Yamashiro Norie, Tozaki Mitsuhiro, Ogawa Tomoko, Kawano Naoko, Suzuki Takako, Ozaki Shinji, Sakamoto Naomi, Abe Satoko, Fukuma Eisuke
Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba 296-8602, Japan.
Breast Cancer. 2009;16(3):223-8. doi: 10.1007/s12282-008-0088-2. Epub 2009 Feb 10.
When performing breast-conserving surgery (BCS), it is essential to achieve a complete resection of the tumor while preserving the cosmetic outcome. The aim of this study was to evaluate the accuracy of a MRI marking technique for planning of BCS.
A retrospective review was performed of 14 consecutive patients who underwent MRI in the supine position (supine MRI) using a MRI marking technique. The preoperative histopathological diagnosis was ductal carcinoma in situ in 11 and invasive ductal carcinoma in 3. All of the patients with invasive ductal carcinoma were treated with neoadjuvant chemotherapy. The pills of Breath Care used as MRI markers were placed in the Penrose drain with 2-cm intervals, and drains were put on the resection lines as determined by ultrasonography (US). The final resection lines were modified using information obtained by supine MRI. The rate of the margin-tumor distance (RMTD: longer margin-tumor distance/shorter margin-tumor distance) was calculated.
Thirteen patients (93%) needed modification of the first resection line, whereas one patient (7%) needed no modification. Twelve patients (86%) had negative margins, but two patients (14%) had positive margins: one patient had a medial margin, while the other had a distal margin. One patient showed a pathologically complete response after chemotherapy; the RMTD was not evaluated. Among the 12 patients with medial and lateral negative margins, the medial and lateral margin-tumor distances ranged from 1.0 to 3.5 cm (average 2.1 cm), and the RMTD ranged from 1 to 3.0 (average 1.5).
Our MRI marking technique may be useful for evaluating the extent of the tumor as determined by the US examination in difficult cases.
在进行保乳手术（BCS）时，在保留美观效果的同时实现肿瘤的完整切除至关重要。本研究的目的是评估一种用于保乳手术规划的MRI标记技术的准确性。
对14例连续患者进行回顾性研究，这些患者采用MRI标记技术在仰卧位接受了MRI检查（仰卧位MRI）。术前组织病理学诊断为导管原位癌11例，浸润性导管癌3例。所有浸润性导管癌患者均接受了新辅助化疗。用作MRI标记物的呼吸护理药丸以2厘米的间隔放置在彭罗斯引流管中，并将引流管放置在超声（US）确定的切除线上。使用仰卧位MRI获得的信息修改最终切除线。计算切缘-肿瘤距离率（RMTD：较长切缘-肿瘤距离/较短切缘-肿瘤距离）。
13例患者（93%）需要修改第一条切除线，而1例患者（7%）无需修改。12例患者（86%）切缘阴性，但2例患者（14%）切缘阳性：1例患者为内侧切缘，另1例为远端切缘。1例患者化疗后病理完全缓解；未评估RMTD。在12例内侧和外侧切缘阴性的患者中，内侧和外侧切缘-肿瘤距离为1.0至3.5厘米（平均2.1厘米），RMTD为1至3.0（平均1.5）。
我们的MRI标记技术可能有助于评估在疑难病例中由超声检查确定的肿瘤范围。
