磁共振成像有助于对隐匿性乳腺癌进行保乳治疗。

Magnetic resonance imaging facilitates breast conservation for occult breast cancer.

作者信息

Olson J A, Morris E A, Van Zee K J, Linehan D C, Borgen P I

机构信息

Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.

出版信息

Ann Surg Oncol. 2000 Jul;7(6):411-5. doi: 10.1007/s10434-000-0411-4.

DOI:10.1007/s10434-000-0411-4

PMID:10894136

Abstract

INTRODUCTION

Occult primary breast cancer, i.e., isolated axillary adenocarcinoma without detectable tumor in the breast by either physical exam or mammography, represents up to 1% of operable breast cancer. Modified radical mastectomy (MRM) is generally the accepted treatment for this condition although tumor is identified in only two-thirds of mastectomy specimens. Breast magnetic resonance imaging (MRI) can identify occult breast carcinoma and may direct therapy. This study examined the ability of breast MRI to detect occult breast cancer and to facilitate breast conservation therapy.

METHODS

Forty women with biopsy-proven metastatic adenocarcinoma to an axillary lymph node and no evidence of primary cancer were studied. All patients had a physical examination, mammography, and MRI of the breast. Using a dedicated breast coil, MRI imaging was performed with and without gadolinium enhancement. Positive MRI scans were compared with histopathologic findings at the time of operation (n = 21).

RESULTS

MRI identified the primary breast lesion in 28 of 40 women (70%). Of these 28 patients, 11 had MRM, 11 had lumpectomy/axillary lymph node dissection (ALND)/radiotherapy (XRT), 2 had ALND/XRT alone, and 4 had no local treatment secondary to stage IV disease. Two women initially treated with lumpectomy/ALND subsequently had mastectomy for positive margins. Of the women with positive MRI who had breast surgery, 21 of 22 (95%) had tumor within the surgical specimen. Twelve women had negative MRI of the breast. Five of these 12 underwent MRM, of whom 4 had no tumor in the mastectomy specimen. The remaining 7 patients had ALND and whole breast radiation (ALND/XRT) (n = 5), or were observed (n = 2). Overall, 18 of 34 women surgically treated had MRM, while 16 (47%) preserved their breast. Tumor yield for patients having breast surgery was 81%.

CONCLUSIONS

MRI of the breast can identify occult breast cancer in many patients and may facilitate breast conservation in select women. Negative breast MRI predicts low tumor yield at mastectomy.

摘要

引言

隐匿性原发性乳腺癌，即通过体格检查或乳腺X线摄影在乳腺中未检测到肿瘤的孤立性腋窝腺癌，占可手术乳腺癌的比例高达1%。改良根治性乳房切除术（MRM）通常是这种情况的公认治疗方法，尽管在仅三分之二的乳房切除标本中发现了肿瘤。乳腺磁共振成像（MRI）可以识别隐匿性乳腺癌并可能指导治疗。本研究检查了乳腺MRI检测隐匿性乳腺癌和促进保乳治疗的能力。

方法

对40名经活检证实腋窝淋巴结有转移性腺癌且无原发性癌症证据的女性进行了研究。所有患者均接受了体格检查、乳腺X线摄影和乳腺MRI检查。使用专用乳腺线圈，在有和没有钆增强的情况下进行MRI成像。将阳性MRI扫描结果与手术时的组织病理学结果进行比较（n = 21）。

结果

MRI在40名女性中的28名（70%）中发现了原发性乳腺病变。在这28名患者中，11名接受了MRM，11名接受了乳房肿瘤切除术/腋窝淋巴结清扫术（ALND）/放射治疗（XRT），2名仅接受了ALND/XRT，4名因IV期疾病未接受局部治疗。最初接受乳房肿瘤切除术/ALND治疗的两名女性随后因切缘阳性而接受了乳房切除术。在接受乳房手术的MRI阳性女性中，22名中的21名（95%）手术标本中有肿瘤。12名女性乳腺MRI为阴性。这12名中的5名接受了MRM，其中4名乳房切除标本中没有肿瘤。其余7名患者接受了ALND和全乳放疗（ALND/XRT）（n = 5），或进行了观察（n = 2）。总体而言，34名接受手术治疗的女性中有18名接受了MRM，而16名（47%）保留了乳房。接受乳房手术的患者肿瘤检出率为81%。