浸润性小叶癌术前MRI引导下的重复手术：原位癌及背景实质强化的作用

Repeated surgeries in invasive lobular breast cancer with preoperative MRI: Role of additional carcinoma in situ and background parenchymal enhancement.

作者信息

Preibsch H, Richter V, Bahrs S D, Hattermann V, Wietek B M, Bier G, Kloth C, Blumenstock G, Hahn M, Staebler A, Nikolaou K, Wiesinger B

机构信息

Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.

出版信息

Eur J Radiol. 2017 May;90:181-187. doi: 10.1016/j.ejrad.2017.02.045. Epub 2017 Mar 2.

DOI:10.1016/j.ejrad.2017.02.045

PMID:28583631

Abstract

OBJECTIVES

Analysing the influence of additional carcinoma in situ (CIS) and background parenchymal enhancement (BPE) in preoperative MRI on repeated surgeries in patients with invasive lobular carcinoma (ILC) of the breast.

METHODS

Retrospective analysis of 106 patients (mean age 58.6±9.9years) with 108 ILC. Preoperative tumour size as assessed by MRI, mammography and sonography was recorded and compared to histopathology. In contrast-enhanced MRI, the degree of BPE was categorised by two readers. The influence of additionally detected CIS and BPE on the rate of repeated surgeries was analysed.

RESULTS

Additional CIS was present in 45.4% of the cases (49/108). The degree of BPE was minimal or mild in 80% of the cases and moderate or marked in 20% of the cases. In 17 cases (15.7%) at least one repeated surgery was performed. In n=15 of these cases, repeated surgery was performed after BCT (n=9 re-excisions, n=6 conversions to mastectomy), in n=2 cases after initial mastectomy. The initial surgical procedure (p=0.008) and additional CIS (p=0.046) significantly influenced the rate of repeated surgeries, while tumour size, patient age and BPE did not (p=ns).

CONCLUSIONS

Additional CIS was associated with a higher rate of repeated surgeries, whereas BPE had no influence.

摘要

目的

分析术前MRI中额外原位癌（CIS）和背景实质强化（BPE）对乳腺浸润性小叶癌（ILC）患者再次手术的影响。

方法

回顾性分析106例（平均年龄58.6±9.9岁）患有108例ILC的患者。记录通过MRI、乳腺X线摄影和超声检查评估的术前肿瘤大小，并与组织病理学结果进行比较。在对比增强MRI中，由两名阅片者对BPE程度进行分类。分析额外检测到的CIS和BPE对再次手术率的影响。

结果

45.4%的病例（49/108）存在额外的CIS。80%的病例BPE程度为轻微或轻度，20%的病例为中度或显著。17例（15.7%）患者至少进行了一次再次手术。其中15例在保乳手术后进行了再次手术（9例再次切除，6例改为乳房切除术），2例在初次乳房切除术后进行了再次手术。初次手术方式（p=0.008）和额外的CIS（p=0.046）对再次手术率有显著影响，而肿瘤大小、患者年龄和BPE则无影响（p=无统计学意义）。