Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
BMC Cancer. 2020 Sep 29;20(1):934. doi: 10.1186/s12885-020-07443-7.
Preoperative breast magnetic resonance imaging (MRI) provides more information than mammography and ultrasonography for determining the surgical plan for patients with breast cancer. This study aimed to determine whether breast MRI is more useful for patients with ductal carcinoma in situ (DCIS) lesions than for those with invasive ductal carcinoma (IDC).
A total of 1113 patients with breast cancer underwent mammography, ultrasonography, and additional breast MRI before surgery. The patients were divided into 2 groups: DCIS (n = 199) and IDC (n = 914), and their clinicopathological characteristics and oncological outcomes were compared. Breast surgery was classified as follows: conventional breast-conserving surgery (Group 1), partial mastectomy with volume displacement (Group 2), partial mastectomy with volume replacement (Group 3), and total mastectomy with or without reconstruction (Group 4). The initial surgical plan (based on routine mammography and ultrasonography) and final surgical plan (after additional breast MRI) were compared between the 2 groups. The change in surgical plan was defined as group shifting between the initial and final surgical plans.
Changes (both increasing and decreasing) in surgical plans were more common in the DCIS group than in the IDC group (P < 0.001). These changes may be attributed to the increased extent of suspicious lesions on breast MRI, detection of additional daughter nodules, multifocality or multicentricity, and suspicious findings on mammography or ultrasonography but benign findings on breast MRI. Furthermore, the positive margin incidence in frozen biopsy was not different (P = 0.138).
Preoperative breast MRI may provide more information for determining the surgical plan for patients with DCIS than for those with IDC.
术前乳腺磁共振成像（MRI）比乳腺钼靶和超声检查能提供更多关于乳腺癌患者手术方案的信息。本研究旨在确定乳腺 MRI 对导管原位癌（DCIS）病变患者是否比浸润性导管癌（IDC）患者更有用。
共有 1113 例乳腺癌患者在术前接受了乳腺钼靶、超声和额外的乳腺 MRI 检查。患者分为 2 组：DCIS（n=199）和 IDC（n=914），比较其临床病理特征和肿瘤学结局。乳腺手术分为以下几类：常规保乳手术（1 组）、部分乳房切除术伴容积置换（2 组）、部分乳房切除术伴容积重建（3 组）和全乳房切除术伴或不伴重建（4 组）。比较两组患者的初始手术方案（基于常规乳腺钼靶和超声）和最终手术方案（在进行额外的乳腺 MRI 后）。将初始和最终手术方案之间的手术方案变化定义为组间转移。
DCIS 组的手术方案变化（包括增加和减少）比 IDC 组更常见（P<0.001）。这些变化可能归因于乳腺 MRI 上可疑病变的范围增加、额外的子结节检出、多灶性或多中心性、乳腺钼靶或超声上的可疑发现而乳腺 MRI 上为良性发现。此外，冷冻活检的阳性切缘发生率无差异（P=0.138）。
术前乳腺 MRI 可能为 DCIS 患者提供比 IDC 患者更全面的手术方案信息。
