Weber Joseph J, Bellin Lisa S, Milbourn David E, Verbanac Kathryn M, Wong Jan H
Division of Surgical Oncology, Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
Arch Surg. 2012 Sep;147(9):834-9. doi: 10.1001/archsurg.2012.1660.
The use of preoperative magnetic resonance (MR) imaging may have an effect on the reoperation rate in women with operable breast cancer.
Retrospective cohort study.
University medical center.
Women with operable breast cancer treated by a single surgeon between January 1, 2006, and December 31, 2010.
Selective preoperative MR imaging based on breast density and histologic findings.
Reoperation rate and pathologically avoidable mastectomy at initial operation.
Of 313 patients in the study, 120 underwent preoperative MR imaging. Patients undergoing MR imaging were younger (mean age, 53.6 vs 59.5 years; P < .001), were more often of non-Hispanic white race/ethnicity (61.7% vs 52.3%, P < .05), and more likely had heterogeneously dense or very dense breasts (68.4% vs 22.3%, P < .001). The incidence of lobular carcinoma (8.3% in the MR imaging group vs 5.2% in the no MR imaging group, P = .27) and the type of surgery performed (mastectomy vs partial mastectomy, P = .67) were similar in both groups. The mean pathological size of the index tumor in the MR imaging group was larger than that in the no MR imaging group (2.02 vs 1.72 cm, P = .009), but the extent of disease was comparable (75.8% in the MR imaging group vs 82.9% in the no MR imaging group had pathologically localized disease, P = .26). The reoperation rate was similar between the 2 groups (19.1% in the MR imaging group vs 17.6% in the no MR imaging group, P = .91) even when stratified by breast density (P = .76), pT2 tumor size (P = .35), or lobular carcinoma histologic findings (P = .26). Pathologically avoidable mastectomy (multifocal or multicentric MR imaging and unifocal histopathological findings) was observed in 12 of 47 patients (25.5%) with preoperative MR imaging who underwent mastectomy.
The selective use of preoperative MR imaging to decrease reoperation in women with breast cancer is not supported by these data. In a considerable number of patients, MR imaging overestimates the extent of disease.
术前磁共振成像（MR）的使用可能会对可手术乳腺癌女性的再次手术率产生影响。
回顾性队列研究。
大学医学中心。
2006年1月1日至2010年12月31日期间由单一外科医生治疗的可手术乳腺癌女性。
根据乳腺密度和组织学结果进行选择性术前MR成像。
初次手术时的再次手术率和病理上可避免的乳房切除术。
在该研究的313例患者中，120例接受了术前MR成像。接受MR成像的患者更年轻（平均年龄，53.6岁对59.5岁；P < 0.001），非西班牙裔白人种族/族裔的比例更高（61.7%对52.3%，P < 0.05），并且更有可能具有不均匀致密或非常致密的乳房（68.4%对22.3%，P < 0.001）。两组小叶癌的发生率（MR成像组为8.3%，无MR成像组为5.2%，P = 0.27）和所进行的手术类型（乳房切除术对保乳手术，P = 0.67）相似。MR成像组中索引肿瘤的平均病理大小大于无MR成像组（2.02对1.72 cm，P = 0.009），但疾病范围相当（MR成像组中75.8%的患者与无MR成像组中82.9%的患者有病理上局限的疾病，P = 0.26）。两组的再次手术率相似（MR成像组为19.1%，无MR成像组为17.6%，P = 0.91），即使按乳腺密度（P = 0.76）、pT2肿瘤大小（P = 0.35）或小叶癌组织学结果（P = 0.26）分层也是如此。在47例接受乳房切除术的术前MR成像患者中，有12例（25.5%）观察到病理上可避免的乳房切除术（多灶性或多中心MR成像和单灶性组织病理学结果）。
这些数据不支持选择性使用术前MR成像来降低乳腺癌女性的再次手术率。在相当数量的患者中，MR成像高估了疾病范围。
