Dietzel Frederic, Kolberg Leoni, Vesper Anne Sophie, Hoffmann Jürgen, Nestle-Krämling Carolin, Zwiefel Karin, Friebe Verena, Sawicki Lino M, Bruckmann Nils Martin, Jannusch Kai, Morawitz Janna, Antoch Gerald, Fehm Tanja Natascha, Kirchner Julian, Mohrmann Svjetlana
Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany.
Department of Obstetrics and Gynecology, Medical Faculty, University Dusseldorf, 40225 Dusseldorf, Germany.
Cancers (Basel). 2023 Jan 29;15(3):829. doi: 10.3390/cancers15030829.
This study seeks to evaluate MR imaging morphological factors and other covariates that influence the presence of residual glandular tissue after risk-reducing mastectomy in patients with a familial predisposition.
We analyzed women of a high-risk collective with pathogenic mutation (BRCA1 (n = 49), BRCA2 (n = 24), or further mutation (n = 9)). A total of 117 breasts were analyzed, 63 left and 54 right, from a cohort of 81 patients, who were on average 40 years old. The mean follow-up was 63 months (range 12-180 months, SD = 39.67). Retrospective analysis of MR imaging data from 2006-2022 of patients of a high-risk collective (all carriers of a pathogenic mutation) with contralateral (RRCM) or bilateral risk-reducing mastectomy (RRBM) was performed. In the image data the remaining skin flap thickness by distance measurements at eight equally distributed, clockwise points and the retromamillary area, as well as by volumetry of each breast, was elected. Residual glandular tissue was also volumetrized. In addition, patient-related covariates were recorded and their influence on postoperative residual glandular tissue and skin flap thickness was analyzed by uni- and multivariate regressions.
A significant association with postoperative residual glandular tissue was shown in multivariate analysis for the independent variables breast density, skin flap mean, and surgical method (all -values < 0.01). A negatively significant association could be seen for the variables preoperative breast volume (-values < 0.01) and surgeon experience (most -values < 0.05-<0.1).
Postoperative residual glandular tissue is an important tool for quantifying the risk of developing breast cancer after risk-reducing mastectomy. Different effects on residual glandular tissue were shown for the independent variables breast density, skin flap, surgical method, preoperative breast volume, and surgeon experience, so these should be considered in future surgical procedures preoperatively as well as postoperatively. Breast MRI has proven to be a suitable method to analyze the skin flap as well as the RGT.
本研究旨在评估影响有家族性易患倾向患者行降低风险乳房切除术后残留腺组织存在情况的磁共振成像（MR）形态学因素及其他协变量。
我们分析了一个高危群体中携带致病突变的女性（BRCA1基因携带者49例、BRCA2基因携带者24例或其他突变携带者9例）。对81例平均年龄40岁患者的117个乳房进行了分析，其中左侧63个，右侧54个。平均随访时间为63个月（范围12 - 180个月，标准差 = 39.67）。对2006 - 2022年高危群体（所有致病突变携带者）中行对侧降低风险乳房切除术（RRCM）或双侧降低风险乳房切除术（RRBM）患者的MR成像数据进行回顾性分析。在图像数据中，通过在八个等距、顺时针分布的点测量皮瓣厚度以及乳晕后区域，并对每个乳房进行容积测量来选取相关数据。残留腺组织也进行了容积测量。此外，记录患者相关协变量，并通过单因素和多因素回归分析它们对术后残留腺组织和皮瓣厚度的影响。
多因素分析显示，独立变量乳腺密度、皮瓣均值和手术方式与术后残留腺组织存在显著相关性（所有P值 < 0.01）。术前乳房体积（P值 < 0.01）和外科医生经验（大多数P值 < 0.05 - <0.1）与术后残留腺组织呈负显著相关。
术后残留腺组织是量化降低风险乳房切除术后患乳腺癌风险的重要工具。独立变量乳腺密度、皮瓣、手术方式、术前乳房体积和外科医生经验对残留腺组织有不同影响，因此在未来手术操作的术前和术后均应予以考虑。乳腺MRI已被证明是分析皮瓣以及残留腺组织的合适方法。
