Department of Plastic and Reconstructive Surgery, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
Breast Cancer. 2018 Jan;25(1):81-85. doi: 10.1007/s12282-017-0791-y. Epub 2017 Jun 23.
Whether a durometer was suitable for objectively measuring reconstructed breast hardness was evaluated.
Subjects were 81 women who underwent expander-implant reconstructions following breast cancer ablation. Capsular contracture was evaluated with Baker grading. Capsular thickness was measured with T1-weighted MRI at the upper areola area. The durometer was placed on the upper areola. Multiple logistic regression analysis was performed to compare variables.
On Baker grading, 17 breasts were Baker grade I, 52 breasts were Baker grade II, 11 breasts were Baker grade III, and 1 breast was Baker grade IV. Mean capsular thickness on MRI was 1.1 (SD 0.4) mm with Baker grade I, 1.2 (SD 0.3) mm with Baker grade II, 1.4 (SD 0.4) mm with Baker grade III, and 1.9 mm with Baker grade IV. Mean durometer value was 0 with Baker grade I, 0.2 (SD 0.5) with Baker grade II, 2.0 (SD 1.7), with Baker grade III, and 8 with Baker grade IV. Baker grade IV was excluded from analysis because there was only one case. When Baker grade III was defined as positive for hardness, multiple logistic regression analysis showed that durometer value was associated with Baker grade III (p = 0.0005), but capsular thickness was not. On receiver operating characteristic curve analysis of the durometer value for Baker grade III, the optimal cutoff value was 0.5 (sensitivity 0.92, 1-specificity 0.17, area under the curve 0.92).
The durometer offers an objective index of hardness that might replace the subjective Baker grading. Further studies are needed to confirm the utility of this index.
评估硬度计是否适合客观测量重建乳房的硬度。
研究对象为 81 名接受乳腺癌消融后扩张器-植入物重建的女性。采用 Baker 分级评估包膜挛缩。在乳晕上方区域用 T1 加权 MRI 测量包膜厚度。硬度计放置在乳晕上方。采用多变量逻辑回归分析比较变量。
在 Baker 分级中，17 个乳房为 Baker 分级 I，52 个乳房为 Baker 分级 II，11 个乳房为 Baker 分级 III，1 个乳房为 Baker 分级 IV。MRI 上包膜厚度的平均值为 Baker 分级 I 为 1.1（SD 0.4）mm，Baker 分级 II 为 1.2（SD 0.3）mm，Baker 分级 III 为 1.4（SD 0.4）mm，Baker 分级 IV 为 1.9mm。Baker 分级 I 的硬度计值为 0，Baker 分级 II 为 0.2（SD 0.5），Baker 分级 III 为 2.0（SD 1.7），Baker 分级 IV 为 8。由于只有 1 例，Baker 分级 IV 被排除在分析之外。当将 Baker 分级 III 定义为硬度阳性时，多变量逻辑回归分析表明，硬度计值与 Baker 分级 III 相关（p=0.0005），而包膜厚度则不然。在硬度计值对 Baker 分级 III 的受试者工作特征曲线分析中，最佳截断值为 0.5（灵敏度 0.92，1 特异性 0.17，曲线下面积 0.92）。
硬度计提供了硬度的客观指标，可能取代主观的 Baker 分级。需要进一步的研究来确认该指标的实用性。
