Mennella Simone, Garlaschi Alessandro, Paparo Francesco, Perillo Marco, Celenza Matteo, Massa Tiberio, Rollandi Gian Andrea, Garlaschi Giacomo
School of Radiology, University of Genoa, Genoa, Italy.
Department of Radiology, IRCCS A.O.U. San Martino-IST, Genoa, Italy.
Acta Radiol. 2015 Mar;56(3):260-8. doi: 10.1177/0284185114524089. Epub 2014 Feb 13.
Accurate preoperative sizing of breast cancer with imaging modalities has a great importance in the surgical planning.
To assess the influence of tumor size and histology on the accuracy of measurement of cancer local extension by magnetic resonance imaging (MRI).
One hundred and eighty-six patients with primary breast cancer, for a total of 221 lesions, were included in this retrospective study. Tumors were divided into five histological groups: invasive ductal carcinoma (IDC), IDC with extensive intraductal component (EIC), invasive lobular carcinoma (ILC), ductal carcinoma in situ (DCIS), and "other histology" (mucinous, papillary, medullary, tubular, and apocrine breast cancer). Microscopic measurement of the largest diameter of tumors at pathology was chosen as reference standard and compared with MRI measurement. Concordance was defined as a difference ≤ 5 mm between MRI and pathology.
The mean size of tumors at pathology was 24.8 ± 19.4 mm, while at MRI it was 29.7 ± 20 mm (P < 0.05), with a significant overestimation of MRI. MRI-pathology concordance was found in 98/221 cases (44.3%), while MRI overestimated the size of 81/221 tumors (36.7%). The extent of overestimation was significantly different among the five histological groups (P < 0.05). At multivariate analysis, DCIS histology was the factor more significantly associated with MRI-pathology discordance (P = 0.0005), while the influence of tumor dimension at pathology was less significant (P = 0.0073).
DCIS histology is strongly associated with discordance between MRI and pathology sizing of breast cancer. Lesion size can also influence the accuracy of MRI measurements, but to a lesser extent.
采用影像学方法对乳腺癌进行准确的术前测量对手术规划极为重要。
评估肿瘤大小和组织学类型对磁共振成像（MRI）测量癌症局部扩展准确性的影响。
本回顾性研究纳入了186例原发性乳腺癌患者，共221个病灶。肿瘤分为五个组织学组：浸润性导管癌（IDC）、伴有广泛导管内成分的IDC（EIC）、浸润性小叶癌（ILC）、导管原位癌（DCIS）以及“其他组织学类型”（黏液性、乳头状、髓样、管状和大汗腺样乳腺癌）。将病理检查时肿瘤最大直径的显微镜测量值作为参考标准，并与MRI测量值进行比较。一致性定义为MRI测量值与病理测量值之间的差异≤5 mm。
病理检查时肿瘤的平均大小为24.8±19.4 mm，而MRI测量值为29.7±20 mm（P<0.05），MRI存在明显高估。221例病例中有98例（44.3%）MRI与病理检查结果一致，而81例（36.7%）肿瘤的MRI测量值高估了其大小。五个组织学组之间的高估程度存在显著差异（P<0.05）。多因素分析显示，DCIS组织学类型是与MRI和病理检查结果不一致最显著相关的因素（P = 0.0005），而病理检查时肿瘤大小的影响较小（P = 0.0073）。
DCIS组织学类型与乳腺癌MRI测量值和病理测量值不一致密切相关。病灶大小也会影响MRI测量的准确性，但影响程度较小。
