Universiteit Hasselt, Agoralaan D, B-3590 Diepenbeek, Belgium.
Eur J Obstet Gynecol Reprod Biol. 2013 Feb;166(2):215-20. doi: 10.1016/j.ejogrb.2012.10.029. Epub 2012 Dec 7.
Although magnetic resonance imaging (MRI) has a high sensitivity in the detection of tumours, there is still much discussion about its role in breast cancer detection. MRI is not yet routinely used to further characterize lesions in patients diagnosed with breast cancer. This study investigated the impact of preoperative MRI on the surgical treatment of women with biopsy proven breast cancer. The diagnostic value of preoperative MRI was compared with that of conventional imaging (mammography and ultrasonography), and the diffusion-weighted imaging technique was also evaluated.
40 women underwent conventional imaging and biopsy as part of the clinical workup. In addition, preoperative MRI was performed in each patient. The kinetics of contrast captation were monitored and apparent diffusion coefficients were calculated. All imaging findings were compared with the histopathologic results, which were used as the gold standard. Differences in tumour extent, as determined by ultrasonography, MRI and histopathology, were evaluated.
Contrast captation kinetics curves are mostly aspecific, while apparent diffusion coefficient values seem to correlate much better with tumour malignancy. MRI correlated more accurately with histopathological findings than ultrasonography and even revealed unsuspected multifocal and multicentric breast carcinoma in 20 patients (50%). The surgical plan of seven patients (18%) was changed as a result of the additional information provided by MRI.
Diffusion-weighted imaging as a complementary tool to contrast captation kinetics and morphologic measurements may increase the specificity of MRI and help in differentiating between benign and malignant breast lesions. In addition, MRI yields more precise information than mammography and ultrasonography about the exact location, the extent, the multifocality or multicentricity of the tumour and can also detect possible additional tumours. Although MRI will never replace mammography (screening) or ultrasonography as a test for breast cancer in women with no high risk (e.g. BRCA 1 or 2 carriers), its use in a preoperative setting may allow more accurate staging of the disease, which in turn could result in a change in the treatment planning.
尽管磁共振成像（MRI）在肿瘤检测方面具有很高的敏感性，但关于其在乳腺癌检测中的作用仍存在很多争议。MRI 尚未常规用于进一步描述经活检确诊为乳腺癌患者的病变。本研究旨在探讨术前 MRI 对经活检确诊为乳腺癌女性的手术治疗的影响。比较了术前 MRI 的诊断价值与常规影像学（乳房 X 线摄影术和超声检查）的诊断价值，并评估了弥散加权成像技术。
40 名女性接受了常规影像学检查和活检，作为临床评估的一部分。此外，每位患者还进行了术前 MRI 检查。监测对比剂摄取的动力学，并计算表观弥散系数。将所有影像学发现与组织病理学结果进行比较，后者作为金标准。评估了超声、MRI 和组织病理学确定的肿瘤范围差异。
对比剂摄取动力学曲线大多无特异性，而表观弥散系数值似乎与肿瘤恶性程度相关性更好。MRI 与组织病理学发现的相关性比超声更准确，甚至在 20 名患者（50%）中发现了未被怀疑的多灶性和多中心乳腺癌。7 名患者（18%）的手术计划因 MRI 提供的额外信息而改变。
扩散加权成像作为对比剂摄取动力学和形态学测量的补充工具，可能会提高 MRI 的特异性，并有助于区分良性和恶性乳腺病变。此外，MRI 比乳房 X 线摄影术和超声检查提供更准确的关于肿瘤的位置、范围、多灶性或多中心性的信息，还可以检测可能存在的其他肿瘤。尽管 MRI 永远不会取代乳房 X 线摄影术（筛查）或超声检查作为无高危因素（例如 BRCA1 或 2 携带者）女性的乳腺癌检测方法，但在术前应用可能会使疾病分期更准确，从而可能改变治疗计划。
