Skandarajah Anita R, Mann G Bruce
Department of Surgery, University of Melbourne, Royal Melbourne and Royal Women's Hospital, Melbourne, Victoria, Australia.
Asia Pac J Clin Oncol. 2012 Mar;8(1):24-30. doi: 10.1111/j.1743-7563.2012.01517.x.
Despite recent evidence that fails to detect a benefit in surgical and local recurrence outcomes in those who receive optimal surgery and adjuvant systemic and radiotherapy, magnetic resonance imaging (MRI) is still being employed. We review the recent literature to clarify the role in the use of MRI in early breast cancer. A literature search using the Medline and Ovid databases was conducted between 2004 and 2011 using the terms "magnetic resonance imaging' and 'early breast cancer'. Only articles with clinical trials published in English in adult humans with available abstracts were included. Articles on high-risk women, response to neoadjuvant therapy, advanced breast cancer, the occult primary, the contralateral breast and technical articles were excluded. Articles examining the role of MRI in the staging of early breast cancer were retained. Over 260 articles regarding breast MRI have been published in the last 5 years. Additional foci may be found in 16% of patients but the impact on the extent of surgery and local recurrence rate is yet to be defined. Certain sub-groups who may benefit include those with invasive lobular carcinoma and mammographically dense breasts and those for consideration of partial breast irradiation. With standard adjuvant radiotherapy, there is no benefit in routine MRI with respect surgical extent and local recurrence. Should MRI be used, pre-operative biopsy to confirm additional disease must be undertaken prior to a change in surgical extent of resection. However, MRI may be useful in the evaluation of those who can be considered for partial breast irradiation. Centres undertaking breast MRI must have MRI-biopsy capabilities and constantly audit the reporting of MRI with correlation to the final pathology.
尽管近期证据表明，对于接受了最佳手术、辅助性全身治疗及放疗的患者，在手术及局部复发结果方面未发现磁共振成像（MRI）有任何益处，但MRI仍在被使用。我们回顾了近期文献，以阐明MRI在早期乳腺癌应用中的作用。在2004年至2011年间，使用“磁共振成像”和“早期乳腺癌”等术语，通过Medline和Ovid数据库进行了文献检索。仅纳入了在成年人类中发表的、有英文摘要且为临床试验的文章。关于高危女性、新辅助治疗反应、晚期乳腺癌、隐匿性原发灶、对侧乳房以及技术类文章被排除。保留了研究MRI在早期乳腺癌分期中作用的文章。在过去5年里，已发表了260多篇关于乳腺MRI的文章。在16%的患者中可能发现额外病灶，但对手术范围及局部复发率的影响尚未明确。可能受益的特定亚组包括浸润性小叶癌患者、乳腺钼靶显示致密的患者以及考虑接受部分乳腺照射的患者。对于标准辅助放疗，常规MRI在手术范围和局部复发方面并无益处。若使用MRI，在改变手术切除范围之前，必须先进行术前活检以确认是否存在额外病变。然而，MRI在评估可考虑接受部分乳腺照射的患者时可能有用。开展乳腺MRI检查的中心必须具备MRI活检能力，并持续审核MRI报告与最终病理结果的相关性。
