Cortadellas Tomas, Argacha Paula, Acosta Juan, Rabasa Jordi, Peiró Ricardo, Gomez Margarita, Rodellar Laura, Gomez Sandra, Navarro-Golobart Alejandra, Sanchez-Mendez Sonia, Martinez-Medina Milagros, Botey Mireia, Muñoz-Ramos Carlos, Xiberta Manel
Department of Obstetrics and Gynecology, Breast Cancer Unit, Hospital Universitari General de Catalunya, Universitat Internacional de Catalunya, Barcelona, Spain.
Department of General Surgery, Breast Cancer Unit, Hospital Universitari General de Catalunya, Universitat Internacional de Catalunya, Barcelona, Spain.
Gland Surg. 2017 Aug;6(4):330-335. doi: 10.21037/gs.2017.03.09.
To evaluate the best method in our center to measure preoperative tumor size in breast tumors, using as reference the tumor size in the postoperative surgical specimen. We compared physical examination . mammography . resonance . ultrasound. There are different studies in the literature with disparate results.
This is a retrospective study. All the included patients have been studied by clinical examination performed by gynecologist or surgeon specialists in senology, and radiological tests (mammography, ultrasound and magnetic resonance imaging). The correlation of mammary examination, ultrasound, mammography and resonance with pathological anatomy was studied using the Pearson index. Subsequently, the results of such imaging tests were compared with the tumor size of the infiltrating component measured by anatomopathological study using a student's test for related variables. The level of significance was set at 95%. Statistical package R. was used.
A total of 73 cases were collected from October 2015 to July 2016 with diagnosis of infiltrating breast carcinoma. Twelve cases of carcinoma in situ and seven cases of neoadjuvant carcinoma are excluded. Finally, a total of 56 cases were included in the analysis. The mean age of the patients is 57 years. The histology is of infiltrating ductal carcinoma in 46 patients (80.7%), lobular in 8 (14%) and other carcinomas in 3 cases (5.2%). We verified the relationship between preoperative tumor size by physical examination, mammography, ultrasound (US) and magnetic resonance imaging (MRI), and the final size of the surgical specimen by applying a Pearson correlation test. A strong correlation was found between the physical examination results 0.62 (0.43-0.76 at 95% CI), ultrasound 0.68 (0.51-0.8 at 95% CI), mammography 0.57 (0.36-0.72 at 95% CI) and RM 0.51 (0.29-0.68 at 95% CI) with respect to pathological anatomy. The mean tumor size of the surgical specimen was 16.1 mm. Mean of tumor size by physical examination was 12.1 mm (P<0.05), by 14 mm US (P<0.05), by mammography of 14.3 (P<0.05) and by MRI of 22.53 mm (P>0.05).
Ultrasonography is the best predictor of tumor size in breast cancer, compared with clinical examination, mammography, and resonance. Our work could help the decision-making process such as the type of conservative surgery, the possible need for oncoplastic surgery or the decision to start treatment with neoadjuvant therapy, in patients with unifocal tumors.
为评估在我们中心测量乳腺肿瘤术前肿瘤大小的最佳方法，以术后手术标本中的肿瘤大小作为参考。我们比较了体格检查、乳腺X线摄影、磁共振成像、超声检查。文献中有不同的研究，结果各异。
这是一项回顾性研究。所有纳入患者均接受了由乳腺科妇科医生或外科专家进行的临床检查以及放射学检查（乳腺X线摄影、超声检查和磁共振成像）。使用Pearson指数研究乳腺检查、超声、乳腺X线摄影和磁共振成像与病理解剖学之间的相关性。随后，使用学生相关变量检验将这些影像学检查结果与通过解剖病理学研究测量的浸润成分的肿瘤大小进行比较。显著性水平设定为95%。使用统计软件包R。
2015年10月至2016年7月共收集了73例浸润性乳腺癌诊断病例。排除12例原位癌和7例新辅助癌病例。最终，共56例纳入分析。患者平均年龄为57岁。组织学类型为浸润性导管癌46例（80.7%），小叶癌8例（14%），其他癌3例（5.2%）。我们通过应用Pearson相关性检验验证了体格检查、乳腺X线摄影、超声（US）和磁共振成像（MRI）术前肿瘤大小与手术标本最终大小之间的关系。发现体格检查结果与病理解剖学的相关性为0.62（95%CI为0.43 - 0.76），超声为0.68（95%CI为0.51 - 0.8），乳腺X线摄影为0.57（95%CI为0.36 - 0.72），磁共振成像为0.51（95%CI为0.29 - 0.68）。手术标本的平均肿瘤大小为16.1毫米。体格检查的肿瘤大小平均值为12.1毫米（P<0.05），超声为14毫米（P<0.05），乳腺X线摄影为14.3毫米（P<0.05），磁共振成像为22.53毫米（P>0.05）。
与临床检查、乳腺X线摄影和磁共振成像相比，超声检查是乳腺癌肿瘤大小的最佳预测指标。我们的工作有助于单灶性肿瘤患者的决策过程，如保乳手术的类型、是否可能需要整形手术或决定开始新辅助治疗。
