Vernet-Tomas Maria, Mojal Sergi, Gamero Rocío, Nicolau Pau, Rodríguez-Arana Ana, Plancarte Francisco, Corominas Josep M, Serrano-Munne Laia, Carreras Ramon, Sabadell Dolors
Breast Surgery, Obstetrics and Gynaecology Department, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.
Consulting Service on Methodology for Biomedical Research, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Dr. Aiguader 88, 08003, Barcelona, Spain.
Breast Cancer. 2017 May;24(3):466-472. doi: 10.1007/s12282-016-0729-9. Epub 2016 Sep 17.
The aim of our study was to establish which clinical, radiologic and pathologic factors could predict the risk of under- and overestimation of the breast ductal carcinoma in situ (DCIS) size when preoperatively measuring the maximum mammographic extent of microcalcifications (MEM).
We made a retrospective review of patients with a DCIS treated in our Breast Unit between May 2005 and May 2012. Clinical, pathologic and radiologic data were evaluated as possible predictive factors for over- or underestimation of DCIS size when measuring MEM.
We obtained precise measurements of MEM in 82 patients (84 DCIS lesions). Maximum MEM measurement correctly estimated maximum pathology size in 57 lesions (68.7 %). Patients with a correctly estimated DCIS, with an underestimated DCIS and with an overestimated DCIS significantly differed in DCIS ER expression (p = 0.022) and in maximum MEM measurement (p = 0.000). Constructing two ROC curves, we found that a maximum MEM measurement ≥25 mm and ER expression ≥90 % were both discrimination points for overestimation and ER ≤ 45 % was a discrimination point for underestimation. Using these cutoff points, we defined four groups of patients with different risks of over- and underestimation.
Risk of over- or underestimation of DCIS size through MEM measurement depends on DCIS ER expression and MEM itself. Identifying which patients are at a significant risk of over- or underestimation could help the breast surgeon when discussing the surgical options with the patient.
我们研究的目的是确定在术前测量乳腺导管原位癌（DCIS）微钙化的最大乳房X线摄影范围（MEM）时，哪些临床、放射学和病理学因素可预测DCIS大小被低估和高估的风险。
我们对2005年5月至2012年5月在我们乳腺科接受治疗的DCIS患者进行了回顾性研究。评估临床、病理和放射学数据，作为测量MEM时DCIS大小被高估或低估的可能预测因素。
我们对82例患者（84个DCIS病灶）进行了MEM的精确测量。最大MEM测量正确估计了57个病灶（68.7%）的最大病理大小。DCIS大小被正确估计、被低估和被高估的患者在DCIS雌激素受体（ER）表达（p = 0.022）和最大MEM测量值（p = 0.000）方面存在显著差异。构建两条ROC曲线，我们发现最大MEM测量值≥25 mm和ER表达≥90%均为高估的判别点，而ER≤45%为低估的判别点。使用这些截断点，我们定义了四组具有不同高估和低估风险的患者。
通过MEM测量低估或高估DCIS大小的风险取决于DCIS的ER表达和MEM本身。确定哪些患者有显著的高估或低估风险，有助于乳腺外科医生在与患者讨论手术方案时做出决策。
