Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 E 66th Street, New York, NY, 10065, United States.
Eur J Radiol. 2019 Aug;117:171-177. doi: 10.1016/j.ejrad.2019.06.011. Epub 2019 Jun 12.
To determine preoperative magnetic resonance imaging (MRI) features associated with positive or close margins in patients with breast cancer who underwent breast-conserving surgery (BCS).
A retrospective review identified 249 patients with invasive ductal carcinoma (IDC) who underwent preoperative MRI and BCS as a primary procedure between 2008 and 2010. The MR images were reviewed for descriptions of findings with no new interpretations made. Margins were defined as positive (tumor touching the inked specimen margin), close (<2 mm tumor-free margin), or negative (≥2 mm tumor-free margin). Multivariate logistic regression analysis was performed to evaluate imaging and clinical factors predictive of positive or close margins.
Of the 249 patients, 83 (33.3%) had positive or close margins and 166 (66.7%) had negative margins on the initial BCS specimen. Multivariate analysis showed that multifocal disease (odds ratio, 4.8; 95% CI, 1.9-12.2; p = 0.001), nonmass enhancement lesion (odds ratio, 3.0; 95% CI, 1.5-6.2, p = 0.003), greater background parenchymal enhancement (odds ratio, 2.5; 95% CI, 1.1-5.6; p = 0.023), larger lesion size (odds ratio, 1.3; 95% CI, 1.0-1.7, p = 0.032), and presence of ductal carcinoma in situ on needle biopsy (odds ratio, 2.4; 95% CI, 1.3-4.6; p = 0.008) were independent predictors of positive or close margins.
Multifocal disease, nonmass enhancement lesion, or greater background parenchymal enhancement on preoperative breast MRI were significantly associated with positive or close margins. Identifying these MRI features before surgery can be helpful to reduce the reoperation rate in BCS.
确定接受保乳手术（BCS）的乳腺癌患者中与保乳手术切缘阳性或临近相关的术前磁共振成像（MRI）特征。
回顾性分析了 2008 年至 2010 年间 249 例接受术前 MRI 和 BCS 的浸润性导管癌（IDC）患者。对 MRI 图像进行了描述性分析，没有进行新的解释。切缘定义为阳性（肿瘤触及墨渍标本边缘）、临近（＜2mm 无肿瘤的切缘）或阴性（≥2mm 无肿瘤的切缘）。采用多变量逻辑回归分析评估预测保乳手术阳性或临近的影像学和临床因素。
在 249 例患者中，83 例（33.3%）初始 BCS 标本切缘阳性或临近，166 例（66.7%）切缘阴性。多变量分析显示，多发病灶（比值比，4.8；95%置信区间，1.9-12.2；p=0.001）、非肿块样强化病变（比值比，3.0；95%置信区间，1.5-6.2，p=0.003）、更大的背景实质强化（比值比，2.5；95%置信区间，1.1-5.6，p=0.023）、更大的病变大小（比值比，1.3；95%置信区间，1.0-1.7，p=0.032）和术前针吸活检存在导管原位癌（比值比，2.4；95%置信区间，1.3-4.6；p=0.008）是保乳手术阳性或临近的独立预测因素。
术前乳腺 MRI 显示多发病灶、非肿块样强化病变或更大的背景实质强化与保乳手术阳性或临近切缘显著相关。在手术前识别这些 MRI 特征有助于降低 BCS 的再次手术率。
