Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Germany.
Eur J Radiol. 2012 Mar;81(3):e255-9. doi: 10.1016/j.ejrad.2011.02.016. Epub 2011 Mar 4.
The purpose of the study was to assess whether postoperative changes in the tumour bed after intraoperative radiotherapy (IORT) with low-energy X-rays complicate the mammographic evaluation. 54 patients receiving breast-conserving surgery and IORT were compared to a control group of 48 patients with conventional breast-conserving treatment. All patients were included in routine follow-ups (≥3 years) with mammography accompanied by ultrasound. By retrospective consensus reading the mammographic changes in the tumour bed were classified as absent, low or distinct. Using the same grading it was classified whether mammographic evaluation was complicated due to postoperative changes. Focusing the yearly follow-ups within a period of four years, distinct changes were found significantly more often after IORT (52-62% vs. 7-30%). After IORT the evaluation was significantly more often distinctly complicated in each follow-up, except for year 1 (16-21% vs. 0-8%). In the IORT group the distribution of findings was nearly stable over time. In the control group it changed over time and a distinctly complicated evaluation was no longer seen in the follow-ups of years 3 and 4. Overall, further non-routine diagnostic procedures due to unclear findings in the tumour bed became necessary in 7% (IORT) vs. 8% (control group) of the patients (p=0.86). Evaluation of mammograms is complicated after IORT. In contrast to conventionally treated patients postoperative changes and difficulties of evaluation do not decrease over time. Overall, after IORT the diagnostic uncertainty does not seem to be increased in ultrasound supported mammographic follow-ups. The topic needs further evaluation with larger study samples.
本研究旨在评估术中放疗（IORT）低能 X 射线后肿瘤床的术后变化是否会使乳腺 X 线摄影评估复杂化。将 54 例接受保乳手术和 IORT 的患者与 48 例接受常规保乳治疗的对照组患者进行比较。所有患者均接受常规随访（≥3 年），包括乳腺 X 线摄影和超声检查。通过回顾性共识阅读，将肿瘤床的乳腺 X 线变化分为无、低或明显。同样的分级也用于判断是否因术后变化而使乳腺 X 线评估变得复杂。在四年的随访期间，聚焦每年的随访，IORT 后明显变化的发生率明显更高（52%-62% vs. 7%-30%）。除第一年（16%-21% vs. 0%-8%）外，IORT 后每年的随访中评估明显更复杂。在 IORT 组中，发现的分布随时间几乎保持稳定。在对照组中，它随时间而变化，在第 3 年和第 4 年的随访中不再出现明显复杂的评估。总体而言，由于肿瘤床的不明发现，需要进行进一步的非常规诊断程序，IORT 组患者为 7%（IORT），对照组患者为 8%（对照组）（p=0.86）。IORT 后乳腺 X 线摄影评估变得复杂。与常规治疗的患者相比，术后变化和评估困难并未随时间减少。总体而言，在超声支持的乳腺 X 线摄影随访中，IORT 后诊断的不确定性似乎并未增加。该主题需要进一步评估，以获得更大的研究样本。
