Haraldsdóttir K H, Jónsson Þ, Halldórsdóttir A B, Tranberg K-G, Ásgeirsson K S
1 Department of Surgery, Landspitali University Hospital, Reykjavik, Iceland.
2 Department of Surgery, Lund University Hospital, Lund, Sweden.
Scand J Surg. 2017 Mar;106(1):68-73. doi: 10.1177/1457496916631855. Epub 2016 Jul 8.
In Landspitali University Hospital, magnetic resonance imaging is used non-selectively in addition to mammogram and ultrasound in the preoperative assessment of breast cancer patients. The aim of this study was to assess invasive tumor size on imaging, compare with pathological size and evaluate the impact of magnetic resonance imaging on the type of surgery performed.
All women with invasive breast cancer, diagnosed in Iceland, between 2007 and 2009 were reviewed retrospectively. In all, 438 of 641 (68%) patients diagnosed had preoperative magnetic resonance imaging. Twelve patients treated with neoadjuvant chemotherapy were excluded and 65 patients with multifocal or contralateral disease were assessed separately.
Correlations between microscopic and radiologic tumor sizes were relatively weak. All imaging methods were inaccurate especially for large tumors, resulting in an overall underestimation of tumor size for these tumors. Magnetic resonance imaging under- and overestimated pathological tumor size by more than 10 mm in 16/348 (4.6%) and 26/348 patients (7.5%), respectively. In 19 patients (73%), overestimation of size was seen exclusively on magnetic resonance imaging. For tumors under- or overestimated by magnetic resonance imaging, the mastectomy rates were 56% and 65%, respectively, compared to an overall mastectomy rate of 43%. Of 51 patients diagnosed with multifocal disease on pathology, 19 (37%) were diagnosed by mammogram or ultrasound and 40 (78%) by magnetic resonance imaging resulting in a total detection rate of 84% (43 patients). Fourteen (3%) patients were diagnosed preoperatively with contralateral disease. Of those tumors, all were detected on magnetic resonance imaging but seven (50%) were also detected on mammogram or ultrasound or both.
Our results suggest that routine use of magnetic resonance imaging may result in both under- and overestimation of tumor size and increase mastectomy rates in a small proportion of patients. Magnetic resonance imaging aids in the diagnosis of contralateral and multifocal disease.
在冰岛国家大学医院，乳腺癌患者术前评估中除了乳房X线摄影和超声检查外，还非选择性地使用磁共振成像。本研究的目的是评估影像学上的浸润性肿瘤大小，与病理大小进行比较，并评估磁共振成像对所实施手术类型的影响。
回顾性分析2007年至2009年在冰岛诊断为浸润性乳腺癌的所有女性患者。在641例确诊患者中，共有438例（68%）患者术前行磁共振成像检查。排除12例接受新辅助化疗的患者，65例多灶性或对侧病变患者单独评估。
显微镜下肿瘤大小与放射学肿瘤大小之间的相关性相对较弱。所有成像方法均不准确，尤其是对于大肿瘤，导致这些肿瘤的大小总体被低估。磁共振成像对病理肿瘤大小的低估和高估分别发生在16/348例（4.6%）和26/348例患者（7.5%）中，误差超过10毫米。在19例患者（73%）中，仅在磁共振成像上可见大小高估。对于磁共振成像低估或高估大小的肿瘤，乳房切除术率分别为56%和65%，而总体乳房切除术率为43%。在病理诊断为多灶性疾病的51例患者中，19例（37%）通过乳房X线摄影或超声检查诊断，40例（78%）通过磁共振成像诊断，总检出率为84%（43例患者）。14例（3%）患者术前诊断为对侧病变。在这些肿瘤中，所有均在磁共振成像上检测到，但7例（50%）也在乳房X线摄影或超声检查或两者上检测到。
我们的结果表明，常规使用磁共振成像可能导致肿瘤大小的低估和高估，并在一小部分患者中增加乳房切除术率。磁共振成像有助于对侧和多灶性疾病的诊断。
