Uematsu Takayoshi, Yuen Sachiko, Kasami Masako, Uchida Yoshihiro
Breast Imaging Section, Shizuoka Cancer Center Hospital, Naga-Izumi, Shizuoka, Japan.
Breast Cancer Res Treat. 2008 Dec;112(3):461-74. doi: 10.1007/s10549-008-9890-y. Epub 2008 Jan 12.
Breast imaging modalities can assess the tumor extent and adequacy of excision, but there have been no reports comparing magnetic resonance (MR) imaging, multidetector row computed tomography (MDCT), ultrasonography (US) and mammography (MMG) for the tumor extent of breast cancer. We prospectively assessed the accuracy of MR imaging, MDCT, US and MMG for preoperative assessment of the tumor extent of breast cancer.
Preoperative MR imaging, MDCT, US and MMG were performed for 210 breasts with breast cancer. The MR and MDCT images were independently interpreted by one of two radiologists with knowledge of the clinical and MMG findings. The US was performed with knowledge of the clinical and MMG findings by one of five US technologists. The correlation of the results of these examinations with histological findings was examined.
Of the 210 index breast tumors, 210 (100%) could be detected on MR, 208 (99%) were detected on MDCT, 209 (99.5%) were detected on US, and 195 (93%) were detected on MMG. For evaluating local tumor extent, the accuracy of MR imaging (76%) was significantly higher than those of MDCT, US, and MMG (71%, 56%, and 52%, respectively) (P = 0.001, P < 0.0001, and P < 0.0001). MDCT was significantly more accurate than US (P < .0001) or MMG (P < .0001), and US was significantly more accurate than MMG (P = 0.004). MR imaging and US had substantial risk (11% and 17%) of overestimation of the tumor extent. Regarding ductal carcinoma in situ (DCIS), for non-comedo DCIS, the accuracies of MR imaging (89%), MDCT (72%), and US (61%) were significantly higher than the 22% accuracy of MMG (P < 0.0001, P = 0.012, and P = 0.016), but for comedo DCIS, there were no significant differences among the four breast imaging modalities.
MR imaging was the most accurate breast imaging modality for the tumor exten of breast cancer, although MR imaging had a substantial of risk of overestimation. MR imaging, MDCT and US can complement MMG for the preoperative evaluation of patients who are candidates for breast-conserving surgery.
乳腺成像方式可评估肿瘤范围及切除的充分性，但尚无关于比较磁共振（MR）成像、多排螺旋计算机断层扫描（MDCT）、超声检查（US）和乳腺X线摄影（MMG）对乳腺癌肿瘤范围评估的报道。我们前瞻性地评估了MR成像、MDCT、US和MMG对乳腺癌肿瘤范围术前评估的准确性。
对210例患有乳腺癌的乳房进行术前MR成像、MDCT、US和MMG检查。MR和MDCT图像由两名了解临床及MMG检查结果的放射科医生之一独立解读。US由五名超声技师之一在了解临床及MMG检查结果的情况下进行。检查这些检查结果与组织学结果的相关性。
在210例索引乳腺肿瘤中，MR检查能检测出210例（100%），MDCT检测出208例（99%），US检测出209例（99.5%），MMG检测出195例（93%）。对于评估局部肿瘤范围，MR成像的准确性（76%）显著高于MDCT、US和MMG（分别为71%、56%和52%）（P = 0.001、P < 0.0001和P < 0.0001）。MDCT的准确性显著高于US（P <.0001）或MMG（P <.0001），且US的准确性显著高于MMG（P = 0.004）。MR成像和US存在高估肿瘤范围的较大风险（分别为11%和17%）。对于导管原位癌（DCIS），对于非粉刺型DCIS，MR成像（89%）、MDCT（72%）和US（61%）的准确性显著高于MMG的22%准确性（P < 0.0001、P = 0.012和P = 0.016），但对于粉刺型DCIS，四种乳腺成像方式之间无显著差异。
MR成像是评估乳腺癌肿瘤范围最准确的乳腺成像方式，尽管MR成像存在高估的较大风险。MR成像、MDCT和US可补充MMG用于保乳手术候选患者的术前评估。
