术前MRI动态增强扫描可降低早期非肿块型乳腺癌保乳术切缘阳性率  

Preoperative dynamic contrast-enhanced MRI can reduce the rate of tumor-positive resection margins after breast conserving surgery in patients with early non-mass breast carcinoma

作　　者：李相生[1] 宋云龙[1] 李德昌[2] 祝红线[1] 孟利民[1] 黄蓉蓉[3] 王石林[3] 王东[1] 方红[1] 樊红霞[1] 

机构地区：[1]解放军空军总医院磁共振科,北京100142 [2]解放军空军总医院病理科,北京100142 [3]解放军空军总医院腹部外科,北京100142

出　　处：《中华肿瘤杂志》2017年第10期768-774,共7页Chinese Journal of Oncology

摘　　要：目的探讨术前MRI动态增强扫描在降低早期非肿块型乳腺癌保乳术切缘阳性率中的价值。方法拟接受保乳术的72例早期非肿块型乳腺癌患者接受了术前MRI动态增强扫描（术前MRI组），既往行超声和钼靶X线检查。选取接受保乳术的74例早期非肿块型乳腺癌患者作为对照组，仅接受了彩超和钼靶X检查。比较术前MRI组和对照组患者的保乳术切缘阳性率，并对影响手术切缘阳性率的MRI征象进行多因素分析。结果72例术前行MRI的患者中。28例（38．9％）患者根据MRI动态增强扫描征象纠正或补充了彩超和钼靶x线检查结果，合理地改变了保乳术方案。在30例浸润型导管癌患者中，术前MRI组和对照组患者的保乳术切缘阳性率分别为23．3％和40．0％，差异有统计学意义（P=0．02）；在14例其他病理类型乳腺癌患者中，术前MRI组和对照组患者的保乳术切缘阳性率分别为14．3％和38．9％，差异有统计学意义（P=0．02）；在28例导管原位癌患者中，术前MRI组和对照组患者的保乳术切缘阳性率分别为21．4％和26．9％，差异无统计学意义（P=0．10）。Logistic多因素分析显示，病灶周围改变、肿瘤大小和病灶离乳晕距离均为影响保乳术切缘阳性患者的MRI征象（均P〈0．05）。结论术前MRI动态增强扫描可明显提高评价非肿块型乳腺癌保乳术切缘的准确性，显著降低保乳术切缘的阳性率。Objective To investigate the value of preoperative dynamic contrast-enhanced MRI in reducing the rate of tumor-positive resection margins after breast conserving surgery in patients with early non-mass breast carcinoma. Methods Seventy-two patients with early non-mass breast carcinoma received ultrasonographic and mammographic examination and subsequently underwent dynamic contrast-enhanced MRI examination before breast conserving surgery. The control group consisted of 74 patients who had early non-mass breast carcinoma. They only received uhrasonographic and mammographie examination and didn＇t undergo contrast-enhanced MRI examination. The comparison of the rate of tumor-positive resection margins between two groups was performed. The MRI findings that had the significant influence on the rate of tumor- positive resection margins were analyzed using Logistic regression model. Results In 28 patients （28/72, 38. 9%）, dynamic contrast-enhanced MRI could correct or supplement the uhrasonographic and mammographic findings and resulted in the reasonable change of surgical program. The preoperative MRI examination group （n = 30） had lower rate of tumor-positive resection margins than control group for invasive ductal carcinoma （23.3% vs 40.0%, P=0.02） , but there was no significant difference （21.4% vs 26.9%, P = 0.10） between two groups for ductal carcinoma in situ （n= 28）. The preoperative MRI examination group （n= 14） had lower rate of tumor-positive resection margins than control group for the other pathologic types of breast carcinoma （14.3% vs 38.9%, P=0.02）. The statistical analysis on the basis of Logistic regression model showed that some main MRI findings, including change surrounding the tumor, distance between tumor and nipple and tumor size, had the significant influence on the rate of tumor-positive resection margins. Conclusion Preoperative dynamic contrast-enhanced MRI significantly increased the accuracy of resection margins evaluation, and greatly reduced the rate of tum

关 键 词：乳腺肿瘤 磁共振成像 保乳手术 手术切缘 动态增强 

分 类 号：R445.2[医药卫生—影像医学与核医学] R737.9[医药卫生—诊断学]