Rahbar Habib, Hanna Lucy G, Gatsonis Constantine, Mahoney Mary C, Schnall Mitchell D, DeMartini Wendy B, Lehman Constance D
From the Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 825 Eastlake Ave E, PO Box 19023, Seattle, WA 98109-1023 (H.R., C.D.L.); Center for Statistical Sciences, Brown University, Providence, RI (L.G.H., C.G.); Department of Radiology, University of Cincinnati School of Medicine, Cincinnati, Ohio (M.C.M.); Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa (M.D.S.); and Department of Radiology, University of Wisconsin School of Medicine, Madison, Wis (W.B.D.).
Radiology. 2014 Oct;273(1):53-60. doi: 10.1148/radiol.14132029. Epub 2014 Jun 16.
To assess which patient and magnetic resonance (MR) imaging factors are associated with the likelihood of contralateral prophylactic mastectomy (CPM) in patients with newly diagnosed breast cancer.
The American College of Radiology Imaging Network 6667 trial was compliant with HIPAA; institutional review board approval was obtained at each site. All patients provided written informed consent. This study was a retrospective review of data from 934 women enrolled in the trial who did not have a known contralateral breast cancer at the time of surgical planning. The authors assessed age, menopausal status, index breast cancer histologic results, contralateral breast histologic results, breast density, family history, race and/or ethnicity, MR imaging Breast Imaging Reporting and Data System (BI-RADS) assessment, and number of MR imaging lesions for association with CPM by using the Fisher exact test, exact χ(2) test, and multivariate logistic regression analyses.
Eighty-six of the 934 (9.2%) women underwent CPM and were more likely to be younger (mean age, 48 years [range, 27-78 years] vs mean age, 54 years [range, 25-86 years]; P < .0001), be premenopausal (55 of 86 [64%] vs 349 of 845 [41%], P < .0001), have ductal carcinoma in situ (DCIS) in the index breast (31% [27 of 86] vs 19% [164 of 848], P = .02), have greater breast density (71 of 86 [83%] vs 572 of 848 [68%], P = .004), and have a family history of breast cancer (44 of 86 [30%] vs 150 of 488 [18%], P = .01) than those who did not undergo CPM. Distributions of race and/or ethnicity, contralateral lesion pathologic results, and number of MR imaging lesions were similar in both groups. With multivariate modeling, younger age, greater breast density, DCIS index cancer, and family history remained significant, whereas menopausal status did not. Positive MR imaging assessments were not significantly more frequent in the CPM group than in the group of women who did not undergo CPM (14 of 86 [16.3%] vs 113 of 848 [13.3%], P = .43).
In patients with newly diagnosed breast cancer who underwent breast MR imaging at which a contralateral breast cancer was not identified, patient factors and not breast MR imaging BI-RADS scores were chief determinants in decisions regarding CPM. Online supplemental material is available for this article.
评估哪些患者因素和磁共振（MR）成像因素与新诊断乳腺癌患者对侧预防性乳房切除术（CPM）的可能性相关。
美国放射学会成像网络6667试验符合《健康保险流通与责任法案》（HIPAA）；各研究点均获得机构审查委员会批准。所有患者均提供书面知情同意书。本研究是对934名参与该试验的女性的数据进行的回顾性分析，这些女性在手术规划时没有已知的对侧乳腺癌。作者使用Fisher精确检验、精确χ²检验和多因素逻辑回归分析，评估年龄、绝经状态、索引侧乳腺癌组织学结果、对侧乳腺组织学结果、乳腺密度、家族史、种族和/或民族、MR成像乳腺影像报告和数据系统（BI-RADS）评估以及MR成像病变数量与CPM的相关性。
934名女性中有86名（9.2%）接受了CPM，她们比未接受CPM的女性更可能年龄较小（平均年龄48岁[范围27 - 78岁]对比平均年龄54岁[范围25 - 86岁]；P <.0001）、处于绝经前（86名中的55名[64%]对比845名中的349名[41%]，P <.0001）、索引侧乳腺有导管原位癌（DCIS）（31%[86名中的27名]对比19%[848名中的164名]，P =.02）、乳腺密度更高（86名中的71名[83%]对比848名中的572名[68%]，P =.004）以及有乳腺癌家族史（86名中的44名[30%]对比488名中的150名[18%]，P =.01）。两组在种族和/或民族分布、对侧病变病理结果以及MR成像病变数量方面相似。通过多因素建模，年龄较小、乳腺密度更高、索引侧癌为DCIS以及家族史仍然具有显著意义，而绝经状态则不然。CPM组中MR成像评估为阳性的情况并不比未接受CPM的女性组更频繁（86名中的14名[16.3%]对比848名中的113名[13.3%]，P =.43）。
在新诊断乳腺癌且接受了乳腺MR成像但未发现对侧乳腺癌的患者中，患者因素而非乳腺MR成像BI-RADS评分是CPM决策的主要决定因素。本文提供在线补充材料。
