Washington University St. Louis, Siteman Cancer Center, St. Louis, MO, USA.
Ann Surg Oncol. 2023 Oct;30(10):6188-6197. doi: 10.1245/s10434-023-13891-9. Epub 2023 Aug 2.
The purpose was to determine what factors help predict benefit from preoperative MRI.
We conducted an IRB approved retrospective review of patients with breast cancer who underwent preoperative MRI (2018-2021). Patients were divided into a cohort of no new disease detected on MRI versus new disease detected.
Of 420 patients with a new diagnosis of breast cancer who underwent preoperative MRI, 17% had new multicentric, multifocal, or contralateral disease detected. There was no difference between the two cohorts for age (p = 0.23), race (p = 0.45), family history (p = 0.47), breast density (p = 0.14), or hormone status (p = 0.90). In multivariate analysis, age (p = 0.61, OR 0.99), race (p = 0.58, OR 1.26), family history (p = 0.54, OR 0.82), breast density (p = 0.83, OR 0.87), grade (p = 0.87, OR 1.09), tumor size (p = 0.37, OR 0.92), and use of neoadjuvant therapy (p = 0.41, OR 0.72) were not predictive of detection of additional new disease. Presence of positive nodes on ultrasound or mammogram was associated with new or multifocal disease on MRI (p = 0.0005, OR 3.48). Pre-MRI positive nodes increased the likelihood of detection of new disease (p = 0.0002, OR 3.04). Preoperative MRI resulted in more extensive surgery than indicated for 22.2% of the no new disease detected cohort and 6.9% of the new multicentric disease cohort (p < 0.001).
Patients with nodal disease detected in their evaluation are more likely to have new multifocal, multicentric, or contralateral disease detected on MRI. The use of preoperative MRI may be particularly helpful in patients with node-positive disease in identifying additional disease that would alter surgical management.
本研究旨在确定哪些因素有助于预测术前 MRI 的获益。
我们对 2018 年至 2021 年间接受术前 MRI 的乳腺癌患者进行了一项经过机构审查委员会批准的回顾性研究。将患者分为 MRI 未检出新发疾病组和检出新发疾病组。
在 420 例新诊断为乳腺癌且接受了术前 MRI 的患者中，有 17%的患者检出了多中心、多灶或对侧新发疾病。两组患者在年龄（p = 0.23）、种族（p = 0.45）、家族史（p = 0.47）、乳腺密度（p = 0.14）或激素状态（p = 0.90）方面无差异。多变量分析显示，年龄（p = 0.61，OR 0.99）、种族（p = 0.58，OR 1.26）、家族史（p = 0.54，OR 0.82）、乳腺密度（p = 0.83，OR 0.87）、分级（p = 0.87，OR 1.09）、肿瘤大小（p = 0.37，OR 0.92）和新辅助治疗的使用（p = 0.41，OR 0.72）均不能预测额外新发疾病的检出。超声或乳腺钼靶检查中阳性淋巴结与 MRI 上新发或多灶性疾病相关（p = 0.0005，OR 3.48）。术前 MRI 阳性淋巴结增加了检出新发疾病的可能性（p = 0.0002，OR 3.04）。术前 MRI 导致更多的手术，而在无新发疾病检出组和新多中心疾病组中，分别有 22.2%和 6.9%的患者需要进行手术（p < 0.001）。
在评估中检出淋巴结疾病的患者更有可能在 MRI 上检出新的多灶性、多中心或对侧疾病。术前 MRI 的使用可能对淋巴结阳性疾病患者特别有帮助，可识别出改变手术管理的其他疾病。
