Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, 330 Cedar St. Boardman Bld 3rd fl., New Haven, CT 06510, United States.
Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, 330 Cedar St. Boardman Bld 3rd fl., New Haven, CT 06510, United States.
J Plast Reconstr Aesthet Surg. 2019 May;72(5):789-794. doi: 10.1016/j.bjps.2018.11.015. Epub 2018 Nov 22.
CT angiography (CTA) can be performed pre-operatively for perforator mapping in autologous breast reconstruction. The full impact of incidental CTA findings on breast reconstruction remains unclear.
CTAs were reviewed for all patients who underwent imaging prior to autologous breast reconstruction at Yale New Haven Hospital from 2013-2018. CTA findings and all resulting follow-up imaging, treatment, and change in management were catalogued. Our findings were compared to other published reports in the literature to better categorize the impact of CTA findings on patient care.
Records from 341 patients were reviewed. One hundred fifty-four patients (45.2%) had incidental findings with 15.6% requiring further imaging or biopsy. Three patients (0.9%) underwent a change in management. One patient was diagnosed with metastatic disease prior to mastectomy. Another two patients required gynecologic procedures as a result of the CTA findings. Data was pooled with three other series in the literature for aggregate analysis of 959 operative planning CTAs. In total, incidental findings were present in 53.7% of patients. In the meta-analysis, 10.4% of patients required additional imaging or biopsy and 1.4% of screening CTAs impacted medical management.
Pre-operative autologous breast reconstruction planning reveals incidental findings in approximately half of all imaging studies. In an analysis of nearly 1000 CTAs, patient care was impacted in 1.4% of cases. If imaging is obtained for planning purposes, the reconstructive microsurgeon should carefully review the full imaging report given its potential impact on patient care.
CT 血管造影（CTA）可在自体乳房重建术前进行穿支映射。CTA 偶然发现对乳房重建的全面影响尚不清楚。
回顾了 2013 年至 2018 年在耶鲁纽黑文医院进行自体乳房重建术前进行影像学检查的所有患者的 CTA 检查结果。对 CTA 结果以及所有后续影像学检查、治疗和管理变更进行了分类。我们的发现与文献中的其他已发表报告进行了比较，以更好地对 CTA 结果对患者护理的影响进行分类。
共回顾了 341 名患者的记录。154 名患者（45.2%）有偶然发现，其中 15.6%需要进一步进行影像学检查或活检。有 3 名患者（0.9%）改变了治疗方案。有 1 名患者在乳房切除术前被诊断为转移性疾病。另有 2 名患者因 CTA 结果需要进行妇科手术。数据与文献中的另外三个系列进行了汇总分析，共分析了 959 例手术计划 CTA。总的来说，偶然发现存在于 53.7%的患者中。在荟萃分析中，10.4%的患者需要额外的影像学检查或活检，1.4%的筛查 CTA 影响了医疗管理。
术前自体乳房重建计划揭示了约一半影像学研究中的偶然发现。在近 1000 例 CTA 的分析中，有 1.4%的病例患者的护理受到影响。如果为了计划目的进行影像学检查，重建显微外科医生应仔细审查完整的影像学报告，因为其可能对患者护理产生影响。
