Debald Manuel, Abramian Alina, Nemes Lisa, Döbler Michael, Kaiser Christina, Keyver-Paik Mignon-Denise, Leutner Claudia, Höller Tobias, Braun Michael, Kuhl Christiane, Kuhn Walther, Schild Hans H
Department of Obstetrics and Gynecology, Centre for Integrated Oncology (CIO), University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
Department of Radiology, Centre for Integrated Oncology, University of Bonn, Bonn, Germany.
Breast Cancer Res Treat. 2015 Oct;153(3):531-7. doi: 10.1007/s10549-015-3556-3. Epub 2015 Sep 1.
Several authors question the potential benefit of preoperative magnetic resonance imaging (MRI) against the background of possible overdiagnosis, false-positive findings, and unnecessary resections in patients with newly diagnosed breast cancer. In order to reveal a better selection of patients who should undergo preoperative MRI after histological confirmed breast cancer, the present analysis was implemented. We aimed to evaluate the influence of preoperative breast MRI in patients with newly diagnosed breast cancer to find subgroups of patients that are most likely to benefit from preoperative MRI by the detection of occult malignant foci. A total of 1102 consecutive patients who underwent treatment for primary breast cancer between 2002 and 2013 were retrospectively analyzed. All patients underwent triple assessment by breast ultrasound, mammography, and bilateral breast MRI. MRI findings not seen on conventional imaging that suggested additional malignant disease was found in 344 cases (31.2 %). Histological confirmed malignant foci were found in 223 patients (20.2 %) within the index breast and in 28 patients (2.5 %) in the contralateral breast. The rate of false-negative biopsies was 31 (2.8 %) and 62 (5.6 %), respectively. Premenopausal women (p = 0.024), lobular invasive breast cancer (p = 0.02) as well as patients with high breast density [American College of Radiology (ACR) 3 + 4; p = 0.01] were significantly associated with additional malignant foci in the index breast. Multivariate analysis confirmed lobular histology (p = 0.041) as well as the co-factors "premenopausal stage" and "high breast density (ACR 3+4)" (p = 0.044) to be independently significant. Previous studies revealed that breast MRI is a reliable tool for predicting tumor extension as well as for the detection of additional ipsilateral and contralateral tumor foci in histological confirmed breast cancer. In the present study, we demonstrate that especially premenopausal patients with high breast density as well as patients with lobular histology seem to profit from preoperative MRI.
几位作者质疑，在新诊断乳腺癌患者中，鉴于可能存在的过度诊断、假阳性结果以及不必要的切除手术，术前磁共振成像（MRI）的潜在益处。为了更好地筛选出组织学确诊乳腺癌后应接受术前MRI检查的患者，我们进行了本项分析。我们旨在评估术前乳腺MRI对新诊断乳腺癌患者的影响，通过检测隐匿性恶性病灶来找出最有可能从术前MRI中获益的患者亚组。我们对2002年至2013年间接受原发性乳腺癌治疗的1102例连续患者进行了回顾性分析。所有患者均接受了乳腺超声、乳腺X线摄影和双侧乳腺MRI的三联评估。在344例（31.2%）患者中发现了常规成像未显示但提示存在额外恶性病变的MRI表现。在索引侧乳腺中，223例（20.2%）患者经组织学确诊存在恶性病灶，对侧乳腺中有28例（2.5%）患者存在恶性病灶。假阴性活检率分别为31例（2.8%）和62例（5.6%）。绝经前女性（p = 0.024）、小叶浸润性乳腺癌（p = 0.02）以及乳腺密度高的患者[美国放射学会（ACR）3 + 4级；p = 0.01]与索引侧乳腺中存在额外恶性病灶显著相关。多因素分析证实小叶组织学（p = 0.041）以及“绝经前阶段”和“高乳腺密度（ACR 3 + 4）”这两个辅助因素（p = 0.044）具有独立显著性。先前的研究表明，乳腺MRI是预测肿瘤范围以及检测组织学确诊乳腺癌同侧和对侧额外肿瘤病灶的可靠工具。在本研究中，我们证明，尤其是绝经前乳腺密度高的患者以及小叶组织学类型的患者似乎能从术前MRI中获益。
