Schaefer Amanda R, Yang Limin, Park Jeong Mi, Xiong Jinhu, Fajardo Laurie L
Broadlawns Medical Center, Des Moines, Iowa.
Department of Radiology, University of Iowa, Iowa City, Iowa.
Breast J. 2015 Jul-Aug;21(4):395-402. doi: 10.1111/tbj.12416. Epub 2015 Apr 11.
The purpose of this study is to characterize sternal lesions detected on breast magnetic resonance imaging (MRI), compare MRI detection of sternal lesions with other imaging modalities (bone scan, positron emission tomography/computed tomography (PET/CT) and chest CT), and ascertain how often patient management is altered by discovery of sternal lesions. Retrospective review of 1143 breast MRIs between 2007 and 2012 identified 17 patients with sternal lesions including 15 patients with newly diagnosed breast cancer and two patients with remote history of breast cancer. Tumor size, histopathology, receptor status, nodal and distant metastasis, and images of breast MRI, and other modalities were reviewed. Sternal lesions in 9 of the 17 patients were determined to be malignant (metastasis) either by biopsy or presence of widespread metastases. Sternal lesions in 8 of the 17 were benign, confirmed by biopsy or presumed benign as not detected by other modalities. The malignant group had statistically significant larger breast cancer size (malignant: 6.4 cm; benign: 2.3 cm), a higher percentage of diffuse sternal lesions (malignant: 56%; benign: 0%), and more frequently showed rapid initial enhancing (malignant: 100%; benign: 63%) and delayed washout curves (malignant: 67%; benign: 13%). Although not statistically significant, the malignant group had a higher frequency of invasive lobular carcinoma (malignant: 44%; benign: 13%) and more lymph node involvement (malignant: 78%; benign: 50%). Breast MRI detected more sternal lesions than did bone scan, PET/CT and chest CT. Four of the 17 (24%) patients were upgraded to stage 4 due to unsuspected metastatic sternal lesions on breast MRI. In conclusion, breast MRI is more sensitive than other modalities in detecting sternal lesions. Sternal metastases occur more frequently in aggressive breast cancer and exhibit malignant-type dynamics on breast MRI. Detection of unsuspected sternal metastasis alters staging and improves patient management with more appropriate treatment.
本研究的目的是对乳腺磁共振成像（MRI）检测到的胸骨病变进行特征描述，将胸骨病变的MRI检测结果与其他成像方式（骨扫描、正电子发射断层扫描/计算机断层扫描（PET/CT）和胸部CT）进行比较，并确定胸骨病变的发现对患者治疗管理的改变频率。对2007年至2012年间的1143例乳腺MRI进行回顾性分析，确定了17例有胸骨病变的患者，其中包括15例新诊断的乳腺癌患者和2例有乳腺癌既往史的患者。回顾了肿瘤大小、组织病理学、受体状态、淋巴结及远处转移情况，以及乳腺MRI和其他检查方式的图像。17例患者中有9例的胸骨病变经活检或存在广泛转移被确定为恶性（转移）。17例中有8例的胸骨病变为良性，经活检证实或因其他检查方式未检测到而推测为良性。恶性组的乳腺癌大小在统计学上显著更大（恶性：6.4 cm；良性：2.3 cm），弥漫性胸骨病变的比例更高（恶性：56%；良性：0%），且更常表现为快速初始强化（恶性：100%；良性：63%）和延迟廓清曲线（恶性：67%；良性：13%）。虽然无统计学意义，但恶性组浸润性小叶癌的发生率更高（恶性：44%；良性：13%），淋巴结受累更多（恶性：78%；良性：50%）。乳腺MRI检测到的胸骨病变比骨扫描、PET/CT和胸部CT更多。17例患者中有4例（24%）因乳腺MRI上意外发现的转移性胸骨病变而被升级为IV期。总之，乳腺MRI在检测胸骨病变方面比其他检查方式更敏感。胸骨转移在侵袭性乳腺癌中更常见，且在乳腺MRI上表现出恶性类型的动态变化。意外胸骨转移的检测改变了分期，并通过更合适的治疗改善了患者管理。
