Struttura Complessa di Radiodiagnostica 1, Dipartimento di Diagnostica per Immagini, Terapia Radiante e Metabolica, Istituto Nazionale per lo studio e la cura dei Tumori, IRCCS Fondazione Giovanni Pascale, Naples, Italy.
Breast Cancer Res Treat. 2013 Aug;140(3):527-33. doi: 10.1007/s10549-013-2651-6. Epub 2013 Jul 27.
Our aim was to evaluate the surgical impact of preoperative MRI in young patients. We reviewed a single-institution database of 283 consecutive patients below 40 years of age and who were treated for breast cancer. Thirty-seven (13 %) patients who received neoadjuvant chemotherapy were excluded. The remaining 246 patients included 124 (50 %) who preoperatively underwent conventional imaging (CI), i.e., mammography/ultrasonography (CI-group), and 122 (50 %) who underwent CI and dynamic MRI (CI + MRI-group). Pathology of surgical specimens served as a reference standard. Mann-Whitney, χ (2), and McNemar statistics were used. There were no significant differences between groups in terms of age, tumor pathologic subtype, stage, receptor, or nodal status. The mastectomy rate was 111/246 (45 %) overall but was significantly different between groups (46/124, 37 %, for the CI group and 65/122, 53 %, for the CI + MRI group; p = 0.011). Of 122 CI + MRI patients, 46 (38 %) would have undergone mastectomy due to CI alone, while MRI determined 19 additional mastectomies, increasing the mastectomy rate from 38 % to 53 % (p < 0.001). The number of patients with multifocal, multicentric, synchronous, or bilateral cancers was significantly different between groups (10/124, 8 %, for the CI group and 33/122, 27 %, for the CI + MRI group; p < 0.001). In the CI + MRI group, multifocal, multicentric, or synchronous bilateral cancers were detected with mammography in 5/33 (15 %) patients, with ultrasonography in 15/33 (45 %) patients, and with MRI in 32/33 (97 %) patients (p < 0.005). Two mastectomies were due to false positives at both conventional tests in the CI group (2/124, 1.6 %) and two mastectomies were due to MRI false positives in the CI + MRI group (2/122, 1.6 %). In conclusion, breast cancer in young patients was treated with mastectomy in 37-38 % of cases on the basis of CI only and in these patients MRI was more sensitive than CI for multifocal, multicentric, or synchronous bilateral cancers, resulting in an additional mastectomy rate of 15 %. A low probability of inappropriate imaging-based decision-making for mastectomy exists for both CI alone and for CI + MRI, making presurgical needle biopsy mandatory for findings that suggest a need for mastectomy.
我们的目的是评估年轻患者术前 MRI 的手术影响。我们回顾了一家机构的 283 名连续接受乳腺癌治疗的 40 岁以下患者的数据库。排除了 37 名（13%）接受新辅助化疗的患者。剩余的 246 名患者中，124 名（50%）术前接受常规影像学检查（CI），即乳腺 X 线摄影/超声检查（CI 组），122 名（50%）接受 CI 和动态 MRI（CI+MRI 组）。手术标本的病理学作为参考标准。使用 Mann-Whitney、χ(2)和 McNemar 统计。两组在年龄、肿瘤病理亚型、分期、受体或淋巴结状态方面无显著差异。整体乳房切除术率为 246 例中的 111 例（45%），但组间差异显著（CI 组 46/124，37%，CI+MRI 组 65/122，53%；p=0.011）。在 122 例 CI+MRI 患者中，46 例（38%）仅因 CI 而接受乳房切除术，而 MRI 确定了另外 19 例乳房切除术，使乳房切除术率从 38%增加到 53%（p<0.001）。多灶性、多中心、同步或双侧癌症的患者数量在组间差异显著（CI 组 10/124，8%，CI+MRI 组 33/122，27%；p<0.001）。在 CI+MRI 组中，5/33（15%）的患者通过乳腺 X 线摄影、15/33（45%）的患者通过超声检查、32/33（97%）的患者通过 MRI 检测到多灶性、多中心或同步的双侧癌症（p<0.005）。CI 组中 2 例（2/124，1.6%）的常规检查出现假阳性导致乳房切除术，CI+MRI 组中 2 例（2/122，1.6%）的 MRI 出现假阳性导致乳房切除术。总之，基于 CI，年轻患者的乳腺癌有 37-38%需要进行乳房切除术，在这些患者中，MRI 对多灶性、多中心或同步的双侧癌症比 CI 更敏感，导致额外的乳房切除术率为 15%。单独使用 CI 和 CI+MRI 进行基于影像学的决策均存在低概率的不适当性，因此对于提示需要乳房切除术的发现，术前有必要进行针吸活检。
