Department of Surgery, Drexel University College of Medicine, Philadelphia, PA, USA.
Ann Surg Oncol. 2010 Sep;17(9):2395-400. doi: 10.1245/s10434-010-1000-9. Epub 2010 Mar 9.
Breast magnetic resonance imaging (MRI) is used to identify residual and additional disease in patients with invasive carcinoma. The use of MRI in assessing extent of disease for ductal carcinoma in situ (DCIS) is less well defined. This study assessed the value of MRI in the preoperative evaluation of DCIS.
We identified 98 patients with DCIS in 2007. Of these, 63 underwent stereotactic biopsy, followed by MRI. There were 35 who underwent stereotactic biopsy alone. Concordance between MRI and histopathology was defined as the presence or absence of residual disease.
There was no significant difference in mastectomy rates between the MRI and non-MRI group (20.3% vs 25.7%, P = .62). In patients undergoing breast-conserving surgery (BCS), there were fewer positive margins in the MRI versus the non-MRI group (21.2% vs 30.8%, P = .41). Of the 64 cases that underwent preoperative MRI, 43 (67.2%) were concordant. Also, 15 of 43 cases (34.8%) had MRI results that accurately predicted pathologic size. In 28 of 43 patients (65.2%), MRI overestimated disease in 20, by a mean of 1.97 cm. In patients with MRI tumor size >2 cm, MRI overestimated disease by a mean of 3.17 cm. Of the 64 cases, 21 (32.8%) were discordant. Also, 10 of 21 (47.6%) had a positive MRI and no residual disease on histopathology, and 11 of 21 (52.3%) had negative MRI and residual disease on pathology.
MRI does not accurately predict extent of disease in patients with extensive DCIS. In patients with MRI tumor size < or = 2 cm, MRI may assist in surgical planning. MRI results in patients with DCIS should be interpreted with caution; decision for mastectomy should not be made on MRI findings alone.
乳腺磁共振成像（MRI）用于识别浸润性癌患者的残留和新增疾病。MRI 在评估导管原位癌（DCIS）疾病范围方面的应用尚未得到明确界定。本研究评估了 MRI 在 DCIS 术前评估中的价值。
我们在 2007 年确定了 98 例 DCIS 患者。其中，63 例行立体定向活检，随后进行 MRI 检查；35 例仅行立体定向活检。MRI 与组织病理学的一致性定义为是否存在残留疾病。
MRI 组和非-MRI 组的乳房切除术率无显著差异（20.3% vs. 25.7%，P =.62）。在接受保乳手术（BCS）的患者中，MRI 组的阳性切缘比例低于非-MRI 组（21.2% vs. 30.8%，P =.41）。在接受术前 MRI 的 64 例病例中，43 例（67.2%）结果一致。此外，15 例（34.8%）MRI 结果准确预测了病理大小。在 43 例患者中，28 例（65.2%）MRI 高估了 20 例患者的疾病程度，平均高估 1.97 cm。在 MRI 肿瘤大小>2 cm 的患者中，MRI 平均高估了 3.17 cm。在 64 例病例中，21 例（32.8%）结果不一致。此外，10 例（47.6%）MRI 阳性但组织病理学无残留疾病，11 例（52.3%）MRI 阴性但病理学有残留疾病。
MRI 不能准确预测广泛 DCIS 患者的疾病范围。在 MRI 肿瘤大小<或=2 cm 的患者中，MRI 可能有助于手术计划。应谨慎解读 DCIS 患者的 MRI 结果；不应仅凭 MRI 结果决定是否行乳房切除术。
