Tendulkar Rahul D, Chellman-Jeffers Melanie, Rybicki Lisa A, Rim Alice, Kotwal Ashwin, Macklis Roger, Obi Betty B
Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, USA.
Cancer. 2009 Apr 15;115(8):1621-30. doi: 10.1002/cncr.24172.
Accelerated partial breast irradiation (APBI) of patients with early breast cancer is being investigated on a multi-institutional protocol National Surgical Adjuvant Breast and Bowel Project (NSABP) B-39/RTOG 0413. Breast magnetic resonance imaging (MRI) is more sensitive than mammography (MG) and may aid in selection of patients appropriate for PBI.
Patients with newly diagnosed breast cancer or ductal carcinoma in situ (DCIS) routinely undergo contrast-enhanced, bilateral breast MRI at the Cleveland Clinic. We retrospectively reviewed the medical records of all early-stage breast cancer patients who had a breast MRI, MG, and surgical pathology data at our institution between June of 2005 and December of 2006. Any suspicious lesions identified on MRI were further evaluated by targeted ultrasound +/- biopsy.
A total of 260 patients met eligibility criteria for NSABP B-39/RTOG 0413 by MG, physical exam, and surgical pathology. The median age was 57 years. DCIS was present in 63 patients, and invasive breast cancer was found in 197 patients. MRI identified suspicious lesions in 35 ipsilateral breasts (13%) and in 16 contralateral breasts (6%). Mammographically occult, synchronous ipsilateral foci were found by MRI in 11 patients (4.2%), and in the contralateral breast in 4 patients (1.5%). By univariate analysis, lobular histology (infiltrating lobular carcinoma [ILC]), pathologic T2, and American Joint Committee on Cancer stage II were significantly associated with additional ipsilateral disease. Of patients with ILC histology, 18% had ipsilateral secondary cancers or DCIS, compared with 3% in the remainder of histologic subtypes (P = .004). No patient older than 70 years had synchronous cancers or DCIS detected by MRI.
Breast MRI identified synchronous mammographically occult foci in 5.8% of early breast cancer patients who would otherwise be candidates for APBI.
早期乳腺癌患者的加速部分乳腺照射（APBI）正在一项多机构方案——国家外科辅助乳腺和肠道项目（NSABP）B - 39/RTOG 0413中进行研究。乳腺磁共振成像（MRI）比乳腺X线摄影（MG）更敏感，可能有助于选择适合部分乳腺照射（PBI）的患者。
新诊断为乳腺癌或原位导管癌（DCIS）的患者在克利夫兰诊所常规接受双侧乳腺对比增强MRI检查。我们回顾性分析了2005年6月至2006年12月期间在本机构有乳腺MRI、MG及手术病理数据的所有早期乳腺癌患者的病历。MRI上发现的任何可疑病变均通过靶向超声±活检进一步评估。
共有260例患者通过MG、体格检查和手术病理符合NSABP B - 39/RTOG 0413的入选标准。中位年龄为57岁。63例患者为DCIS，197例患者为浸润性乳腺癌。MRI在35个同侧乳房（13%）和16个对侧乳房（6%）中发现了可疑病变。MRI在11例患者（4.2%）的同侧乳房和4例患者（1.5%）的对侧乳房中发现了乳腺X线摄影隐匿的同步病灶。单因素分析显示，小叶组织学类型（浸润性小叶癌[ILC]）、病理T2以及美国癌症联合委员会II期与同侧额外疾病显著相关。ILC组织学类型的患者中，18%有同侧继发性癌症或DCIS，而其余组织学亚型患者中这一比例为3%（P = .004）。没有年龄超过70岁的患者通过MRI检测到同步癌症或DCIS。
乳腺MRI在5.8%的早期乳腺癌患者中发现了乳腺X线摄影隐匿的同步病灶，否则这些患者将是APBI的候选者。
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