Moloney Brian M, McAnena Peter F, Ryan Éanna J, Beirn Ellen O, Waldron Ronan M, Connell AnnaMarie O, Walsh Sinead, Ennis Rachel, Glynn Catherine, Lowery Aoife J, McCarthy Peter A, Kerin Michael J
Department of Radiology, Galway University Hospital, Saolta University Health Care Group, Galway, Ireland.
Discipline of Surgery, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Galway, Ireland.
Breast Cancer (Auckl). 2020 Aug 14;14:1178223420948477. doi: 10.1177/1178223420948477. eCollection 2020.
Due to an insidious proliferative pattern, invasive lobular breast cancer (ILC) often fails to form a defined radiological or palpable lesion and accurate diagnosis remains challenging. This study aimed to determine the value of preoperative magnetic resonance imaging (MRI) for ILC and its impact on surgical outcomes.
Consecutive symptomatic patients diagnosed with ILC in a tertiary centre over a 9-year period were reviewed. The time from diagnosis until surgery, initial type of surgery/index operation (breast-conserving surgery [BCS]/mastectomy) and the rates of reoperation (re-excision/completion mastectomy) were recorded. Patients were grouped into those who received conventional imaging and preoperative MRI (MR+) and those who received conventional imaging alone (MR-).
There were 218 cases of ILC, and 32.1% (n = 70) had preoperative MRI. Time from diagnosis to surgery was longer in the MR+ than the MR- group (32.5 vs 21.1 days, < .001) even when adjusting for age and breast density. Initial BCS was performed on 71.4% (n = 50) of MR+ patients and 72.3% (n = 107) of the MR- group. While the rate of completion mastectomy following initial BCS was higher in the MR+ group (30.0%, n = 15 vs 14.0%, n = 15; χ = 5.63; = .018), this association was not maintained in multivariable analysis. No difference was recorded in overall (initial and completion) mastectomy rate between the MR+ and MR- group (50.0%, n = 35 vs 37.8%, n = 56; χ = 2.89; = .089). Margin re-excision following BCS was comparable between groups (8.0%, n =4, vs 9.3%, n = 10; χ = 0.076, = .783) despite the selection bias for borderline conservable cases in the MR+ group. The rate of usage of MRI for ILC cases declined over the study period.
While MRI was associated with minor delays in treatment and did not reduce overall rates of margin re-excision or completion mastectomy, it altered the choice of surgical procedure in almost a quarter of MR+ cases. The benefit of preoperative breast MRI appears to be confined to select (younger, dense breast, borderline conservable) cases in symptomatic ILC.
由于浸润性小叶癌（ILC）具有隐匿性增殖模式，常常无法形成明确的放射学或可触及病变，准确诊断仍然具有挑战性。本研究旨在确定术前磁共振成像（MRI）对ILC的价值及其对手术结果的影响。
回顾了在一家三级中心9年期间连续诊断为ILC的有症状患者。记录从诊断到手术的时间、初始手术类型/索引手术（保乳手术[BCS]/乳房切除术）以及再次手术（再次切除/完成乳房切除术）的发生率。患者分为接受传统成像和术前MRI的患者（MR+）以及仅接受传统成像的患者（MR-）。
共有218例ILC病例，32.1%（n = 70）进行了术前MRI检查。即使在调整年龄和乳房密度后，MR+组从诊断到手术的时间仍比MR-组长（32.5天对21.1天，P <.001）。71.4%（n = 50）的MR+患者和72.3%（n = 107）的MR-组进行了初始BCS。虽然初始BCS后完成乳房切除术的发生率在MR+组中较高（30.0%，n = 15对14.0%，n = 15；χ² = 5.63；P =.018），但在多变量分析中这种关联未得到维持。MR+组和MR-组之间总体（初始和完成）乳房切除术发生率无差异（50.0%，n = 35对37.8%，n = 56；χ² = 2.89；P =.089）。尽管MR+组对临界可保乳病例存在选择偏倚，但BCS后切缘再次切除率在两组之间相当（8.0%，n = 4对9.3%，n = 10；χ² = 0.076，P =.783）。在研究期间，ILC病例中MRI的使用率有所下降。
虽然MRI与治疗轻微延迟有关，且未降低切缘再次切除或完成乳房切除术的总体发生率，但它改变了近四分之一MR+病例的手术方式选择。术前乳房MRI的益处似乎仅限于有症状ILC中的特定（年轻、乳房致密、临界可保乳）病例。
