateral breast malignancies with MRI suggests that breast MRI may have a role in the evaluation of new breast cancers.