Department of Diagnostic and Interventional Radiology, University Hospital of Cologne, Germany.
Department of Diagnostic and Interventional Radiology, University Hospital of Cologne, Germany.
Surg Oncol. 2019 Jun;29:126-133. doi: 10.1016/j.suronc.2019.04.009. Epub 2019 May 3.
Prophylactic mastectomy (PME) is increasingly performed in women carrying deleterious BRCA1 and BRCA2 germline mutations. The oncologic risk resulting from residual fibroglandular tissue (RGT) is unknown.
All women who had received a mastectomy and at least one postoperative breast MRI, between 2006 and 2016 were extracted from the register of the Center for Hereditary Breast and Ovarian Cancer Cologne (CHBOC). The index MRI was evaluated in terms of basic clinical data and the morphological criteria of RGT. The RGT volume was measured in diameter and was semi-automatically evaluated using software.
We identified 169 women carrying BRCA1/2 mutations who underwent prophylactic and curative mastectomy: a total of 338 breasts. RGT was found in 128 of the 338 breasts (37.9%). 68 of the 128 breasts (53.1%) were related to bilateral PME, 37 (28.9%) to unilateral PME and 23 (18.0%) to curative mastectomy. RGT was predominantly unifocal and located in the retroareolar breast region. RGT was observed more often after bilateral PME (p < 0.0001). In this subgroup, the nipple-sparing mastectomy dominated (108 of 136, 79.4%), in contrast to 23 standard mastectomies (23 of 94, 24.5%) in the subgroup of curative mastectomy (23%). There was a trend towards higher amounts of RGT in surgical units with fewer mastectomies performed. During follow-up, two breast cancers were detected after bilateral and unilateral PME, respectively.
Our results suggest that the indication for surgery and in particular the selected surgical procedure affect the surgical outcome with respect to RGT. Oncological safety should not be neglected, especially in the high-risk group of BRCA1/2 mutation carriers.
预防性乳房切除术（PME）在携带有害 BRCA1 和 BRCA2 种系突变的女性中越来越多地进行。残留纤维腺体组织（RGT）引起的肿瘤风险尚不清楚。
从科隆遗传性乳腺癌和卵巢癌中心（CHBOC）的登记处提取了 2006 年至 2016 年间接受过乳房切除术和至少一次术后乳房 MRI 的所有女性。对索引 MRI 进行了基本临床数据和 RGT 的形态学标准评估。使用软件对 RGT 体积进行了直径测量和半自动评估。
我们确定了 169 名携带 BRCA1/2 突变的女性接受了预防性和根治性乳房切除术：共 338 只乳房。在 338 只乳房中发现了 128 只（37.9%）有 RGT。128 只乳房中的 68 只（53.1%）与双侧 PME 有关，37 只（28.9%）与单侧 PME 有关，23 只（18.0%）与根治性乳房切除术有关。RGT 主要为单灶，位于乳晕后乳房区域。双侧 PME 后 RGT 更常见（p < 0.0001）。在这个亚组中，乳头保留乳房切除术占主导地位（136 例中的 108 例，79.4%），而根治性乳房切除术亚组中的标准乳房切除术（94 例中的 23 例，24.5%）（23 例）。在手术单位中，手术次数越少，RGT 的数量就越高。在随访期间，分别在双侧和单侧 PME 后发现了两例乳腺癌。
我们的结果表明，手术适应证，特别是选择的手术方式，会影响 RGT 的手术结果。特别是在 BRCA1/2 突变携带者的高危人群中，不应忽视肿瘤学安全性。
