Department of Surgery, Orbis Medical Centre, Sittard, The Netherlands.
Eur J Surg Oncol. 2010 Feb;36(2):114-9. doi: 10.1016/j.ejso.2009.09.007. Epub 2009 Oct 12.
Axillary metastatic lymphadenopathy with no primary tumour identified in the breast on physical examination, mammography or ultrasound is referred to as occult breast cancer. The goal of this systematic review is to give an overview of the value and additional considerations of using breast MRI in occult breast cancer.
The databases of Pubmed, Embase, CINAHL and the Cochrane library were searched for studies addressing the use of breast MRI in occult breast cancer. Cross-referencing was used to find additional articles.
8 retrospective studies were included. Breast MRI can detect an otherwise occult breast cancer in more than two thirds of patients with a high sensitivity but lower specificity. In 80% of patients MRI detected lesions could be localized again by using ultrasound. Furthermore the size and localization of the lesions found on MRI most often correlated closely with findings at pathology. Breast MRI also provided the possibility of breast conserving surgery in one thirds of patients.
Breast MRI can result in additional detection of otherwise occult lesions in occult breast cancer. Because of low specificity of malignant lesion detection by breast MRI, lesions should be histologically confirmed. This can be achieved either by MRI or ultrasound guided biopsy, as long as all MRI detected lesions are histologically checked. Routine application of breast MRI in occult breast cancer may also alter locoregional treatment by offering the possibility of breast conserving surgery in one thirds of patients.
临床上通过体格检查、乳房 X 线摄影术或超声检查无法发现乳房内原发性肿瘤的腋窝转移性淋巴结病被称为隐匿性乳腺癌。本系统评价的目的是概述在隐匿性乳腺癌中使用乳房 MRI 的价值和额外考虑因素。
检索了 Pubmed、Embase、CINAHL 和 Cochrane 图书馆中的数据库，以寻找关于在隐匿性乳腺癌中使用乳房 MRI 的研究。通过交叉引用找到了其他文章。
纳入了 8 项回顾性研究。乳房 MRI 可以在超过三分之二的隐匿性乳腺癌患者中检测到原本隐匿的癌症，其具有较高的敏感性和较低的特异性。在 80%的患者中，MRI 检测到的病变可以通过超声再次定位。此外，MRI 上发现的病变的大小和定位通常与病理检查结果密切相关。乳房 MRI 还使三分之一的患者有可能进行保乳手术。
乳房 MRI 可使隐匿性乳腺癌中原本隐匿的病变得到额外的检测。由于乳房 MRI 对恶性病变的检测特异性较低，因此应进行组织学确认。这可以通过 MRI 或超声引导活检来实现，只要对所有 MRI 检测到的病变进行组织学检查。常规应用乳房 MRI 可能会改变局部区域治疗方法，因为它使三分之一的患者有可能进行保乳手术。
