Department of Radiology, Erasmus MC Rotterdam, Groene Hilledijk 301, 3075 EA Rotterdam, The Netherlands.
AJR Am J Roentgenol. 2013 Feb;200(2):304-10. doi: 10.2214/AJR.12.9185.
In breast cancer patients eligible for breast-conserving surgery, we evaluated whether the information provided by preoperative MRI of the breast would result in fewer tumor-positive resection margins and fewer reoperations.
The study group consisted of 123 consecutive patients diagnosed with either breast cancer or ductal carcinoma in situ eligible for breast-conserving surgery between April 2007 and July 2010. For these patients, a first plan for breast-conserving surgery was made on the basis of clinical examination and conventional imaging. The final surgical plan was made with knowledge of the preoperative breast MRI. The rates of tumor-positive resection margins and reoperations were compared with those of a historical control group consisting of 119 patients who underwent 123 breast-conserving procedures between January 2005 and December 2006. The percentage of change in the surgical plan was recorded.
Preoperative breast MRI changed the surgical plan to more extensive surgery in 42 patients (34.1%), mainly to mastectomy (29 patients, 23.6%). Ninety-four patients underwent 95 breast-conserving procedures. Significantly fewer patients had tumor-positive resection margins than in the control group (15.8%, 15/95 versus 29.3%, 36/123; p < 0.01). Patients in the study group underwent significantly fewer reoperations compared with the historical control group (18.9%, 18/95 vs 37.4%, 46/123; p < 0.01).
Preoperative breast MRI can substantially decrease the rate of tumor-positive resection margins and reoperations in breast cancer patients eligible for breast-conserving surgery.
在适合保乳手术的乳腺癌患者中，我们评估术前乳房 MRI 提供的信息是否会导致更少的肿瘤阳性切缘和更少的再次手术。
研究组由 123 例 2007 年 4 月至 2010 年 7 月间诊断为乳腺癌或导管原位癌、适合保乳手术的连续患者组成。对于这些患者，根据临床检查和常规影像学制定了保乳手术的初步计划。最终的手术计划是在了解术前乳房 MRI 的情况下制定的。比较了肿瘤阳性切缘和再次手术的发生率与 2005 年 1 月至 2006 年 12 月间接受 123 例保乳手术的 119 例历史对照组的发生率。记录了手术计划变化的百分比。
术前乳房 MRI 将 42 例（34.1%）患者的手术计划改为更广泛的手术，主要为乳房切除术（29 例，23.6%）。94 例患者接受了 95 例保乳手术。与对照组相比，肿瘤阳性切缘的患者明显减少（15.8%，15/95 与 29.3%，36/123；p<0.01）。与历史对照组相比，研究组患者再次手术的次数明显减少（18.9%，18/95 与 37.4%，46/123；p<0.01）。
术前乳房 MRI 可显著降低适合保乳手术的乳腺癌患者肿瘤阳性切缘和再次手术的发生率。
