Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, NC.
Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Duke University Medical Center, Durham, NC.
J Am Coll Surg. 2020 Apr;230(4):605-614.e1. doi: 10.1016/j.jamcollsurg.2020.01.006. Epub 2020 Feb 5.
Few guidelines exist regarding surveillance and diagnostic imaging after breast reconstruction. This study investigated the influence of breast reconstruction on the frequency of post-mastectomy imaging, the relative utility of imaging, and its effect on overall and locoregional recurrence-free survival.
A retrospective review identified breast cancer patients (n = 1,216) who underwent mastectomy with or without reconstruction. Logistic regression identified surgical and oncologic predictors of post-reconstruction imaging. Kaplan-Meier method determined the impact of post-reconstruction imaging on overall and locoregional recurrence-free survival.
Overall, 662 (54.4%) patients underwent mastectomy only and 554 (45.6%) underwent breast reconstruction. Patients undergoing reconstruction were more likely to receive imaging compared with patients undergoing mastectomy only (n = 205, 37.0% vs n = 168, 25.4%; p < 0.0001); however, this difference was not statistically significant after adjusting for age and follow-up time (p = 0.16). Most radiographic studies were Breast Imaging Reporting and Data System (BI-RADS) 1 (n = 58, 30%) or 2 (n = 95, 49%) and were ordered by nonsurgical providers (n = 128, 63%). Post-reconstruction imaging did not influence overall or locoregional recurrence-free survival. The 5-year survival probabilities for breast reconstruction patients who underwent imaging for a palpable mass, surveillance, or who did not undergo imaging were 100%, 95% (95% CI 89% to 100%), and 96% (95% CI 94% to 99%), respectively. Post-reconstruction imaging was not a significant predictor of overall survival (hazard ratio [HR] 0.95; 95% CI 0.61 to 1.46; p = 0.30).
The limited utility of routine post-reconstruction imaging should be reinforced when evaluating breast reconstruction patients. Multidisciplinary collaboration should be emphasized when attempting to distinguish benign postoperative findings from a malignant process to reduce unnecessary imaging and biopsy after breast reconstruction.
目前针对乳房重建术后的监测和诊断影像学检查，尚缺乏相关指南。本研究旨在探讨乳房重建术对乳房切除术后影像学检查频率、影像学检查相对效用及其对总生存和局部区域无复发生存的影响。
本研究回顾性分析了 1216 例接受乳房切除术（伴或不伴重建术）的乳腺癌患者。采用逻辑回归分析确定了与术后重建影像学检查相关的手术和肿瘤学预测因素。采用 Kaplan-Meier 法评估了术后重建影像学检查对总生存和局部区域无复发生存的影响。
总体而言，662 例（54.4%）患者仅行乳房切除术，554 例（45.6%）患者行乳房重建术。与仅行乳房切除术的患者相比，行重建术的患者更有可能接受影像学检查（n=205，37.0% vs n=168，25.4%；p<0.0001）；然而，在校正年龄和随访时间后，这种差异无统计学意义（p=0.16）。大多数影像学研究为乳腺影像报告和数据系统（BI-RADS）1 级（n=58，30%）或 2 级（n=95，49%），且由非外科医生开具（n=128，63%）。术后重建影像学检查并未影响总生存或局部区域无复发生存。行影像学检查用于触诊肿块、监测或未行影像学检查的乳房重建术患者的 5 年生存率分别为 100%、95%（95%CI 89%100%）和 96%（95%CI 94%99%）。术后重建影像学检查不是总生存的显著预测因素（风险比[HR]0.95；95%CI 0.61~1.46；p=0.30）。
在评估乳房重建术患者时，应强调术后常规重建影像学检查的效用有限。在尝试区分良性术后表现与恶性过程时，应强调多学科协作，以减少乳房重建术后不必要的影像学检查和活检。
