Menes Tehillah S, Zissman Sivan, Golan Orit, Sperber Fani, Klausner Joseph, Schneebaum Schlomo
Department of Surgery, Sourasky Medical Center, Tel Aviv, Israel.
Am Surg. 2012 Apr;78(4):451-5.
The role of routine preoperative magnetic resonance imaging (MRI) in newly diagnosed breast cancer patients planned for breast conserving surgery is presently being debated. In our medical center we practice selective use of preoperative MRI; we sought to examine the yield of MRI in this highly selected group of patients. A retrospective study of all newly diagnosed breast cancer patients presenting between January 2007 and July 2010 to the Tel Aviv Sourasky Medical Center (Tel Aviv, Israel) was completed. Patients planned for breast conserving surgery who underwent preoperative MRI were included in this study. Patients and tumor characteristics, indication for MRI, findings on MRI, consequent workup, and impact on surgical treatment were recorded. Association between preoperative characteristics and yield of MRI was examined. During the study period, 105 patients that were candidates for breast conserving surgery underwent preoperative evaluation with MRI. Use of breast MRI increased over time. Rates of mastectomy were stable throughout the study years. Dense mammogram was the most frequent (51, 68%) indication for MRI. Additional suspicious findings were found in 41 (39%) patients, prompting further workup including 36 biopsies in 25 patients, of which 22 (61%) were with cancer. These additional findings prompted a change in the surgical plan in a third of the patients. In most patients (92; 88%) clear margins were achieved. Limiting the use of MRI in the preoperative workup of breast cancer patients to a selected group of patients can increase the yield of MRI.
对于计划接受保乳手术的新诊断乳腺癌患者，术前常规磁共振成像（MRI）的作用目前仍存在争议。在我们的医疗中心，我们实行选择性使用术前MRI；我们试图研究MRI在这一经过高度筛选的患者群体中的诊断价值。对2007年1月至2010年7月期间就诊于特拉维夫索罗卡医疗中心（以色列特拉维夫）的所有新诊断乳腺癌患者进行了一项回顾性研究。本研究纳入了计划接受保乳手术且接受了术前MRI检查的患者。记录患者和肿瘤特征、MRI检查指征、MRI检查结果、后续检查以及对手术治疗的影响。研究术前特征与MRI诊断价值之间的关联。在研究期间，105例计划接受保乳手术的患者接受了术前MRI评估。随着时间的推移，乳腺MRI的使用有所增加。在整个研究年份中，乳房切除术的比例保持稳定。乳腺钼靶密度高是MRI检查最常见的指征（51例，68%）。41例（39%）患者发现了其他可疑病变，促使进行进一步检查，包括对25例患者进行36次活检，其中22例（61%）确诊为癌症。这些额外的检查结果促使三分之一的患者改变了手术方案。在大多数患者（92例；88%）中实现了切缘阴性。将乳腺癌患者术前检查中MRI的使用限制在特定患者群体中可以提高MRI的诊断价值。
