Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrookes' Hospital, Hills Road, Cambridge, UK.
Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Level 5, Cambridge Biomedical Campus, Cambridge, UK.
Br J Radiol. 2022 Sep 1;95(1138):20220306. doi: 10.1259/bjr.20220306. Epub 2022 Jul 25.
High-grade DCIS (HG DCIS) is associated with upgrade to invasive disease but few studies evaluate the role of MRI in this subset of DCIS. This study compared surgical outcomes of females with HG DCIS on biopsy who had pre-operative MRI with those that proceeded directly to surgery.
This single-centre retrospective, observational study identified patients with pure HG DCIS on pre-operative biopsy from the pathology database. Surgical outcomes, clinicopathological and radiological features were obtained for all patients.
From August 2015 to February 2020, 217 patients had HG DCIS on biopsy. Pre-operative MRI was performed in 40 (MRI group) and not in 88 (No MRI group) patients. Initial mastectomy was performed in 25/40 (63%) women in the MRI group and 20/88 (23%) women in the no MRI group ( < 0.0001). No difference was observed in re-operation rate between the two groups, 15% in MRI group 22% in No MRI group ( = 0.4749). Mean tumour size on histology was larger in mastectomy cases in the MRI group (73.4 mm, range 6-140 mm), than the total MRI group, (58.3 mm, range 0-140 mm) or no MRI group (30.7 mm, range 0-130 mm) ( < 0.0001).
Pre-operative MRI in HG DCIS is associated with higher mastectomy rates, possibly due to patient selection for MRI, as tumours on final histology were significantly larger. Fewer re-operations were observed in the MRI group although this was not significant.
Breast MRI performed pre-operatively in HG DCIS is associated with higher mastectomy rates and fewer re-operation rates.
高级别导管原位癌（HG-DCIS）与浸润性疾病的升级相关，但很少有研究评估 MRI 在 DCIS 这一分支中的作用。本研究比较了术前 MRI 检查和直接手术的 HG-DCIS 女性患者的手术结果。
本单中心回顾性观察性研究从病理数据库中确定了术前活检为纯 HG-DCIS 的患者。为所有患者获得了手术结果、临床病理和影像学特征。
2015 年 8 月至 2020 年 2 月，217 例患者在活检中出现 HG-DCIS。40 例（MRI 组）和 88 例（无 MRI 组）患者进行了术前 MRI 检查。MRI 组 25 例（63%）女性行初始乳房切除术，无 MRI 组 20 例（23%）女性行乳房切除术（<0.0001）。两组间再次手术率无差异，MRI 组 15%，无 MRI 组 22%（=0.4749）。MRI 组乳房切除术中的肿瘤大小在组织学上较大（73.4mm，范围 6-140mm），明显大于 MRI 组的平均值（58.3mm，范围 0-140mm）或无 MRI 组（30.7mm，范围 0-130mm）（<0.0001）。
术前 MRI 在 HG-DCIS 中的应用与更高的乳房切除术率相关，这可能是由于对 MRI 的患者选择，因为最终组织学上的肿瘤明显更大。尽管 MRI 组的再手术率较低，但差异无统计学意义。
术前在 HG-DCIS 中进行乳腺 MRI 检查与更高的乳房切除术率和更低的再手术率相关。
