1 Department of Plastic and General Surgery, University of Turku and Turku University Hospital, Turku, Finland.
2 Department of Pathology, University of Turku and Turku University Hospital, Turku, Finland.
Scand J Surg. 2018 Mar;107(1):14-22. doi: 10.1177/1457496917701669. Epub 2017 Apr 12.
Preoperative magnetic resonance imaging has become an important complementary imaging technique in patients with breast cancer, providing additional information for preoperative local staging. Magnetic resonance imaging is recommended selectively in lobular breast cancer and in patients with dense breast tissue in the case when mammography and ultrasound fail to fully evaluate the lesion, but the routine use of magnetic resonance imaging in all patients with invasive ductal carcinoma is controversial. The purpose of this randomized study was to investigate the diagnostic value of preoperative magnetic resonance imaging and its impact on short-term surgical outcome in newly diagnosed unifocal stage I invasive ductal carcinoma.
A total of 100 patients were randomized to either receive preoperative breast magnetic resonance imaging or to be scheduled directly to operation without magnetic resonance imaging on a 1:1 basis. There were 50 patients in both study arms.
In 14 patients (28%), breast magnetic resonance imaging detected an additional finding and seven of them were found to be malignant. Six additional cancer foci were found in the ipsilateral breast and one in the contralateral breast. Magnetic resonance imaging findings caused a change in planned surgical management in 10 patients (20%). Mastectomy was performed in six patients (12%) in the magnetic resonance imaging group and in two patients (4%) in the control group ( p = 0.140). The breast reoperation rate was 14% in the magnetic resonance imaging group and 24% in the control group ( p = 0.202). The mean interval between referral and first surgical procedure was 34 days in the magnetic resonance imaging group and 21 days in the control group ( p < 0.001).
Preoperative magnetic resonance imaging may be beneficial for some patients with early-stage invasive ductal carcinoma, but its routine use is not recommended without specific indications.
术前磁共振成像已成为乳腺癌患者重要的补充影像学检查手段，为术前局部分期提供了更多信息。在乳腺钼靶和超声检查不能充分评估病灶的情况下，推荐选择性使用磁共振成像检查乳腺小叶癌和乳腺组织致密的患者，但在所有浸润性导管癌患者中常规使用磁共振成像存在争议。本随机研究旨在探讨术前磁共振成像的诊断价值及其对新诊断的单发Ⅰ期浸润性导管癌短期手术结果的影响。
将 100 例患者随机分为术前乳腺磁共振成像组和直接手术组，每组各 50 例。
在 14 例（28%）患者中，磁共振成像检测到额外发现，其中 7 例为恶性。同侧乳腺发现 6 个额外癌灶，对侧乳腺发现 1 个癌灶。磁共振成像结果导致 10 例（20%）患者计划手术方式发生改变。在磁共振成像组中，6 例（12%）患者行乳房切除术，而在对照组中仅 2 例（4%）患者行乳房切除术（p=0.140）。磁共振成像组乳房再次手术率为 14%，对照组为 24%（p=0.202）。磁共振成像组的转诊至首次手术的平均间隔为 34 天，对照组为 21 天（p<0.001）。
术前磁共振成像可能对一些早期浸润性导管癌患者有益，但不建议在没有明确适应证的情况下常规使用。
