Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
Ann Surg Oncol. 2021 Oct;28(11):5929-5938. doi: 10.1245/s10434-021-09868-1. Epub 2021 Apr 1.
This study aimed to examine the association between preoperative magnetic resonance imaging (MRI) and surgical margin involvement, as well as to determine the factors associated with positive resection margins in screen-detected breast cancer patients undergoing breast-conserving surgery (BCS).
Breast cancer patients eligible for BCS and diagnosed after biennial screening mammography in the south of The Netherlands (2008-2017) were retrospectively included. Missing values were imputed and multivariable regression analyses were performed to analyze whether preoperative MRI was related to margin involvement after BCS, as well as to examine what factors were associated with positive resection margins, defined as more than focally (>4 mm) involved.
Overall, 2483 patients with invasive breast cancer were enrolled, of whom 123 (5.0%) had more than focally involved resection margins. In multivariable regression analyses, preoperative MRI was associated with a reduced risk of positive resection margins after BCS (adjusted odds ratio [OR] 0.56, 95% confidence interval [CI] 0.33-0.96). Lobular histology (adjusted OR 2.86, 95% CI 1.68-4.87), large tumor size (per millimeter increase, adjusted OR 1.05, 95% CI 1.03-1.07), high (>75%) mammographic density (adjusted OR 3.61, 95% CI 1.07-12.12), and the presence of microcalcifications (adjusted OR 4.45, 95% CI 2.69-7.37) and architectural distortions (adjusted OR 1.85, 95% CI 1.01-3.40) were independently associated with positive resection margins after BCS.
Preoperative MRI was associated with lower risk of positive resection margins in patients with invasive breast cancer eligible for BCS using multivariable analysis. Furthermore, specific mammographic characteristics and tumor characteristics were independently associated with positive resection margins after BCS.
本研究旨在探讨术前磁共振成像（MRI）与手术切缘受累之间的关系，并确定接受保乳手术（BCS）的筛查性乳腺癌患者中与阳性切缘相关的因素。
回顾性纳入 2008-2017 年在荷兰南部接受双年度筛查乳房 X 线摄影检查后诊断为乳腺癌并适合接受 BCS 的患者。对缺失值进行了插补，并进行了多变量回归分析，以分析术前 MRI 是否与 BCS 后切缘受累相关，并探讨哪些因素与阳性切缘相关，定义为局部>4mm 受累。
共纳入 2483 例浸润性乳腺癌患者，其中 123 例（5.0%）存在局部>4mm 受累的阳性切缘。多变量回归分析显示，术前 MRI 与 BCS 后阳性切缘的风险降低相关（调整后的优势比 [OR] 0.56，95%置信区间 [CI] 0.33-0.96）。小叶组织学（调整后的 OR 2.86，95% CI 1.68-4.87）、肿瘤较大（每毫米增加，调整后的 OR 1.05，95% CI 1.03-1.07）、高（>75%）乳腺密度（调整后的 OR 3.61，95% CI 1.07-12.12）以及微钙化（调整后的 OR 4.45，95% CI 2.69-7.37）和结构扭曲（调整后的 OR 1.85，95% CI 1.01-3.40）的存在与 BCS 后阳性切缘独立相关。
多变量分析显示，术前 MRI 与接受 BCS 的浸润性乳腺癌患者的阳性切缘风险降低相关。此外，特定的乳房 X 线摄影特征和肿瘤特征与 BCS 后阳性切缘独立相关。
