Hill Maureen V, Beeman Julia L, Jhala Khushboo, Holubar Stefan D, Rosenkranz Kari M, Barth Richard J
Section of General Surgery, Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
Breast Cancer Res Treat. 2017 Jun;163(3):615-622. doi: 10.1007/s10549-017-4205-9. Epub 2017 Mar 18.
The effect of pre-operative MRI on the in-breast tumor recurrence rate (IBTR) of patients undergoing breast-conservation treatment (BCT) remains uncertain. We began to routinely perform pre-operative MRI in 2006. Our goal was to determine the effect of pre-operative MRI on IBTR.
Retrospective review of a prospective database of all patients undergoing BCT (n = 1396) from 2000 to 2010. IBTR were calculated using Kaplan-Meier estimates.
664 (47.6%) patients underwent pre-operative MRI. The use of MRI increased from 13.9% in 2000-2005 to 80.7% in 2006-2010. Ten percent of patients who underwent MRI were found to have an additional ipsilateral cancer, with a mean diameter of 1.6 cm. The IBTR for patients with and without MRI were 4% vs. 8% at 8 years (p = 0.04). In multivariate analysis, radiation therapy and endocrine therapy were associated with decreased IBTR, but MRI was not (RR 0.77 (0.45-1.28)). For 1030 patients with invasive cancer, the IBTR at 8 years with and without MRI was 4.2% vs. 7.3% (p = 0.28). For 366 DCIS patients with and without MRI, the IBTR was 3.6% vs. 10.9% (p = 0.06). In the subgroup of DCIS patients who did not receive radiation, the IBTR with and without MRI was 0% vs. 18.2% (p = 0.08). Patients with an additional cancer found by MRI had a higher IBTR at 8 years (10.1% vs. 3.3%, p = 0.02).
In a study analyzing BCT patients from one time period who rarely had a pre-operative MRI and a subsequent time period where most patients had MRI, the use of MRI was associated with a decrease in the IBTR on univariate, but not multivariate analysis. Patients who had additional cancers detected had a significantly higher IBTR.
术前MRI对接受保乳治疗（BCT）患者的乳腺内肿瘤复发率（IBTR）的影响仍不确定。我们于2006年开始常规进行术前MRI检查。我们的目标是确定术前MRI对IBTR的影响。
回顾性分析2000年至2010年所有接受BCT患者（n = 1396）的前瞻性数据库。使用Kaplan-Meier估计法计算IBTR。
664例（47.6%）患者接受了术前MRI检查。MRI的使用比例从2000 - 2005年的13.9%增至2006 - 2010年的80.7%。接受MRI检查的患者中有10%被发现患有额外的同侧癌症，平均直径为1.6厘米。有和没有接受MRI检查的患者在8年时的IBTR分别为4%和8%（p = 0.04）。在多因素分析中，放疗和内分泌治疗与IBTR降低相关，但MRI与IBTR降低无关（风险比0.77（0.45 - 1.28））。对于1030例浸润性癌患者，有和没有接受MRI检查的患者在8年时的IBTR分别为4.2%和7.3%（p = 0.28）。对于366例有和没有接受MRI检查的导管原位癌（DCIS）患者，IBTR分别为3.6%和10.9%（p = 0.06）。在未接受放疗的DCIS患者亚组中，有和没有接受MRI检查的患者的IBTR分别为0%和18.2%（p = 0.08）。通过MRI发现患有额外癌症的患者在8年时的IBTR更高（10.1%对3.3%，p = 0.02）。
在一项分析同一时期很少进行术前MRI检查的BCT患者以及随后大多数患者进行MRI检查的研究中，单因素分析显示MRI的使用与IBTR降低相关，但多因素分析未显示此关联。检测到患有额外癌症的患者的IBTR显著更高。
