Department of Radiology, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea.
AJR Am J Roentgenol. 2013 Sep;201(3):684-91. doi: 10.2214/AJR.12.10167.
The objective of our study was to determine the cancer yield of preoperative breast MRI in women with newly diagnosed ductal carcinoma in situ (DCIS) and to identify subgroups of DCIS patients for whom MRI is more likely to identify additional cancers.
A database search for patients with DCIS who had undergone breast surgery between 2007 and 2011 was performed. A total of 308 women (median age, 49 years; range, 25-82 years) with DCIS underwent mammography, sonography, and a preoperative evaluation with MRI. The cancer yield and positive biopsy rate were determined. Patient age at diagnosis, menopausal status, family history of breast cancer, mammographic breast density, index cancer size, nuclear grade, and estrogen receptor (ER) status were examined, and a multivariate logistic regression analysis was performed.
The cancer yield was 8% (24/308), and the positive biopsy rate was 53% (24/45). Of the 24 additional cancers, 14 (58%) represented multifocal disease, two (8%) represented multicentric disease, and eight (33%) represented contralateral cancer. In a multivariate analysis, age and index cancer size were factors significantly associated with additional MRI-detected cancers. Compared with women≥50 years, women<50 years had a 3.2-fold higher frequency of detection (95% CI, 1.2-8.9; p=0.02). Compared with women with DCIS lesions smaller than 2.5 cm, women with DCIS lesions 2.5 cm or larger showed a 2.6-fold higher frequency of detection (95% CI, 1.1-6.3; p=0.04).
Preoperative breast MRI can be considered in patients with DCIS who are <50 years old, have index cancers≥2.5 cm, or fulfill both criteria.
本研究旨在确定新诊断为导管原位癌（DCIS）的女性中术前乳腺 MRI 的癌症检出率，并确定更有可能发现额外癌症的 DCIS 患者亚组。
对 2007 年至 2011 年间接受乳腺手术的 DCIS 患者进行了数据库检索。共有 308 名（中位年龄 49 岁；年龄范围 25-82 岁）DCIS 患者接受了乳房 X 线摄影、超声检查和术前 MRI 评估。确定了癌症检出率和阳性活检率。检查了患者诊断时的年龄、绝经状态、乳腺癌家族史、乳房 X 线摄影乳房密度、指数癌大小、核分级和雌激素受体（ER）状态，并进行了多变量逻辑回归分析。
癌症检出率为 8%（24/308），阳性活检率为 53%（24/45）。在 24 例额外癌症中，14 例（58%）为多灶性疾病，2 例（8%）为多中心性疾病，8 例（33%）为对侧癌症。在多变量分析中，年龄和指数癌大小是与额外 MRI 检测到的癌症相关的因素。与≥50 岁的女性相比，<50 岁的女性检出率高 3.2 倍（95%CI，1.2-8.9；p=0.02）。与 DCIS 病变<2.5cm 的女性相比，DCIS 病变≥2.5cm 的女性检出率高 2.6 倍（95%CI，1.1-6.3；p=0.04）。
对于<50 岁、指数癌≥2.5cm 或符合这两个标准的 DCIS 患者，可以考虑行术前乳腺 MRI。
