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[术前动态对比增强磁共振成像可降低早期非肿块型乳腺癌患者保乳手术后肿瘤阳性切缘率]

[Preoperative dynamic contrast-enhanced MRI can reduce the rate of tumor-positive resection margins after breast conserving surgery in patients with early non-mass breast carcinoma].

作者信息

Li X S, Song Y L, Li D C, Zhu H X, Meng L M, Huang R R, Wang S L, Wang D, Fang H, Fan H X

机构信息

Department of Magnetic Resonance Imaging, Air Force General Hospital of People's Liberation Army, Beijing 100142, China.

Department of Pathology, Air Force General Hospital of People's Liberation Army, Beijing 100142, China.

出版信息

Zhonghua Zhong Liu Za Zhi. 2017 Oct 23;39(10):768-774. doi: 10.3760/cma.j.issn.0253-3766.2017.10.010.

Abstract

To investigate the value of preoperative dynamic contrast-enhanced MRI in reducing the rate of tumor-positive resection margins after breast conserving surgery in patients with early non-mass breast carcinoma. Seventy-two patients with early non-mass breast carcinoma received ultrasonographic and mammographic examination and subsequently underwent dynamic contrast-enhanced MRI examination before breast conserving surgery. The control group consisted of 74 patients who had early non-mass breast carcinoma. They only received ultrasonographic and mammographic examination and didn't undergo contrast-enhanced MRI examination. The comparison of the rate of tumor-positive resection margins between two groups was performed. The MRI findings that had the significant influence on the rate of tumor-positive resection margins were analyzed using Logistic regression model. In 28 patients (28/72, 38.9%), dynamic contrast-enhanced MRI could correct or supplement the ultrasonographic and mammographic findings and resulted in the reasonable change of surgical program. The preoperative MRI examination group (=30) had lower rate of tumor-positive resection margins than control group for invasive ductal carcinoma (23.3% vs 40.0%, =0.02), but there was no significant difference (21.4% vs 26.9%, =0.10) between two groups for ductal carcinoma in situ (=28). The preoperative MRI examination group (=14) had lower rate of tumor-positive resection margins than control group for the other pathologic types of breast carcinoma (14.3% vs 38.9%, =0.02). The statistical analysis on the basis of Logistic regression model showed that some main MRI findings, including change surrounding the tumor, distance between tumor and nipple and tumor size, had the significant influence on the rate of tumor-positive resection margins. Preoperative dynamic contrast-enhanced MRI significantly increased the accuracy of resection margins evaluation, and greatly reduced the rate of tumor-positive resection margins after breast conserving surgery in patients with early non-mass breast carcinoma.

摘要

探讨术前动态对比增强磁共振成像(MRI)在降低早期非肿块型乳腺癌患者保乳手术后肿瘤阳性切缘率方面的价值。72例早期非肿块型乳腺癌患者接受了超声和乳腺钼靶检查,随后在保乳手术前行动态对比增强MRI检查。对照组由74例早期非肿块型乳腺癌患者组成,他们仅接受了超声和乳腺钼靶检查,未行对比增强MRI检查。对两组患者的肿瘤阳性切缘率进行比较。采用Logistic回归模型分析对肿瘤阳性切缘率有显著影响的MRI表现。在28例患者(28/72,38.9%)中,动态对比增强MRI能够纠正或补充超声和乳腺钼靶检查结果,并导致手术方案的合理改变。术前MRI检查组(n = 30)浸润性导管癌的肿瘤阳性切缘率低于对照组(23.3% 对40.0%,P = 0.02),但原位导管癌两组间无显著差异(21.4% 对26.9%,P = 0.10)(n = 28)。术前MRI检查组(n = 14)其他病理类型乳腺癌的肿瘤阳性切缘率低于对照组(14.3% 对38.9%,P = 0.02)。基于Logistic回归模型的统计分析表明,一些主要的MRI表现,包括肿瘤周围改变、肿瘤与乳头的距离和肿瘤大小,对肿瘤阳性切缘率有显著影响。术前动态对比增强MRI显著提高了切缘评估的准确性,并大大降低了早期非肿块型乳腺癌患者保乳手术后肿瘤阳性切缘率。

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