Clinic of Radiology, Acıbadem Maslak Hospital, İstanbul, Turkey
Department of Radiology, Acıbadem University, Senology Research Institute, İstanbul, Turkey
Diagn Interv Radiol. 2023 Nov 7;29(6):761-770. doi: 10.4274/dir.2023.211218. Epub 2023 Mar 20.
This study aims to describe imaging findings in patients treated with intraoperative electron radiotherapy and compare them with those detected in patients treated with external whole breast radiotherapy (WBRT).
The study population consisted of 25 patients who received intraoperative radiotherapy [IORT (21 Gy)] as single-dose radiotherapy and a control group of 25 patients who received WBRT at the same institution. Mammography and ultrasound (US) findings were divided into three groups: minor, intermediate, and advanced. On mammography, mass lesions were considered advanced, and asymmetries or architectural distortions were considered intermediate. Oil cysts, linear scars, and the increase in parenchymal density were considered minor findings. On US, irregular non-mass lesions were considered advanced, and circumscribed hypoechoic lesions or planar irregular scars with shadowing were considered intermediate. Oil cysts, fluid collections, or linear scars were considered minor findings.
On mammography, skin thickening ( = 0.001), edema ( < 0.001), increased parenchymal density ( < 0.001), dystrophic calcifications ( = 0.045), and scar/distortion ( = 0.005) were significantly more common in the WBRT group. On US, irregular non-mass lesions, which made interpretation considerably difficult, were significantly more common in the IORT group ( = 0.004). Dominant US findings were fluid collections and postoperative linear or planar scars in the WBRT group. Minor findings were more common in low-density breasts, and major findings (intermediate and advanced) were more common in high-density breasts on both mammographies ( = 0.011) and US ( = 0.027) in the IORT group.
Ill-defined non-mass lesions detected on US in the IORT group have not been defined previously. Radiologists should be aware of these lesions because they can be confusing, especially in early follow-up studies. This study has found that minor findings are seen more frequently in low-density breasts, while major findings are more common in high-density breasts in the IORT group. This has not been reported before, and further studies with more cases are needed to verify these results.
本研究旨在描述接受术中电子放射治疗的患者的影像学表现，并将其与接受外部全乳房放射治疗（WBRT）的患者进行比较。
研究人群包括 25 名接受术中放疗（IORT（21 Gy））单次剂量放疗的患者和同一机构接受 WBRT 的 25 名对照患者。乳腺 X 线摄影和超声（US）检查结果分为三组：轻度、中度和重度。在乳腺 X 线摄影中，肿块被认为是重度，不对称或结构扭曲被认为是中度。油囊肿、线性瘢痕和实质密度增加被认为是轻度发现。在 US 中，不规则的非肿块病变被认为是重度，而边界清晰的低回声病变或伴有阴影的平面不规则瘢痕被认为是中度。油囊肿、液体积聚或线性瘢痕被认为是轻度发现。
在乳腺 X 线摄影中，皮肤增厚（=0.001）、水肿（<0.001）、实质密度增加（<0.001）、营养不良性钙化（=0.045）和瘢痕/扭曲（=0.005）在 WBRT 组中更为常见。在 US 中，不规则的非肿块病变，使解释变得相当困难，在 IORT 组中更为常见（=0.004）。在 WBRT 组中，占主导地位的 US 发现是液体积聚和术后线性或平面瘢痕。在 IORT 组中，低密度乳房中更常见轻度发现，而在乳腺 X 线摄影（=0.011）和 US（=0.027）中，高密度乳房中更常见中度和重度发现。
在 IORT 组中，US 上检测到的定义不明确的非肿块病变以前没有被定义过。放射科医生应该意识到这些病变，因为它们可能会造成混淆，尤其是在早期随访研究中。本研究发现，在 IORT 组中，轻度发现更常见于低密度乳房，而在 IORT 组中，重度发现更常见于高密度乳房。这以前没有报道过，需要更多病例的进一步研究来验证这些结果。
