Duke University Medical Center, Department of Radiology, DUMC Box 3808, Durham, NC 27710, United States of America.
Duke University Medical Center, Department of Medicine, DUMC Box 3913, Durham, NC 27710, United States of America.
Clin Imaging. 2019 Sep-Oct;57:45-49. doi: 10.1016/j.clinimag.2019.05.006. Epub 2019 May 15.
PURPOSE: The purpose of this study is to identify predictors of tumor-positive surgical margins after breast-conserving surgery on dynamic contrast-enhanced (DCE) MRI. MATERIALS AND METHODS: We conducted a retrospective study of consecutive women who underwent DCE MRI before breast-conserving surgery from 2005 to 2014. Patient demographics, indication for surgery, MRI findings, biopsy pathology results, and surgical outcomes were reviewed. The unpaired t-test and chi-square test were used to compare the positive and negative margins groups. RESULTS: 554 women (mean age, 56; range, 26-90) underwent DCE MRI before 575 breast-conserving surgeries for invasive carcinoma (n = 473) or ductal carcinoma in situ (DCIS) (n = 102). Positive margins requiring re-excision occurred in 19.7% (93/473) of surgeries for invasive carcinoma and 31.4% (32/102) of surgeries for DCIS. For invasive carcinoma surgeries, positive margins were more common when MRI demonstrated the finding of non-mass enhancement (NME) rather than the finding of enhancing mass (33.8% [22/65] versus 16.9% [61/360], p < 0.01). Tumor size on MRI was significantly larger in the positive margins group (2.5 cm versus 1.9 cm, p < 0.001). Positive margins were more common with invasive lobular rather than invasive ductal histology at core biopsy (38.3% [18/47] versus 16.0% [56/350], p < 0.001). For DCIS surgeries, there were no significant differences in positive margin rates related to MRI features. CONCLUSION: For invasive carcinoma surgeries, positive margins are associated with NME on MRI, larger tumor size on MRI, and lobular histology at core biopsy. These findings may be used to predict which patients are at risk for positive margins after breast-conserving surgery.
目的:本研究旨在确定保乳手术后动态对比增强(DCE)MRI 上肿瘤阳性切缘的预测因素。
材料与方法:我们对 2005 年至 2014 年间接受 DCE MRI 检查后行保乳手术的连续女性患者进行了回顾性研究。回顾患者的人口统计学资料、手术适应证、MRI 结果、活检病理结果和手术结果。采用配对 t 检验和卡方检验比较阳性和阴性切缘组。
结果:554 例女性(平均年龄 56 岁;范围 26-90 岁)在 575 例浸润性癌(n=473)或导管原位癌(DCIS)(n=102)行保乳术前接受了 DCE MRI 检查。浸润性癌手术中有 19.7%(93/473)出现需要再次切除的阳性切缘,而 DCIS 手术中有 31.4%(32/102)出现阳性切缘。对于浸润性癌手术,MRI 显示非肿块样强化(NME)而非强化肿块(33.8%[22/65]与 16.9%[61/360],p<0.01)时,阳性切缘更为常见。阳性切缘组肿瘤在 MRI 上的大小明显更大(2.5cm 与 1.9cm,p<0.001)。在核心活检中,阳性切缘组浸润性小叶癌而非浸润性导管癌更为常见(38.3%[18/47]与 16.0%[56/350],p<0.001)。对于 DCIS 手术,MRI 特征与阳性切缘率无显著差异。
结论:对于浸润性癌手术,阳性切缘与 MRI 上的 NME、MRI 上肿瘤较大和核心活检中的小叶癌组织学相关。这些发现可用于预测哪些患者在保乳手术后存在阳性切缘的风险。
Clin Imaging. 2019-5-15
Breast Cancer Res Treat. 2020-9