Department of Radiological Sciences, University of Rome La Sapienza, Rome, Italy.
Invest Radiol. 2012 Feb;47(2):128-35. doi: 10.1097/RLI.0b013e318230061c.
To evaluate breast magnetic resonance imaging (MRI) for cancer staging and surgical planning in patients with known breast cancer, and to evaluate recurrence rates at long-term follow-up.
Institutional review board approval and patient consent were obtained. Preoperative MRI with 0.1 mmol/kg gadobenate dimeglumine (MultiHance) was performed in 203/274 women with confirmed breast cancer. The sensitivity, accuracy, and positive predictive value of MRI compared with mammography/ultrasound for malignant lesion detection were calculated, and the effect of MRI on surgical decision making evaluated. The cancer recurrence rate was determined for 172 patients with available 2- to 8-year follow-up data.
Mammography/ultrasound detected 229 suspicious lesions. Breast MRI detected 159 additional lesions in 48/203 (23.6%) patients; of which 110/110 were correctly classified as malignant and 28/49 as benign, giving sensitivity, accuracy, and positive predictive values for malignant lesion detection of 100% (110/110), 86.8% (138/159), and 84.0% (110/131), respectively. MRI revealed unsuspected multifocal, multicentric, and synchronous contralateral lesions in 7/48, 16/48, and 16/48 patients, respectively, and pectoralis muscle infiltration in 3/38 patients. In 6/48 women, MRI revealed lesions not seen on conventional imaging (n = 5) or discounted suspected multifocal disease (n = 1). Therapy was changed for 50/203 (24.6%) patients: 38 patients underwent more extensive surgery and 12 less extensive surgery. Six (3.5%) recurrences occurred, in all cases at >4 years.
Breast MRI positively affects patient management and is recommended for mapping tumor extent in patients with newly diagnosed cancer. The cancer recurrence rate at long-term follow-up after MRI is low.
评估已知乳腺癌患者的乳腺磁共振成像（MRI）在癌症分期和手术计划中的作用，并评估长期随访中的复发率。
获得了机构审查委员会的批准和患者的同意。对 274 例确诊乳腺癌患者中的 203 例进行了术前 MRI 检查，对比剂为 0.1mmol/kg 钆贝葡胺（MultiHance）。计算了 MRI 对恶性病变检测的敏感性、准确性和阳性预测值，并评估了 MRI 对手术决策的影响。对 172 例有 2-8 年随访数据的患者进行了癌症复发率的测定。
乳腺 X 线摄影/超声检测到 229 个可疑病变。乳腺 MRI 在 48/203（23.6%）例患者中发现了 159 个额外病变；其中 110/110 正确分类为恶性，28/49 为良性，恶性病变检测的敏感性、准确性和阳性预测值分别为 100%（110/110）、86.8%（138/159）和 84.0%（110/131）。MRI 分别在 7/48、16/48 和 16/48 例患者中发现了未预料到的多灶性、多中心性和同侧同步性病变，在 3/38 例患者中发现了胸肌浸润。在 6/48 例女性中，MRI 显示了常规影像学未见病变（n=5）或不考虑可疑多灶性病变（n=1）。有 50/203（24.6%）例患者的治疗发生了改变：38 例患者进行了更广泛的手术，12 例患者进行了较不广泛的手术。有 6 例（3.5%）发生了复发，均在 4 年以上。
乳腺 MRI 对患者的管理有积极影响，建议在新诊断的癌症患者中用于描绘肿瘤范围。MRI 后的长期随访中癌症复发率较低。
