Zeng Zexian, Amin Amanda, Roy Ankita, Pulliam Natalie E, Karavites Lindsey C, Espino Sasa, Helenowski Irene, Li Xiaoyu, Luo Yuan, Khan Seema A
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL USA.
Department of Data Sciences, Dana-Farber Cancer Institute, Harvard T.H.Chan School of Public Health, Boston, MA USA.
NPJ Breast Cancer. 2020 Oct 2;6:49. doi: 10.1038/s41523-020-00192-7. eCollection 2020.
Breast magnetic resonance imaging (MRI) delineates disease extent sensitively in newly diagnosed breast cancer patients, but improved cancer outcomes are uncertain. Young women, for whom mammography is less sensitive, are expected to benefit from MRI-based resection. We identified 512 women aged ≤50 years, undergoing breast-conserving treatment (BCT: tumor-free resection margins and radiotherapy) during 2006-2013 through Northwestern Medicine database queries; 64.5% received preoperative MRI and 35.5% did not. Tumor and treatment parameters were similar between groups. We estimated the adjusted hazard ratios (aHR) for local and distant recurrences (LR and DR), using multivariable regression models, accounting for important therapeutic and prognostic parameters. LR rate with MRI use was 7.9 vs. 8.2% without MRI, aHR = 1.03 (95% CI 0.53-1.99). DR rate was 6.4 vs. 6.6%, aHR = 0.89 (95% CI 0.43-1.84). In 119 women aged ≤40, results were similar to LR aHR = 1.82 (95% CI 0.43-7.76) and DR aHR = 0.93 (95% CI 0.26-3.34). Sensitivity analyses showed similar results. The use of preoperative MRI in women aged ≤50 years should be reconsidered until there is proof of benefit.
乳腺磁共振成像（MRI）能敏感地描绘新诊断乳腺癌患者的疾病范围，但癌症预后改善情况尚不确定。对于乳腺钼靶检查敏感度较低的年轻女性，预计可从基于MRI的切除术中获益。我们通过西北医学数据库查询，确定了2006年至2013年期间接受保乳治疗（BCT：切缘无肿瘤且接受放疗）的512名年龄≤50岁的女性；64.5%的患者接受了术前MRI检查，35.5%未接受。两组间肿瘤及治疗参数相似。我们使用多变量回归模型，考虑重要的治疗和预后参数，估计局部和远处复发（LR和DR）的调整风险比（aHR）。使用MRI的LR率为7.9%，未使用MRI的为8.2%，aHR = 1.03（95%CI 0.53 - 1.99）。DR率分别为6.4%和6.6%，aHR = 0.89（95%CI 0.43 - 1.84）。在119名年龄≤40岁的女性中，结果与LR的aHR = 1.82（95%CI 0.43 - 7.76）和DR的aHR = 0.93（95%CI 0.26 - 3.34）相似。敏感性分析显示结果相似。在有获益证据之前，应重新考虑在年龄≤50岁女性中使用术前MRI。
