乳腺MRI病变的术前定位：以放射性种子定位的MRI引导标记放置作为MRI引导钢丝定位的替代方法
Preoperative Localization of Breast MRI Lesions: MRI-guided Marker Placement With Radioactive Seed Localization as an Alternative to MRI-guided Wire Localization.
作者信息
Saphier Nicole, Kondraciuk Jessica, Morris Elizabeth, Bernard-Davila Blanca, Mango Victoria
机构信息
Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY.
出版信息
J Breast Imaging. 2020 Jun;2(3):250-258. doi: 10.1093/jbi/wbaa012. Epub 2020 Apr 23.
OBJECTIVE
Preoperative MRI-guided wire localization (MWL) presents challenges to both the physician and patient. In this study, we examined the efficiency and outcome of MRI-guided marker placement followed by mammographic-guided radioactive seed localization (MMP/RSL) as an alternative localization method. The primary outcome parameter was pathology upon excision. The secondary outcome parameters were total procedure time and clinical indication for localization.
METHODS
A retrospective review of a large tertiary cancer center's breast imaging database was performed. Records of 21 patients with MMP/RSL (24 markers) from August 2013 to January 2019 were compared with 34 patients receiving MWL (48 wires) from January 2016 to January 2019. Multiple factors, including age, prelocalization pathology, postsurgical pathology, concordance, re-excision rates, and total procedure time required for each technique, were compared. Univariate and descriptive statistical analyses were performed.
RESULTS
Mean patient age in years (MMP/RSL = 54.1 ± 13.1, MWL = 55.1 ± 10.8, = 0.389), time in MR scanner in minutes (MMP/RSL = 31.7 ± 12.0, MWL = 35.8 ± 13.1, = 0.678), and postsurgical pathology malignancy rates (MMP/RSL = 71.4%, MWL = 65.7%, = 0.7715) were similar without statistically significant differences. As expected, the mean total procedure time was slightly longer without a statistically significant difference (47.3 ± 19.8 min versus 35.8 ± 13.1 min, = 0.922) for the MMP/RSL group. All patients in both groups underwent successful localization with 100% radiologic-pathology concordance. Re-excision rates were lower for the MMP/RSL group (9.5%) versus the MWL group (16.7%); however, they were not found to be statistically significant ( = 0.7104).
CONCLUSION
MMP/RSL is a feasible alternative to MWL and may alleviate many challenges presented by MWL. Further studies are needed.
目的
术前磁共振成像引导下金属丝定位（MWL）对医生和患者均构成挑战。在本研究中，我们考察了磁共振成像引导下放置标记物随后进行乳腺X线引导下放射性种子定位（MMP/RSL）作为一种替代定位方法的效率和结果。主要结局参数为切除标本的病理检查结果。次要结局参数为整个操作时间和定位的临床指征。
方法
对一家大型三级癌症中心的乳腺影像数据库进行回顾性研究。将2013年8月至2019年1月接受MMP/RSL的21例患者（24个标记物）的记录与2016年1月至2019年1月接受MWL的34例患者（48根金属丝）的记录进行比较。比较了多个因素，包括年龄、定位前病理、术后病理、一致性、再次切除率以及每种技术所需的整个操作时间。进行了单因素分析和描述性统计分析。
结果
两组患者的平均年龄（MMP/RSL = 54.1 ± 13.1岁，MWL = 55.1 ± 10.8岁，P = 0.389）、在磁共振扫描仪中的时间（分钟）（MMP/RSL = 31.7 ± 12.0，MWL = 35.8 ± 13.1，P = 0.678）以及术后病理恶性率（MMP/RSL = 71.4%，MWL = 65.7%，P = 0.7715）相似，无统计学显著差异。正如预期的那样，MMP/RSL组的平均整个操作时间略长，但无统计学显著差异（47.3 ± 19.8分钟对35.8 ± 13.1分钟，P = 0.922）。两组所有患者均成功定位，放射学-病理学一致性达100%。MMP/RSL组的再次切除率（9.5%）低于MWL组（16.7%）；然而，差异无统计学显著性（P = 0.7104）。
结论
MMP/RSL是MWL的一种可行替代方法，可能减轻MWL带来的许多挑战。需要进一步研究。
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