Eom Hye Joung, Choi Woo Jung, Sun Youn Jin, Kim Hee Jeong, Chae Eun Young, Shin Hee Jung, Cha Joo Hee, Kim Hak Hee
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Korea.
University of Ulsan College of Medicine, Songpa-gu, Korea.
Eur Radiol. 2025 Mar 20. doi: 10.1007/s00330-025-11494-4.
To examine the association between preoperative magnetic resonance imaging (MRI) and surgical outcomes in human epidermal growth factor receptor 2 (HER2)-positive/hormone receptor (HR)-negative breast cancer through a propensity score (PS)-matched analysis.
Patients with HER2-positive/HR-negative invasive ductal carcinoma between 2007 and 2014 were retrospectively assessed and compared according to whether they underwent preoperative MRI. Inverse probability weighting (IPW) analysis and PS matching were used to adjust 17 covariates to control between the MRI and no-MRI groups. Surgical outcomes were compared between two groups and clinicopathologic variables were evaluated to determine who benefited from MRI.
Among 965 women (mean age ± standard deviation, 52 years ± 10), 423 (44%) underwent preoperative MRI and 542 (56%) did not. In the MRI group, a change in surgical management occurred in 48 patients (11%), and the change was appropriate in 31 of those patients (65%). The MRI group had a lower odds of initial mastectomy (odds ratio [OR], 0.63; 95% confidence interval [CI]: 0.47, 0.84; p = 0.002 and OR, 0.67; 95% CI: 0.48, 0.92; p = 0.01 for IPW and PS matching, respectively) and overall mastectomy (OR, 0.60; 95% [CI]: 0.45, 0.80; p = 0.001 and OR, 0.68; 95% CI: 0.49, 0.93; p = 0.02 for IPW and PS matching, respectively). In the subgroup analysis, asymptomatic patients or those with multifocal or multicentric lesions benefited more from MRI (61% vs 36%, p = 0.006 and 52% vs 31%, p = 0.02, respectively).
Patients with HER2-positive/HR-negative breast cancer who received preoperative MRI had a lower likelihood of undergoing mastectomy.
Question The role of preoperative MRI in predicting surgical outcomes in patients with HER2-positive/HR-negative breast cancer remains uncertain. Findings Preoperative MRI in HER2-positive/HR-negative breast cancer reduces mastectomy rates without increasing the positive resection margin or reoperation rate. Clinical relevance Preoperative MRI is beneficial in reducing mastectomy rates in women with HER2-positive/HR-negative breast cancer.
通过倾向评分（PS）匹配分析，研究术前磁共振成像（MRI）与人类表皮生长因子受体2（HER2）阳性/激素受体（HR）阴性乳腺癌手术结果之间的关联。
回顾性评估2007年至2014年间患有HER2阳性/HR阴性浸润性导管癌的患者，并根据他们是否接受术前MRI进行比较。采用逆概率加权（IPW）分析和PS匹配来调整17个协变量，以控制MRI组和非MRI组之间的差异。比较两组的手术结果，并评估临床病理变量以确定哪些患者从MRI中获益。
在965名女性（平均年龄±标准差，52岁±10岁）中，423名（44%）接受了术前MRI，542名（56%）未接受。在MRI组中，48名患者（11%）的手术管理发生了变化，其中31名患者（65%）的变化是合适的。MRI组初始乳房切除术的几率较低（优势比[OR]，0.63；95%置信区间[CI]：0.47，0.84；p = 0.002；IPW和PS匹配的OR分别为0.67；95% CI：0.48，0.92；p = 0.01），总体乳房切除术的几率也较低（OR，0.60；95%[CI]：0.45，0.80；p = 0.001；IPW和PS匹配的OR分别为0.68；95% CI：0.49，0.93；p = 0.02）。在亚组分析中，无症状患者或有多灶性或多中心病变的患者从MRI中获益更多（分别为61%对36%，p = 0.006和52%对31%，p = 0.02）。
接受术前MRI的HER2阳性/HR阴性乳腺癌患者接受乳房切除术的可能性较低。
问题术前MRI在预测HER2阳性/HR阴性乳腺癌患者手术结果中的作用仍不确定。发现HER2阳性/HR阴性乳腺癌的术前MRI可降低乳房切除术率，而不会增加阳性切缘或再次手术率。临床意义术前MRI有助于降低HER2阳性/HR阴性乳腺癌女性的乳房切除术率。
