Glenfield Hospital, University Hospitals of Leicester, Groby Road, Leicester LE3 9QP, United Kingdom.
Heartlands Hospitals, Heart of England NHS foundation Trust, Bordesley Green E, Birmingham B9 5SS, United Kingdom.
Eur J Radiol. 2017 Oct;95:271-277. doi: 10.1016/j.ejrad.2017.08.027. Epub 2017 Aug 31.
Preoperative assessment of pure Ductal Carcinoma Insitu (DCIS) is essential in the surgical planning. The role of Magnetic resonance imaging (MRI) has long been debated. The impact of MRI on the management of High Grade (HG) DCIS was assessed, whether it accurately captures the true size of this entity in comparison to conventional imaging, and, if MRI use would reduce the number of re-excision surgery.
Ninety-one consecutive patients with HG DCIS, who were identified from a prospectively collected data at Kettering General Hospital between April 2011 and December 2015. All patients had preoperative MRI scan in addition to the standard breast imaging. This was compared to a control group of consecutive patients (n=52) which was obtained from a period just before 2011. Impact on surgical planning and number of surgeries for each patient was compared. The size of HG DCIS estimated by MRI was compared to the final histological size. Secondary outcomes included change of initial surgical plan and detection of occult contralateral breast cancer.
MRI group had 91 patients with median age of 63. Seventy percent of which presented through the screening program. The overall sensitivity of MRI to detect HG DCIS was 77% (70/91) with a false negative rate FNR of 23% (21/91). Therefore, 70 patients only were included in the data analysis. The control group included 52 screening patients with comparable baseline characteristics. Re-excision (or completion mastectomy) rates were higher in the control group 26% compared to 8% in the MRI group (P-value 0.012). MRI use correctly converted the initial plan of breast conservation to mastectomy in 9 patients (13%). Five patients had additional ipsilateral malignant features (7%).Occult contra lateral disease, was diagnosed in 2 patients (3%).
This study suggests that MRI could be an important tool in reducing the re-excision rates in the surgical management of HG DCIS. Although still controversial, selective MRI imaging can be useful in the preoperative diagnosis and evaluation of HG DCIS. Case by case discussion at MDT is crucial. Wider adaptation of MRI when indicated in the assessment of breast lesions with proper correlation to histology postoperatively is a key in improving our MRI interpretation skills, helping us to exploit the full scope of this useful tool.
术前评估单纯导管原位癌（DCIS）对于手术计划至关重要。磁共振成像（MRI）的作用一直存在争议。本研究评估了 MRI 对高级别（HG）DCIS 管理的影响，是否能准确地比传统影像学更准确地捕获实体的真实大小，以及 MRI 的使用是否会减少再次切除手术的数量。
从 2011 年 4 月至 2015 年 12 月期间，在凯特林综合医院前瞻性收集的数据中，连续确定了 91 例 HG DCIS 患者。所有患者均接受术前 MRI 扫描和标准乳腺影像学检查。将这组患者与连续患者（n=52）进行对比，后者来自 2011 年之前的一个时期。比较每位患者的手术计划和手术次数的影响。通过 MRI 估计的 HG DCIS 大小与最终组织学大小进行比较。次要结果包括初始手术计划的变化和隐匿性对侧乳腺癌的检测。
MRI 组有 91 例患者，中位年龄为 63 岁。其中 70%是通过筛查计划发现的。MRI 检测 HG DCIS 的总体敏感性为 77%（70/91），假阴性率为 23%（21/91）。因此，只有 70 例患者纳入数据分析。对照组包括 52 例筛查患者，具有可比的基线特征。对照组（26%）的再次切除（或完成乳房切除术）率高于 MRI 组（8%）（P 值=0.012）。MRI 组 9 例（13%）患者的初始保乳手术计划被正确转为乳房切除术。5 例患者同侧有额外的恶性特征（7%）。2 例（3%）患者诊断出隐匿性对侧疾病。
本研究表明，MRI 可能是减少 HG DCIS 手术管理中再次切除率的重要工具。尽管仍存在争议，但选择性 MRI 成像可在 HG DCIS 的术前诊断和评估中发挥作用。多学科团队（MDT）的病例讨论至关重要。在评估具有适当术后组织学相关性的乳腺病变时，在适当的情况下广泛采用 MRI，并提高我们对 MRI 解读技能的认识，这是充分利用这一有用工具的关键。
