Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1600 Divisadero St, Rm C-250, San Francisco, CA 94115.
Department of Radiology, Mayo Clinic, Rochester, MN.
AJR Am J Roentgenol. 2020 Jul;215(1):254-261. doi: 10.2214/AJR.19.21640. Epub 2020 May 6.
MRI is not routinely used to screen for cancer recurrence after therapeutic mastectomy; however, data on this topic are sparse. We performed this study to determine the utility of breast MRI in detecting asymptomatic locoregional recurrence after therapeutic mastectomy. A retrospective record review identified all breast MRI studies performed in women who had undergone unilateral therapeutic mastectomy over a 6-year period (January 1, 2010, to January 1, 2016). A total of 402 studies were performed in 191 women between the ages of 26 and 78 years old, none of whom were experiencing symptoms on the mastectomy side. BI-RADS assessments for the mastectomy side were extracted from the radiology reports, and the electronic medical records were reviewed for surgical and oncologic history, clinical and imaging follow-up, and pathologic results. Malignancy was determined by pathologic results. Benignity was confirmed by at least one of the following: pathologic results, at least 12 months of documented disease-free clinical follow-up, or at least 12 months of documented disease-free imaging follow-up. Descriptive statistical and 2 × 2 contingency table analyses were performed. In all, 395 MR images (98.3%) were assessed as showing benign findings on the mastectomy side. Seven (1.7%) were interpreted as showing positive findings on the mastectomy side (BI-RADS category 4, suspicious for malignancy). Biopsy was performed in four of the seven positive interpretations. All four biopsies yielded malignancy for a positive predictive value of biopsy of 100%. The three remaining positive cases did not include biopsy; however, in each case, follow-up imaging showed improvement or resolution of the finding, yielding a positive predictive value of an abnormal examination of 57.1%. Two MRI studies were false-negative, with local recurrence within 12 months after MRI deemed to show benign findings, yielding a negative predictive value of 99.5%. Sensitivity and specificity were 66.7% and 99.2%, respectively. The cancer detection rate in the asymptomatic mastectomy side for all MRI examinations was 10 cancers per 1000 examinations. Our findings support inclusion of the mastectomy side in MRI examinations of the contralateral breast to screen for cancer recurrence after therapeutic mastectomy.
磁共振成像（MRI）并非常规用于筛查治疗性乳房切除术后的癌症复发；然而，关于这个主题的数据很少。我们进行这项研究是为了确定在治疗性乳房切除术后无症状局部区域复发时，乳房 MRI 的效用。
回顾性记录审查确定了在过去 6 年期间（2010 年 1 月 1 日至 2016 年 1 月 1 日）接受单侧治疗性乳房切除术的女性中进行的所有乳房 MRI 研究。在 26 至 78 岁的 191 名女性中总共进行了 402 项研究，她们在乳房切除术侧均无任何症状。从放射学报告中提取乳房切除术侧的 BI-RADS 评估结果，并审查电子病历以获取手术和肿瘤学病史、临床和影像学随访以及病理结果。通过病理结果确定恶性肿瘤。良性通过以下至少一种方式确认：病理结果、至少 12 个月无疾病临床随访记录或至少 12 个月无疾病影像学随访记录。进行描述性统计和 2×2 列联表分析。
在所有研究中，395 个 MRI 图像（98.3%）被评估为在乳房切除术侧显示良性发现。7 个（1.7%）被解释为在乳房切除术侧显示阳性发现（BI-RADS 类别 4，恶性肿瘤可疑）。在 7 个阳性解释中的 4 个进行了活检。所有 4 个活检均为恶性肿瘤，活检的阳性预测值为 100%。其余 3 个阳性病例未进行活检；然而，在每个病例中，随访影像学显示发现有所改善或消退，异常检查的阳性预测值为 57.1%。有 2 项 MRI 研究为假阴性，在 MRI 后 12 个月内发现局部复发，被认为显示良性发现，阴性预测值为 99.5%。敏感性和特异性分别为 66.7%和 99.2%。所有 MRI 检查中，无症状乳房切除术侧的癌症检出率为每 1000 例检查 10 例癌症。
我们的研究结果支持将乳房切除术侧纳入对侧乳房的 MRI 检查中，以筛查治疗性乳房切除术后的癌症复发。
