Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, 300 E 66th St., New York, NY 10065, USA.
AJR Am J Roentgenol. 2010 Sep;195(3):799-807. doi: 10.2214/AJR.10.4305.
The objective of our study was to define the usual alterations in the ipsilateral and contralateral breast on MRI of women who have undergone surgery and radiation for the treatment of primary breast cancer.
Database searches identified 744 breast MR examinations of 248 women with newly diagnosed primary breast cancer who had undergone standard breast conservation therapy (BCT) and who had undergone MRI before radiotherapy and at least twice after BCT; these MR examinations were reviewed retrospectively. In each MR study, both breasts were evaluated for background enhancement and cystic alteration. In the treated breast, edema, skin thickening, seroma, and enhancement at the lumpectomy site were assessed.
Background enhancement and cystic alteration decreased bilaterally on MRI after completion of surgery and radiation. Edema, skin thickening, seroma, and enhancement at the lumpectomy site progressively decreased over time. These changes never resolved in some women, with edema present in 25.9% of women at 6 or more years after BCT and seroma present in 3.7%. Lumpectomy site enhancement was seen in 37% of studies obtained in the first 12 months after treatment and persisted in 15% of women at 5 or more years. Rim enhancement was seen in women with seromas, whereas focal enhancement was typically seen in those without seromas. The persistence of lumpectomy site enhancement was seen in 12 of 16 women with fat necrosis, indicated by fat signal in the seroma and was seen in only five of 19 patients without fat seen in the surgery cavity (p = 0.007).
After a patient has undergone BCT, MRI shows changes in both breasts. Although the changes in our study population were greatest in the treated breast, parenchymal enhancement and cystic alteration decrease bilaterally indicating a systemic influence. Edematous changes, seroma, focal enhancement, and skin thickening were seen only in the treated breast. All posttreatment MRI findings decrease progressively, and all may persist. Lumpectomy site enhancement is most persistent in women with fat necrosis.
本研究旨在定义接受原发性乳腺癌手术和放疗的患者对侧和同侧乳房的常见变化。
数据库检索确定了 248 名接受标准保乳治疗（BCT）的新诊断原发性乳腺癌患者的 744 例乳房磁共振检查，这些患者在放疗前和 BCT 后至少两次接受了 MRI 检查；这些 MRI 检查回顾性地进行了评估。在每一项 MRI 研究中，对双侧乳房的背景强化和囊性改变进行了评估。在治疗过的乳房中，评估了水肿、皮肤增厚、血清肿和乳房切除术部位的强化。
手术后和放疗后，双侧背景强化和囊性改变均在 MRI 上减少。水肿、皮肤增厚、血清肿和乳房切除术部位的强化随时间逐渐减少。在一些女性中，这些变化从未得到解决，在 BCT 后 6 年或以上，25.9%的女性存在水肿，3.7%存在血清肿。在治疗后 12 个月内获得的 37%的研究中可见乳房切除术部位强化，15%的女性在 5 年或以上仍存在强化。在有血清肿的女性中可见边缘强化，而在没有血清肿的女性中通常可见局灶性强化。在 16 名脂肪坏死患者中，有 12 名患者可见乳房切除术部位强化，其特征为血清肿中有脂肪信号，而在没有在手术腔中看到脂肪的 19 名患者中仅可见 5 名（p = 0.007）。
在患者接受 BCT 后，MRI 显示双侧乳房发生变化。尽管在我们的研究人群中，治疗过的乳房变化最大，但实质强化和囊性改变双侧减少表明存在全身性影响。水肿改变、血清肿、局灶性强化和皮肤增厚仅见于治疗过的乳房。所有治疗后 MRI 发现均逐渐减少，且所有发现均可能持续存在。在脂肪坏死的女性中，乳房切除术部位强化最持久。
