Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 1144 Eastlake Avenue East, LG2-200, Seattle, WA 98109.
Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 1144 Eastlake Avenue East, LG2-200, Seattle, WA 98109.
Acad Radiol. 2020 Apr;27(4):478-486. doi: 10.1016/j.acra.2019.05.013. Epub 2019 Jul 5.
Use of preoperative breast MRI (pMRI) to evaluate ductal carcinoma in situ (DCIS) extent is controversial due to limited data on its impact on surgical management. We sought to evaluate the effect of pMRI on surgical management of women with core needle biopsy (CNB)-diagnosed pure DCIS at a multidisciplinary academic institution.
This retrospective study included all women with CNB-diagnosed DCIS (1/2004-12/2013) without prior ipsilateral breast cancer and who underwent surgery within 180 days of diagnosis. Patient features, number of CNBs and surgeries, and single successful breast conserving surgery (BCS) rate were compared between pMRI and no-pMRI cohorts. Number of surgeries and single BCS success rates were also compared to published US (SEER) and Danish National Registry data.
Among the 373 women included, no clinical differences were identified between the pMRI (n = 332) and no-pMRI (n = 41) cohorts (p > 0.05). The pMRI group experienced a higher additional CNB rate (30% vs. 7%, p = 0.002) but fewer total surgeries (mean = 1.2 vs. 1.5, p < 0.001) than the no-pMRI group. Among the 245 women for whom BCS was attempted, the pMRI cohort underwent fewer mean surgeries (1.3 vs. 1.7, p < 0.001) with a greater single successful BCS rate (77% vs. 43%, p < 0.001). Compared to published data, women with pMRI who underwent BCS experienced fewer surgeries (difference (Δ) = -0.22 vs. -0.17, p < 0.001) with a higher single successful BCS rate (Δ = +20% vs. +14%, p < 0.001).
pMRI may improve surgical management of DCIS at multidisciplinary centers with breast cancer specialists.
术前乳腺磁共振成像（pMRI）在评估导管原位癌（DCIS）程度方面存在争议，因为其对手术管理影响的数据有限。我们旨在评估 pMRI 对多学科学术机构中经核心针活检（CNB）诊断为单纯 DCIS 女性手术管理的影响。
本回顾性研究纳入了所有在 2004 年 1 月至 2013 年 12 月期间经 CNB 诊断为 DCIS（无同侧乳腺癌既往史）且在诊断后 180 天内接受手术的女性患者。比较了 pMRI 组和无 pMRI 组的患者特征、CNB 数量和手术数量以及单次保乳手术（BCS）成功率。还比较了手术数量和单次 BCS 成功率与美国（SEER）和丹麦国家登记处的数据。
在纳入的 373 名女性患者中，pMRI 组（n=332）与无 pMRI 组（n=41）之间未发现临床差异（p＞0.05）。pMRI 组的额外 CNB 率较高（30% vs. 7%，p=0.002），但总手术次数较少（平均值 1.2 次 vs. 1.5 次，p＜0.001）。在 245 名尝试行 BCS 的女性患者中，pMRI 组的平均手术次数较少（1.3 次 vs. 1.7 次，p＜0.001），单次成功 BCS 率较高（77% vs. 43%，p＜0.001）。与已发表的数据相比，行 BCS 的 pMRI 女性患者手术次数较少（差异（Δ）=-0.22 次 vs. -0.17 次，p＜0.001），单次成功 BCS 率较高（差异（Δ）=+20% vs. +14%，p＜0.001）。
在具有乳腺癌专家的多学科中心，pMRI 可能改善 DCIS 的手术管理。
