在 MRI 上，距离原发性乳腺癌超过 2 厘米的隐匿性附加肿瘤是否具有临床意义？

Are Mammographically Occult Additional Tumors Identified More Than 2 Cm Away From the Primary Breast Cancer on MRI Clinically Significant?

机构信息

Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Ave., 10th Floor, New York, NY 10032.

Memorial Sloan Kettering Cancer Center, New York, NY 10065.

出版信息

Acad Radiol. 2019 Apr;26(4):502-507. doi: 10.1016/j.acra.2018.05.009. Epub 2018 Jun 9.

DOI:10.1016/j.acra.2018.05.009

PMID:29891105

Abstract

RATIONALE AND OBJECTIVES

To evaluate the clinical significance of mammographically occult additional tumors identified more than 2cm away from the primary breast cancer on preoperative magnetic resonance imaging (MRI).

MATERIALS AND METHODS

An Institutional Review Board approved review of consecutive preoperative breast MRIs performed from 1/1/08 to 12/31/14, yielded 667 patients with breast cancer. These patients underwent further assessment to identify biopsy proven mammographically occult breast tumors located more than 2cm away from the edge of the primary tumor. Additional MRI characteristics of the primary and secondary tumors and pathology were reviewed. Statistical analysis was performed using SPSS (v. 24).

RESULTS

Of 667 patients with breast cancer, 129 patients had 150 additional ipsilateral mammographically occult tumors that were more than 2cm away from the edge of the primary tumor. One hundred twelve of 129 (86.8%) patients had one additional tumor and 17/129 (13.2%) had two or more additional tumors. In 71/129 (55.0%), additional tumors were located in a different quadrant and in 58/129 (45.0%) additional tumors were in the same quadrant but ≥2cm away. Overall, primary tumor size was significantly larger (mean 1.87± 1.25 cm) than the additional tumors (mean 0.79 ± 0.61cm, p < 0.001). However, in 20/129 (15.5%) the additional tumor was larger and in 26/129 (20.2%) the additional tumor was ≥1cm. The primary tumor was significantly more likely to be invasive (81.4%, 105/129) compared to additional tumors (70%, 105/150, p = 0.03). In 9/129 (7.0%) patients, additional tumors yielded unsuspected invasive cancer orhigher tumor grade. The additional tumor was more likely to be nonmass lesion type (37.3% vs 24% p = 0.02) and focus lesion type (10% vs 0.08%, p < 0.001) compared to primary tumor.

CONCLUSION

Mammographically occult additional tumors identified more than 2cm away from the primary breast tumor on MRI are unlikely to be surgically treated if undiagnosed and may be clinically significant.

摘要

背景与目的

评估术前磁共振成像（MRI）上发现的距原发性乳腺癌 2cm 以上的隐匿性附加肿瘤的临床意义。

材料与方法

对 2008 年 1 月 1 日至 2014 年 12 月 31 日连续进行的术前乳腺 MRI 进行机构审查委员会批准的回顾性分析，共纳入 667 例乳腺癌患者。对这些患者进行进一步评估，以确定距原发性肿瘤边缘 2cm 以上的经活检证实的隐匿性乳腺肿瘤。回顾分析了原发性和继发性肿瘤的其他 MRI 特征和病理特征。采用 SPSS（v.24）进行统计学分析。

结果

在 667 例乳腺癌患者中，129 例有 150 个隐匿性的同侧乳腺肿瘤，这些肿瘤距原发性肿瘤边缘 2cm 以上。129 例中有 112 例（86.8%）患者仅有一个附加肿瘤，17 例（13.2%）患者有两个或更多附加肿瘤。在 71 例（55.0%）中，附加肿瘤位于不同象限，在 58 例（45.0%）中，附加肿瘤位于同一象限但距原发性肿瘤 2cm 以上。总体而言，原发性肿瘤大小明显大于（平均 1.87±1.25cm）附加肿瘤（平均 0.79 ±0.61cm，p＜0.001）。然而，在 20/129 例（15.5%）中，附加肿瘤更大，在 26/129 例（20.2%）中，附加肿瘤≥1cm。原发性肿瘤明显更可能是浸润性的（81.4%，105/129），而不是附加肿瘤（70%，105/150，p=0.03）。在 9/129 例（7.0%）患者中，附加肿瘤提示意外的浸润性癌或更高的肿瘤分级。与原发性肿瘤相比，附加肿瘤更可能是无肿块病变类型（37.3%比 24%，p=0.02）和焦点病变类型（10%比 0.08%，p＜0.001）。