1 Department of Radiology, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave, 10th Fl, New York, NY 10032.
AJR Am J Roentgenol. 2015 May;204(5):W599-604. doi: 10.2214/AJR.14.13221.
The objective of our study was to characterize the MRI features of breast carcinomas detected in augmented breasts.
A review of the MRI database identified 54 patients with biopsy-proven breast carcinoma in augmented breasts. The images were reviewed for the type and location of the implant and for the characteristics of the carcinoma. The cases included 46 (85%) invasive cancers (invasive ductal carcinoma, n = 35; invasive lobular carcinoma, n = 7; and mixed features, n = 4) and eight (15%) ductal carcinomas in situ.
The median age of the patients at diagnosis was 49 years (range, 28-72 years). Thirty-eight of the 54 cancers (70%) were palpable. The mean tumor size was 2.8 cm (range, 0.6-9.6 cm). Of the 54 cancers, 34 (63%) presented as masses and 20 (37%) as nonmass enhancement on MRI. There was no detectable difference between implant position and lesion morphology (p = 0.55) or tumor size (p = 1.00). Twenty of 54 (37%) carcinomas abutted the implant, 13 (24%) abutted the pectoralis major muscle, and two (4%) invaded the pectoralis major muscle. Of the tumors abutting the implant, 18 of 20 (90%) spread along the implant capsule for more than 0.5 cm. This pattern of tumor spread was more common in breasts with retroglandular implants (9/16, 56%) than in those with retropectoral implants (9/38, 24%) (p = 0.03). MRI detected the index carcinoma in 16 of 54 (30%) cases, showed a greater extent of disease than was visible on mammography or ultrasound in 21 of 52 (40%) cases, and detected an unsuspected contralateral carcinoma in three of 54 (6%) cases.
In augmented breasts, breast cancer often contacts either the implant or the pectoralis major muscle. Tumor spread along the implant contour is more often seen with retroglandular implants than with retropectoral implants. MRI should be considered to assess disease extent in women with augmented breasts before surgery.
本研究旨在描述隆乳术后检出的乳腺癌的 MRI 特征。
回顾性分析 MRI 数据库，共纳入 54 例经活检证实为隆乳术后乳腺癌的患者。分析内容包括假体类型和位置、乳腺癌特征等。其中浸润性癌 46 例（浸润性导管癌 35 例，浸润性小叶癌 7 例，混合性特征 4 例），导管原位癌 8 例。
患者中位年龄 49 岁（28-72 岁）。54 例乳腺癌中 38 例（70%）可触及，肿瘤平均大小 2.8 cm（0.6-9.6 cm）。54 例乳腺癌中，34 例（63%）表现为肿块，20 例（37%）为非肿块样强化。假体位置与病变形态（p = 0.55）或肿瘤大小（p = 1.00）无明显相关性。54 例乳腺癌中，20 例（37%）癌与假体相邻，13 例（24%）癌与胸大肌相邻，2 例（4%）癌侵犯胸大肌。与假体相邻的 20 例乳腺癌中，18 例（90%）肿瘤沿假体包膜蔓延超过 0.5 cm，这种蔓延模式在经胸后间隙植入假体的乳房中更常见（16/38，42%），而在经胸肌下间隙植入假体的乳房中少见（9/16，56%）（p = 0.03）。MRI 在 16 例（30%）患者中检出了首发乳腺癌，在 21 例（40%）患者中发现了比乳腺 X 线摄影或超声更广泛的病变，在 3 例（6%）患者中发现了未预期的对侧乳腺癌。
在隆乳术后，乳腺癌常与假体或胸大肌接触。经胸后间隙植入假体的乳腺癌更易沿假体轮廓蔓延。在术前评估隆乳术后患者的疾病范围时，应考虑行 MRI 检查。
