35 岁及以下乳腺癌女性的术前乳房 MRI：应用倾向评分分析对手术结果的获益。
Preoperative Breast MRI in Women 35 Years of Age and Younger with Breast Cancer: Benefits in Surgical Outcomes by Using Propensity Score Analysis.
机构信息
From the Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-Gil, Songpa-Gu, Seoul 05505, Republic of Korea.
出版信息
Radiology. 2021 Jul;300(1):39-45. doi: 10.1148/radiol.2021204124. Epub 2021 Apr 20.
Background The role of preoperative MRI in women 35 years of age or younger with breast cancer remains controversial. Purpose To determine the association between preoperative MRI and surgical outcomes in women aged 35 years or younger with breast cancer by using propensity score (PS) analysis to investigate the impact of preoperative MRI. Materials and Methods Women 35 years of age or younger diagnosed with breast cancer between 2007 and 2017 who had or had not undergone preoperative breast MRI were retrospectively identified. The MRI detection rate of additional suspicious lesions was analyzed, and changes in surgical management were recorded. Inverse probability weighting (IPW) and PS matching were used to adjust 19 variables and to create a balance between the two groups. Surgical outcomes were compared by using univariable logistic regression. Results Among 964 women (mean age ± standard deviation, 32 years ± 3), 665 (69%) had undergone preoperative MRI (MRI group; mean age, 32 years ± 3) and 299 (31%) had not (no-MRI group; mean age, 32 years ± 3). In the MRI group, additional suspicious lesions were found in 178 of the 665 women (27%), with 88 of those 178 women (49%) having malignant lesions. The surgical management was changed in 99 of the 665 women (15%) due to MRI findings, which was appropriate for 62 of those 99 women (63%). In the IPW analysis, the MRI group showed lower odds of repeat surgery (odds ratio [OR], 0.13; 95% CI: 0.07, 0.21; < .001) and higher odds of initial mastectomy (OR, 1.62; 95% CI: 1.17, 2.25; = .004). However, there was no difference in the overall mastectomy rate (OR, 1.24; 95% CI: 0.91, 1.68; = .17) compared with the no-MRI group. These results were consistent when using the PS matching method. Conclusion Preoperative MRI in young women with breast cancer is useful for detecting additional malignancy and improving surgical outcomes by reducing the repeat surgery rate, with a similar likelihood of overall mastectomy. © RSNA, 2021
背景
对于 35 岁及以下的乳腺癌女性，术前 MRI 的作用仍存在争议。目的：使用倾向评分（PS）分析来确定术前 MRI 与 35 岁及以下乳腺癌女性手术结果之间的关系，以探讨术前 MRI 的影响。材料与方法：回顾性分析了 2007 年至 2017 年间诊断为乳腺癌且年龄在 35 岁及以下的女性，这些女性或接受了术前乳腺 MRI 检查，或未接受术前 MRI 检查。分析了 MRI 检测到附加可疑病变的检出率，并记录了手术管理的变化。采用逆概率加权（IPW）和 PS 匹配法调整了 19 个变量，使两组之间达到平衡。采用单变量逻辑回归比较手术结果。结果：在 964 例女性（平均年龄±标准差，32 岁±3）中，665 例（69%）接受了术前 MRI（MRI 组；平均年龄，32 岁±3），299 例（31%）未接受术前 MRI（无-MRI 组；平均年龄，32 岁±3）。在 MRI 组中，665 例女性中有 178 例（27%）发现了附加可疑病变，其中 178 例中有 88 例（49%）为恶性病变。由于 MRI 检查结果，665 例女性中有 99 例（15%）的手术管理发生了改变，其中 99 例中有 62 例（63%）的改变是合适的。在 IPW 分析中，MRI 组再次手术的可能性较低（比值比[OR]，0.13；95%CI：0.07，0.21；<.001），初始乳房切除术的可能性较高（OR，1.62；95%CI：1.17，2.25；=.004）。然而，与无-MRI 组相比，总体乳房切除术率（OR，1.24；95%CI：0.91，1.68；=.17）无差异。当使用 PS 匹配方法时，这些结果也是一致的。结论：对于年轻的乳腺癌女性，术前 MRI 有助于检测附加的恶性肿瘤，并通过降低再次手术率来改善手术结果，同时总体乳房切除术的可能性相似。
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