Fasching Peter A, Heusinger Katharina, Loehberg Christian R, Wenkel Evelyn, Lux Michael P, Schrauder Michael, Koscheck Thomas, Bautz Werner, Schulz-Wendtland Rüdiger, Beckmann Matthias W, Bani Mayada R
Department of Gynecology and Obstetrics, Erlangen University Hospital, Universitaetsstrasse 21-23, D-91054 Erlangen, Germany.
Eur J Radiol. 2006 Dec;60(3):398-404. doi: 10.1016/j.ejrad.2006.08.002. Epub 2006 Oct 9.
The accuracy of breast cancer staging involves the estimation of the tumor size for the initial decision-making in the treatment. We investigated the accuracy of tumor size estimation and the association between tumor characteristics and breast density (BD).
A total of 434 women with a primary diagnosis of breast cancer were included in this prospective study at a specialist breast unit. Estimated tumor characteristics included tumor size, nodal status, estrogen/progesterone receptor status, Ki-67, HER2/neu, vascular invasion. Radiomorphological data included tumor size as assessed by mammography, breast ultrasonography, and clinical examination, and American College of Radiology (ACR) categories for BD.
BD did not have a significant impact on the assessment of tumor size using breast ultrasound (deviation from ACR categories 1-4: 0.55-0.68 cm; P=0.331). The deviation in mammography was significantly different dependent on BD (0.42-0.9 cm; P<0.001). The clinical examination was not affected by BD. Age and tumor size were the only parameters associated with a denser breast in the multivariate analysis. Older women were less likely to have dense breasts (odds ratio 0.157 for women aged >or=70 years), and patients with larger tumors were less likely to have dense breasts (adjusted OR 0.36 for tumors>2 cm).
Breast ultrasonography is more accurate than mammography for assessing tumor size in breasts with a higher BD. The difference in tumor size assessment needs to be taken into consideration in the design of clinical trials and treatment decisions.
乳腺癌分期的准确性涉及到对肿瘤大小的估计，这对于治疗的初始决策至关重要。我们研究了肿瘤大小估计的准确性以及肿瘤特征与乳腺密度（BD）之间的关联。
本前瞻性研究纳入了一家专业乳腺科的434例初诊为乳腺癌的女性患者。估计的肿瘤特征包括肿瘤大小、淋巴结状态、雌激素/孕激素受体状态、Ki-67、HER2/neu、血管侵犯情况。放射形态学数据包括通过乳腺X线摄影、乳腺超声检查和临床检查评估的肿瘤大小，以及美国放射学会（ACR）的乳腺密度分类。
乳腺超声检查中，BD对肿瘤大小评估没有显著影响（与ACR 1-4类别的偏差：0.55-0.68厘米；P=0.331）。乳腺X线摄影中的偏差因BD而异（0.42-0.9厘米；P<0.001）。临床检查不受BD影响。在多变量分析中，年龄和肿瘤大小是与乳腺密度较高相关的唯一参数。老年女性乳腺密度高的可能性较小（年龄≥70岁的女性比值比为0.157），肿瘤较大的患者乳腺密度高的可能性较小（肿瘤>2厘米时调整后的比值比为0.36）。
对于乳腺密度较高的乳房，乳腺超声检查在评估肿瘤大小方面比乳腺X线摄影更准确。在临床试验设计和治疗决策中，需要考虑肿瘤大小评估的差异。
