From the Department of Diagnostic and Interventional Radiology (C.K.K., K.S., S.S.), Section of Bioinformatics, Department of Diagnostic and Interventional Radiology (H.B.), and Department of Gynecology and Gynecologic Oncology (N.M.), University of Aachen, RWTH, Pauwelsstr 30, 52074 Aachen, Germany; Department of Pathology, University of Muenster, Muenster, Germany (E.W.); and Department of Gynecology, University of Bonn, Bonn, Germany (W.K.).
Radiology. 2017 Sep;284(3):645-655. doi: 10.1148/radiol.2017161449. Epub 2017 Apr 26.
Purpose To (a) compare the diagnostic accuracy of breast magnetic resonance (MR) imaging with that of conventional imaging (digital mammography and breast ultrasonography) in the identification of ductal carcinoma in situ (DCIS) components of biopsy-proven invasive breast cancer before surgery and (b) investigate the surgical outcome (positive margin rates and mastectomy rates) of women with breast cancer who underwent preoperative MR imaging combined with MR-guided needle biopsy and/or MR-guided lesion localization or bracketing where appropriate. Materials and Methods The authors performed a prospective two-center study of 593 consecutive patients with biopsy-proven invasive breast cancer who underwent breast MR imaging in addition to conventional imaging. MR-guided vacuum biopsy and MR-guided lesion bracketing were performed for DCIS components visible at MR imaging alone. The accuracy of breast MR imaging was compared with that of conventional imaging, and surgical outcomes (positive margin and mastectomy rates) were investigated. Results Surgical-pathologic assessment demonstrated DCIS components in 139 of the 593 women (23.4%). The sensitivity of MR imaging for the diagnosis of DCIS components pre-operatively (84.9%; 118 of 139) was significantly higher than that of conventional imaging (36.7%; 51 of 139) (P < .0001); more than half of DCIS components (51.1%; 71 of 139) were detected only with MR imaging. The sensitivity advantage of MR imaging over conventional imaging increased with increasing relative size of DCIS components, as follows: The sensitivity of MR imaging versus conventional imaging for small, marginal DCIS components was 56.8% (21 of 37) versus 29.7% (11 of 37); the sensitivity for extensive DCIS components was 91.7% (55 of 60) versus 41.7% (25 of 60); the sensitivity for large, predominant DCIS components was 100.0% (42 of 42) versus 35.7% (15 of 42). Moreover, the sensitivity advantage of MR imaging over conventional imaging increased with increasing nuclear grade of DCIS components, as follows: The sensitivity of MR imaging versus conventional imaging for low-grade DCIS components was 74.0% (20 of 27) versus 40.7% (11 of 27); the sensitivity for intermediate-grade DCIS components was 84.1% (53 of 63) versus 34.9% (22 of 63); the sensitivity for high-grade DCIS components was 91.8% (45 of 49) versus 36.7% (18 of 49) (P < .05-.001 for all). Positive margin rates were low overall (3.7% [95% Clopper Pearson confidence interval [CI]: 2.3%, 5.6%]) and did not differ significantly between the 139 women with DCIS components (5.0% [95% CI: 2.0%, 10.1%]) compared with the 454 women without such components (3.3% [95% CI: 1.9%, 5.4%]). The same was true for mastectomy rates (10.8% [95% CI: 6.2%, 17.2%] vs 8.1% [95% CI: 5.8%, 11.1%]). Conclusion Breast MR imaging improves depiction of DCIS components of invasive breast cancers before surgery and is associated with positive margin and mastectomy rates that are low irrespective of the presence or absence of DCIS components. RSNA, 2017.
目的 （a）比较术前乳腺磁共振（MR）成像与传统成像（数字乳腺摄影和乳腺超声）在识别经活检证实的浸润性乳腺癌中导管原位癌（DCIS）成分的诊断准确性，（b）研究接受术前 MR 成像联合 MR 引导下真空活检和/或 MR 引导下病变定位或适当情况下的 MR 引导下病变框定的乳腺癌患者的手术结果（阳性切缘率和乳房切除术率）。
材料与方法 作者对 593 例经活检证实的浸润性乳腺癌患者进行了前瞻性的双中心研究，这些患者除了常规成像外还接受了乳腺 MR 成像。对于仅在 MR 成像上可见的 DCIS 成分，进行了 MR 引导下真空活检和 MR 引导下病变框定。比较了乳腺 MR 成像与常规成像的准确性，并研究了手术结果（阳性切缘率和乳房切除术率）。
结果 手术病理评估显示 593 例女性中有 139 例（23.4%）存在 DCIS 成分。术前 MR 成像对 DCIS 成分的诊断敏感性（84.9%，118/139）明显高于常规成像（36.7%，51/139）（P<.0001）；超过一半的 DCIS 成分（51.1%，71/139）仅通过 MR 成像检测到。MR 成像比常规成像的诊断敏感性优势随着 DCIS 成分的相对大小增加而增加，如下所示：对于小的、边缘性的 DCIS 成分，MR 成像对常规成像的敏感性为 56.8%（21/37）对 29.7%（11/37）；对于广泛的 DCIS 成分，敏感性为 91.7%（55/60）对 41.7%（25/60）；对于大的、主要的 DCIS 成分，敏感性为 100.0%（42/42）对 35.7%（15/42）。此外，MR 成像对常规成像的诊断敏感性优势随着 DCIS 成分的核分级增加而增加，如下所示：对于低分级的 DCIS 成分，MR 成像对常规成像的敏感性为 74.0%（20/27）对 40.7%（11/27）；对于中分级的 DCIS 成分，敏感性为 84.1%（53/63）对 34.9%（22/63）；对于高分级的 DCIS 成分，敏感性为 91.8%（45/49）对 36.7%（18/49）（所有 P<.05-.001）。总的来说，阳性切缘率较低（3.7%[95%Cl：2.3%，5.6%]），且在有 DCIS 成分的 139 例女性（5.0%[95%Cl：2.0%，10.1%]）与无此类成分的 454 例女性（3.3%[95%Cl：1.9%，5.4%]）之间无显著差异。乳房切除术率也是如此（10.8%[95%Cl：6.2%，17.2%]比 8.1%[95%Cl：5.8%，11.1%]）。
结论 术前乳腺 MR 成像可提高经活检证实的浸润性乳腺癌中 DCIS 成分的检出率，并与较低的阳性切缘率和乳房切除术率相关，无论是否存在 DCIS 成分。RSNA，2017。
