From the Department of Radiology, Research Institute of Radiology, Chung-Ang University Hospital, Seoul, Korea (S.M.H.); and Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul 05505, Korea (E.Y.C., J.H.C., H.H.K., H.J.S., W.J.C.).
Radiology. 2018 Jun;287(3):771-777. doi: 10.1148/radiol.2018171472. Epub 2018 Jan 31.
Purpose To investigate the association between preoperative breast magnetic resonance (MR) imaging and surgical outcomes in patients with invasive lobular carcinoma (ILC) by using propensity score matching to decide whether MR examination is beneficial in the ILC subtype of breast cancer. Materials and Methods The authors identified 603 patients with ILC who underwent surgery between January 2005 and December 2016. Of the 603 patients, 369 (61.2%) underwent MR imaging. The authors calculated the MR detection rate of additional lesions that were occult at mammography and ultrasonography and analyzed any alterations in surgical management. After propensity score matching, 196 pairs of patients were allocated to the groups, and the 17 possible confounding variables regarding patient and tumor characteristics and various clinical features were well balanced between the patients who underwent MR imaging and those who did not. Surgical outcomes were compared. Results Of the 369 patients who underwent MR imaging, additional lesions were detected in 145 (39.3%); 95 of the 145 patients (65.5%) had malignant lesions. A change in surgical management occurred because of MR findings in 94 of the 369 patients (25.5%). According to pathologic findings, this change was appropriate for 84 of the 94 patients (89.4%). In the propensity score-matched analysis, breast MR imaging was associated with lower odds of repeat surgery (odds ratio, 0.140; P < .001) and similar likelihood of initial mastectomy (odds ratio, 0.876; P = .528) and final mastectomy (odds ratio, 0.744; P = .151) compared with patients without breast MR imaging. Conclusion Preoperative MR imaging is useful for detecting additional synchronous malignancy and significantly reducing the likelihood of repeat surgery without increasing the rate of mastectomy in patients with ILC. RSNA, 2018.
目的 利用倾向评分匹配来探讨术前乳腺磁共振成像（MR）检查与浸润性小叶癌（ILC）患者手术结果之间的关系，以确定 MR 检查在乳腺癌的 ILC 亚型中是否有益。
材料与方法 本研究回顾性分析了 2005 年 1 月至 2016 年 12 月期间接受手术治疗的 603 例 ILC 患者的资料。其中 369 例（61.2%）患者接受了 MR 检查。本研究计算了在乳腺钼靶和超声检查中隐匿性病变的 MR 检出率，并分析了手术管理的任何改变。经过倾向评分匹配后，将 196 对患者分为两组，对患者和肿瘤特征以及各种临床特征的 17 个可能混杂变量进行了均衡性比较。比较了手术结果。
结果 在接受 MR 检查的 369 例患者中，145 例（39.3%）患者发现了额外病变；其中 95 例（65.5%）患者为恶性病变。369 例患者中有 94 例（25.5%）因 MR 检查结果改变了手术管理方案。根据病理结果，84 例（89.4%）患者的改变是恰当的。在倾向评分匹配分析中，与未接受乳腺 MR 检查的患者相比，MR 检查与较低的再次手术几率（比值比，0.140；P<0.001）和相似的初始乳房切除术（比值比，0.876；P=0.528）及最终乳房切除术（比值比，0.744；P=0.151）几率相关。
结论 术前 MR 成像有助于发现额外的同步恶性肿瘤，并显著降低再次手术的可能性，同时不会增加 ILC 患者乳房切除术的比例。
美国放射学会，2018 年。
