Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon.
Department of Obstetrics and Gynecology/Division of Gynecologic Oncology, The University of Chicago, Chicago, Illinois, USA.
J Med Radiat Sci. 2023 Dec;70(4):360-368. doi: 10.1002/jmrs.694. Epub 2023 Jun 20.
Breast magnetic resonance imaging (MRI) is increasingly being used for staging of patients with breast cancer due to its high sensitivity in detecting additional cancers (ACs). However, the clinical impact of diagnosing and treating these cancers remains unclear.
A retrospective study was undertaken of patients with newly diagnosed breast cancer who underwent staging MRI at The American University of Beirut Medical Centre (AUBMC) between 2012 and 2020. Pathology reports and breast MRI examinations were reviewed. Eighteen breast cancer patients with 19 pathology-proven index cancers (ICs) and 19 pathology-proven MRI-detected ACs were included. Chi-square and Fisher's exact tests for categorical variables and Wilcoxon signed rank test for numerical variables were used to compare ICs to ACs.
The ICs consisted of four ductal carcinoma in situ (DCIS), 13 invasive ductal carcinomas (IDC), of which five with associated DCIS, and two invasive lobular carcinomas, (ILC) of which one with associated DCIS. ACs comprised 12 DCIS, five IDC, two with associated DCIS and two ILC, one with associated DCIS. Interval cancers were more frequently invasive whereas ACs were more frequently in situ (P = 0.021). ACs were more frequently nuclear grade 2 (P = 0.009). There was no statistically significant difference between ICs and ACs in lesion type (P = 0.062), shape (P = 0.073), initial enhancement (P = 1), delayed enhancement (P = 0.732), hormonal receptor profile (P = 0.68) and Ki67 (P = 0.388). Among ACs, ten (53%) were larger than 10 mm of which five (26%) were invasive cancers, and five (26%) were larger than the ICs.
ACs detected by breast MRI were more likely to be in situ and to show a nuclear grade 2. Although not reaching statistical significance, some ACs tend to be clinically significant by their type, size or nuclear grade. The impact on clinical management remains to be determined.
由于乳腺磁共振成像（MRI）在检测额外癌症（ACs）方面具有很高的灵敏度，因此越来越多地用于乳腺癌的分期。然而，诊断和治疗这些癌症的临床影响仍不清楚。
对 2012 年至 2020 年期间在贝鲁特美国大学医学中心（AUBMC）接受分期 MRI 检查的新诊断为乳腺癌的患者进行了回顾性研究。对病理报告和乳腺 MRI 检查进行了回顾。共纳入 18 例乳腺癌患者，19 例病理证实为指数癌（ICs），19 例病理证实为 MRI 检测到的 ACs。使用卡方检验和 Fisher 精确检验进行分类变量比较，使用 Wilcoxon 符号秩检验进行数值变量比较，以比较 ICs 和 ACs。
ICs 包括 4 例导管原位癌（DCIS），13 例浸润性导管癌（IDC），其中 5 例伴有 DCIS，2 例浸润性小叶癌（ILC），其中 1 例伴有 DCIS。ACs 包括 12 例 DCIS、5 例 IDC、2 例伴有 DCIS 和 2 例 ILC，1 例伴有 DCIS。间隔期癌症更常为浸润性，而 ACs 更常为原位（P=0.021）。ACs 的核级更常为 2 级（P=0.009）。ICs 和 ACs 在病变类型（P=0.062）、形状（P=0.073）、初始强化（P=1）、延迟强化（P=0.732）、激素受体谱（P=0.68）和 Ki67（P=0.388）方面无统计学差异。在 ACs 中，有 10 例（53%）大于 10mm，其中 5 例（26%）为浸润性癌，5 例（26%）大于 ICs。
乳腺 MRI 检测到的 ACs 更有可能为原位，且核级为 2 级。尽管没有达到统计学意义，但某些 ACs 倾向于通过其类型、大小或核级具有临床意义。对临床管理的影响仍有待确定。
