Bock E, Bock C, Belli P, Campioni P, Manfredi R, Pastore G
Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma.
Radiol Med. 1998 Jan-Feb;95(1-2):38-43.
In the last 25 years, random trials on the advantages of combined surgery and irradiation/chemotherapy of breast cancer demonstrated similar survival rates to those of massive surgery. However, both irradiation and chemotherapy have advanced and now yield good local control of the disease, so that even large breast cancers can be made operable. Breast cancer follow-up is carried out with imaging and clinical examinations to detect early locoregional recurrences, contralateral lesions and distant recurrences: to this purpose, we carried out a comparative study of all imaging modalities.
We retrospectively reviewed the data of 42 breast cancer (T2-T3 N0-N+) patients of the Senology Center of the Catholic University (Rome, Italy) treated with irradiation and/or chemotherapy for tumor debulking to permit conservative surgery. We investigated the sensitivity and the indications of mammography, B-mode and color Doppler US and MRI in measuring the exact tumor size and detecting locoregional metastatic nodes.
After 3 years' treatment, our recurrence rate (19%) is a little higher than those in the major international trials (4.2-9% and 5 tears). The recurrence was on the surgical scar in 75% of cases (6/8), while multifocal tumors were found in 25% of cases. US was the most accurate method in measuring tumor size in 90% of cases (18/20), while mammography frequently overstaged the lesion and yielded exact measurements in 65% of cases (13/20). MRI was as accurate as US, but this technique is too expensive and little available in Italy. US accurately diagnosed lymph node recurrences (70% sensitivity), but MR rate was even higher (80%), while mammography and color Doppler US had only 5-10%. As for treatment outcome, an irregular and blurred nodule or multifocal lesions at mammography indicate poor/no response, while a much smaller radial scar than at previous similar follow-ups indicates treatment success.
When correctly integrated, mammographic, US and MR patterns permit exact tumor size measurement and show possible locoregional lymph node involvement in the patients submitted to conservative surgery and irradiation/chemotherapy. In contrast, color Doppler findings remain poorly specific in this disease, with about 55% sensitivity. Therefore, radiologic studies, with clinical and laboratory data, have a major prognostic value in assessing the biological response to combined treatment.
在过去25年中，关于乳腺癌联合手术与放疗/化疗优势的随机试验表明，其生存率与大规模手术相似。然而，放疗和化疗都有了进展，现在能很好地实现对疾病的局部控制，以至于即使是大的乳腺癌也可进行手术。乳腺癌随访通过影像学和临床检查来进行，以检测早期局部区域复发、对侧病变和远处复发：为此，我们对所有影像学检查方法进行了一项对比研究。
我们回顾性分析了意大利罗马天主教大学乳腺病中心42例乳腺癌（T2 - T3 N0 - N +）患者的数据，这些患者接受了放疗和/或化疗以缩小肿瘤体积以便进行保乳手术。我们研究了乳腺X线摄影、B超和彩色多普勒超声以及MRI在测量肿瘤确切大小和检测局部区域转移淋巴结方面的敏感性和适应证。
经过3年治疗，我们的复发率（19%）略高于主要国际试验中的复发率（4.2 - 9%，随访5年）。75%的病例（6/8）复发位于手术瘢痕处，25%的病例发现有多灶性肿瘤。在90%的病例（18/20）中，超声是测量肿瘤大小最准确的方法，而乳腺X线摄影常常高估病变情况，在65%的病例（13/20）中能得出准确测量结果。MRI与超声一样准确，但该技术费用过高，在意大利应用较少。超声能准确诊断淋巴结复发（敏感性70%），但MRI的诊断率更高（80%），而乳腺X线摄影和彩色多普勒超声的诊断率仅为5 - 10%。至于治疗效果，乳腺X线摄影显示的不规则且边界模糊的结节或多灶性病变提示反应不佳/无反应，而与之前类似随访时相比，出现一个小得多的放射状瘢痕则提示治疗成功。
当正确整合时，乳腺X线摄影、超声和MRI表现可准确测量肿瘤大小，并显示接受保乳手术及放疗/化疗患者可能存在的局部区域淋巴结受累情况。相比之下，彩色多普勒检查结果在该疾病中的特异性仍然较差，敏感性约为55%。因此，影像学检查结合临床和实验室数据，在评估联合治疗的生物学反应方面具有重要的预后价值。
