Kim Soo-Yeon, Cho Nariya
Department of Radiology, Seoul National University Hospital, Seoul, Korea.
Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
J Breast Cancer. 2022 Aug;25(4):263-277. doi: 10.4048/jbc.2022.25.e35.
Despite the high sensitivity and widespread use of preoperative magnetic resonance imaging (MRI), the American Cancer Society and the National Comprehensive Cancer Network guidelines do not recommend the routine use of preoperative MRI owing to the conflicting results and lack of clear benefit to the surgical outcome (reoperation and mastectomy) and long-term clinical outcomes (local recurrence and metachronous contralateral breast cancer). Preoperative MRI detects additional cancers that are occult at mammography and ultrasound but increases the rate of mastectomy. Concerns about overdiagnosis and overtreatment of preoperative MRI might be mitigated by adjusting the confounding factors when conducting studies, using the state-of-the-art image-guided biopsy technique, applying the radiologists' cumulative experiences in interpreting MRI findings, and performing multiple lumpectomies in patients with multicentric cancer. Among the various imaging methods, dynamic contrast-enhanced MRI has the highest accuracy in predicting pathologic complete response after neoadjuvant chemotherapy. Prospective trials aimed at applying the MRI information to the de-escalation of surgical or radiation treatments are underway. In this review, current studies on the clinical outcomes of preoperative breast MRI are updated, and circumstances in which MRI may be useful for surgical planning are discussed.
尽管术前磁共振成像（MRI）具有高敏感性且应用广泛，但美国癌症协会和美国国立综合癌症网络的指南并不推荐常规使用术前MRI，原因在于结果相互矛盾，且对手术结局（再次手术和乳房切除术）以及长期临床结局（局部复发和异时性对侧乳腺癌）缺乏明确益处。术前MRI能检测出乳腺X线摄影和超声检查中隐匿的其他癌症，但会增加乳房切除术的比率。在开展研究时通过调整混杂因素、使用先进的图像引导活检技术、运用放射科医生解读MRI结果的累积经验以及对多中心癌症患者进行多次肿块切除术，或许可以减轻对术前MRI过度诊断和过度治疗的担忧。在各种成像方法中，动态对比增强MRI在预测新辅助化疗后的病理完全缓解方面具有最高的准确性。旨在将MRI信息应用于降低手术或放疗强度的前瞻性试验正在进行中。在本综述中，更新了关于术前乳腺MRI临床结局的当前研究，并讨论了MRI可能有助于手术规划的情况。
