Olivas-Maguregui Silvia, Villaseñor-Navarro Yolanda, Ferrari-Carballo Tabare, Morales-Chairez Victoria, Michel-Ortega Rosa Mayela, Cerón-Lizarraga Tania, Silva-Godínez Juan Carlos, Arrieta Oscar
Departamento de Radiologia, Instituto Nacional de Cancerología, DF México.
Rev Invest Clin. 2008 Sep-Oct;60(5):382-9.
The presence and detection of multifocal and multicentric disease significantly increases the risk of recurrence and changes the best therapeutic approach in patients with breast cancer. Mammography has low sensitivity to detect multiple malignant foci in patients with dense breast parenchyma. We prospectively evaluated Magnetic Resonance Imaging (MRI) as part of preoperative assessment.
Women with clinical and radiological suspicion of breast cancer and dense breast parenchyma (> 75% dense tissue) were included. All patients underwent mammography, ultrasonogram and MRI prior to surgery. Surgical specimens were used for the detection of multifocal and multicentric disease. Patients who required neoadjuvant chemotherapy or radiotherapy were excluded.
Nineteen patients were evaluated. Histological diagnosis was confirmed in 14 patients, multifocal and multicentric disease was found in five and two patients, respectively. Sensitivity and accuracy to detect multiple malignant foci were 42 and 64%, respectively, for mammography plus ultrasound and 100 and 92% for MRI (p<0.05).
MRI is more sensible and has a better accuracy than mammography plus ultrasound to detect both multicentric and multifocal breast cancer in women with dense breast parenchyma. MRI can improve preoperative assessment of breast cancer in this group of patients.
多灶性和多中心性疾病的存在及检测显著增加了乳腺癌患者复发的风险，并改变了最佳治疗方法。乳腺钼靶对检测乳腺实质致密的患者中的多个恶性病灶敏感性较低。我们前瞻性地评估了磁共振成像（MRI）作为术前评估的一部分。
纳入临床和影像学怀疑患有乳腺癌且乳腺实质致密（致密组织>75%）的女性。所有患者在手术前均接受了乳腺钼靶、超声检查和MRI。手术标本用于检测多灶性和多中心性疾病。排除需要新辅助化疗或放疗的患者。
对19例患者进行了评估。14例患者确诊为组织学诊断，分别在5例和2例患者中发现了多灶性和多中心性疾病。乳腺钼靶联合超声检测多个恶性病灶的敏感性和准确性分别为42%和64%，MRI分别为100%和92%（p<0.05）。
对于乳腺实质致密的女性，MRI在检测多中心性和多灶性乳腺癌方面比乳腺钼靶联合超声更敏感，准确性更高。MRI可改善该组患者乳腺癌的术前评估。
