Massachusetts General Hospital, Department of Radiology, Division of Breast Imaging, 55 Fruit Street, WAC 240, Boston, MA 02114, United States.
Massachusetts General Hospital, Department of Surgery, Division of Surgical Oncology, 55 Fruit Street, Boston, MA 02114, United States.
Eur J Radiol. 2020 Aug;129:109130. doi: 10.1016/j.ejrad.2020.109130. Epub 2020 Jun 20.
To determine if pre-operative MRI is useful for identifying additional disease that would impact surgical management in women with ductal carcinoma in situ (DCIS).
We conducted a retrospective review of consecutive women with calcifications at mammography yielding DCIS at core biopsy from 2007 to 2016 who subsequently underwent MRI examinations. Patient characteristics, imaging findings, and pathology outcomes were collected from the medical records. Standard statistical tests were used to compare the patients who underwent MRI examinations (MRI group) and those who did not (no MRI group).
963 women (age 58 years, range 28-89 years) presented with calcifications that yielded DCIS at biopsy, of whom 236 (24.5 %) underwent MRI examinations. The MRI group was younger, less likely to have a prior breast cancer, and more likely to have dense breasts than the no MRI group (all p < 0.001). 66 women (28.0 %) had 80 MRI findings that were recommended for work-up and/or biopsy. 21 patients had 23 MRI findings that were not pursued pre-operatively, and 45 patients with 57 MRI findings underwent biopsy. The positive predictive value of biopsies performed (PPV3) was 45.6 % (26/57). 26 cancers were detected in 24 women; thus, MRI detected additional sites of cancer in 11.2 % (24/215) of patients. Of the 26 cancers, 13 (50.0 %) were DCIS and 13 (50.0 %) were invasive.
MRI in selected women with DCIS identified additional sites of disease in 11.2 % and thus could be considered in the pre-operative evaluation of this specific patient cohort.
确定术前 MRI 是否有助于识别可能影响乳腺原位癌（DCIS）女性手术管理的额外疾病。
我们对 2007 年至 2016 年期间连续进行的乳腺钙化行核心活检后诊断为 DCIS 的女性患者进行了回顾性研究，这些患者随后接受了 MRI 检查。从病历中收集了患者特征、影像学表现和病理学结果。使用标准统计检验比较了接受 MRI 检查的患者（MRI 组）和未接受 MRI 检查的患者（无 MRI 组）。
963 例女性（年龄 58 岁，范围 28-89 岁）因活检发现钙化而被诊断为 DCIS，其中 236 例（24.5%）接受了 MRI 检查。MRI 组比无 MRI 组年龄更小、乳腺癌病史更少、乳房密度更高（均 p<0.001）。66 例女性（28.0%）有 80 项 MRI 发现，建议进行进一步检查和/或活检。21 例患者有 23 项 MRI 发现未在术前进行追踪，45 例患者有 57 项 MRI 发现进行了活检。活检的阳性预测值（PPV3）为 45.6%（26/57）。26 例癌症在 24 例女性中被检出；因此，MRI 在 11.2%（24/215）的患者中检测到了额外的癌症部位。在 26 例癌症中，13 例（50.0%）为 DCIS，13 例（50.0%）为浸润性癌。
在特定的 DCIS 女性患者中，MRI 发现了额外的疾病部位，占 11.2%，因此可以考虑在这些患者的术前评估中使用 MRI。
