Hôpital Tenon, Département de Gynécologie-Obstétrique et Médecine de la Reproduction, Paris, France.
Surg Oncol. 2010 Dec;19(4):e115-23. doi: 10.1016/j.suronc.2010.06.001. Epub 2010 Jul 8.
Multifocality in breast cancer is a frequent phenomenon, whose prevalence may vary between 13 and 75%. The differences in estimation of the prevalence of multifocality across studies may be explained by the differing definitions used for multifocality and multicentricity; this inconsistency makes it difficult to analyze the literature on the subject. The incidence of multifocality is probably often underestimated. Currently, the diagnosis relies on imaging. The performance of mammography is relatively low, but the addition of breast ultrasonography can improve diagnostic sensitivity. Recently, breast magnetic resonance imaging (MRI) has been shown to be more accurate for detecting multifocality compared to conventional imaging. However, this modality is associated with high rates of false-positives that could result in inappropriate disease management. Thus, the use of MRI is not recommended as a first-line technique for diagnosing multifocality. The diagnosis of multifocality is important for breast cancer management, particularly with regards to the choice of surgery. A finding of multifocality may spur a decision to perform a wider excision that will avoid positive margins. Regarding the results of conservative surgery in the presence of multifocality, studies are contradictory, and no international consensus exists. Multifocality may also modify the management of the axillary basin; studies have shown that multifocality is associated to an over-risk of 20% of lymph node invasion. The sentinel node biopsy has been considered as an alternative to complete axillary lymph node dissection by the American Society of Clinical Oncology. The prognostic value of multifocality is still not well known, although some studies have suggested that it is associated with a worst prognosis. Further studies are needed to better assess the impact of multifocality on breast cancer prognosis.
乳腺癌的多灶性是一种常见现象，其患病率在 13%至 75%之间变化。不同研究中多灶性患病率的估计差异可能是由于多灶性和多中心性的定义不同所致；这种不一致性使得分析该主题的文献变得困难。多灶性的发生率可能经常被低估。目前，诊断依赖于影像学。乳房 X 线摄影的性能相对较低，但添加乳房超声检查可以提高诊断敏感性。最近，与常规成像相比，乳腺磁共振成像（MRI）已被证明在检测多灶性方面更准确。然而，这种方式与高假阳性率相关，这可能导致不适当的疾病管理。因此，不建议将 MRI 用作诊断多灶性的一线技术。多灶性的诊断对乳腺癌的管理很重要，特别是在手术选择方面。多灶性的发现可能会促使进行更广泛的切除以避免阳性边缘。关于多灶性存在时的保守手术结果，研究结果相互矛盾，目前尚无国际共识。多灶性也可能改变腋窝盆地的管理；研究表明，多灶性与淋巴结侵犯的风险增加 20%相关。美国临床肿瘤学会已将前哨淋巴结活检视为完全腋窝淋巴结清扫的替代方法。多灶性的预后价值尚不清楚，尽管一些研究表明它与预后较差相关。需要进一步研究以更好地评估多灶性对乳腺癌预后的影响。
