Hamza Ameer, Khawar Sidrah, Sakhi Ramen, Alrajjal Ahmed, Miller Shelby, Ibrar Warda, Edens Jacob, Salehi Sajad, Ockner Daniel
St. John Hospital and Medical Center, Detroit, MI, USA.
Ultrasound. 2019 Feb;27(1):45-54. doi: 10.1177/1742271X18804278. Epub 2018 Oct 23.
Radiologic assessment of tumor size is an integral part of the work-up for breast carcinoma. With improved radiologic equipment, surgical decision relies profoundly upon radiologic/clinical stage. We wanted to see the concordance between radiologic and pathologic tumor size to infer how accurate radiologic/clinical staging is.
The surgical pathology and ultrasonography reports of patients with breast carcinoma were reviewed. Data were collected for 406 cases. Concordance was defined as a size difference within ±2 mm.
The difference between radiologic and pathologic tumor size was within ±2 mm in 40.4% cases. The mean radiologic size was 1.73 ± 1.06 cm. The mean pathologic size was 1.84 ± 1.24 cm. A paired -test showed a significant mean difference between radiologic and pathologic measurements (0.12 ± 1.03 cm, = 0.03). Despite the size difference, stage classification was the same in 59.9% of cases. Radiologic size overestimated stage in 14.5% of cases and underestimated stage in 25.6% of cases. The concordance rate was significantly higher for tumors ≤2 cm (pT1) (51.1%) as compared to those greater than 2 cm (≥pT2) (19.7%) ( < 0.0001). Significantly more lumpectomy specimens (47.5%) had concordance when compared to mastectomy specimens (29.8%) ( < 0.0001). Invasive ductal carcinoma had better concordance compared to other tumors ( = 0.02).
Mean pathologic tumor size was significantly different from mean radiologic tumor size. Concordance was in just over 40% of cases and the stage classification was the same in about 60% of cases only. Therefore, surgical decision of lumpectomy versus mastectomy based on radiologic tumor size may not always be accurate.
肿瘤大小的影像学评估是乳腺癌检查的一个重要组成部分。随着放射设备的改进，手术决策在很大程度上依赖于影像学/临床分期。我们希望观察影像学与病理肿瘤大小之间的一致性，以推断影像学/临床分期的准确性。
回顾了乳腺癌患者的手术病理和超声检查报告。收集了406例患者的数据。一致性定义为大小差异在±2毫米以内。
40.4%的病例中，影像学与病理肿瘤大小的差异在±2毫米以内。影像学平均大小为1.73±1.06厘米。病理平均大小为1.84±1.24厘米。配对t检验显示影像学与病理测量之间存在显著的平均差异（0.12±1.03厘米，P = 0.03）。尽管存在大小差异，但59.9%的病例分期分类相同。14.5%的病例中影像学大小高估了分期，25.6%的病例中低估了分期。与大于2厘米（≥pT2）的肿瘤（19.7%）相比，≤2厘米（pT1）的肿瘤一致性率显著更高（51.1%）（P < 0.0001）。与乳房切除术标本（29.8%）相比，保乳手术标本的一致性明显更多（47.5%）（P < 0.0001）。与其他肿瘤相比，浸润性导管癌的一致性更好（P = 0.02）。
病理肿瘤平均大小与影像学肿瘤平均大小存在显著差异。一致性仅略高于40%的病例，且仅约60%的病例分期分类相同。因此，基于影像学肿瘤大小进行保乳手术与乳房切除术的手术决策可能并不总是准确的。
