术前乳腺MRI对乳腺癌保乳手术切缘评估的回顾性分析

doi:10.3969/j.issn.1006-7795.2020.06.013

摘要/Abstract

摘要： 目的探讨术前乳腺磁共振成像(magnetic resonance imaging,MRI)在乳腺癌保乳手术中的应用价值。方法回顾性分析2014年1月至2019年9月期间经粗针穿刺病理确诊乳腺癌并同意行保乳手术治疗的236例患者的临床资料。收集患者术前MRI、B超及乳腺X线摄影(钼靶)检查结果、术中及术后病理信息。根据保乳手术切缘病理状态,将所有患者分为切缘阳性组与切缘阴性组。分别对乳腺MRI、超声、钼靶影像学特征以及病理学信息进行统计汇总。所得数据用SPSS 22.0统计软件进行处理。结果乳腺MRI对乳腺癌病灶检出率为100%,钼靶的检出率87.44%;对于病灶直径>2 cm的乳腺癌,B超与钼靶检查均低估了肿瘤大小。对于病灶直径≤2 cm的乳腺癌,MRI检查高估了肿瘤大小 (P<0.05);术中冰冻病理切缘阳性31例,其中再次补切阳性17例,阴性14例,保乳成功率为89.41%。分析显示:乳腺MRI动态增强影像上的病灶形态、病灶周围血管征象、超声检查中病灶数量、病理测量值最大径(Pathmd)、分子分型中HER-2过表达型(HR阴性)以及HER-2阳性状态与保乳手术切缘阳性密切相关(P<0.05)。多因素分析显示,乳腺MRI病灶形态中的“存在其他病灶(Mass & present)”类型、“非肿块型(NME)”类型、MRI上患侧病灶周围存在多发点状血管征象以及HER-2过表达型(HR阴性),是乳腺癌保乳手术切缘阳性的独立危险因素, OR(95%CI)分别为:39.472(9.835~158.421),P<0.001; 56.722(7.908~406.838),P<0.001;24.076(4.979~116.413),P<0.001; 23.170(1.823~294.504),P=0.015。MRI影像无上述危险因素的低危组保乳手术成功率为98.7%,明显高于存在任一危险因素的高危组患者,差异有统计学意义(P<0.001)。结论乳腺MRI检查是乳腺癌术前检查及评估的有效手段之一。MRI检查上Mass & present类型、NME类型、患侧病灶周围存在多发点状血管征象以及HER-2过表达型(HR阴性)与保乳手术切缘阳性密切相关。无危险因素的患者进行保乳手术的成功率更高。

关键词: 乳腺, 磁共振成像, 乳腺癌, 保乳手术, 切缘阳性

Abstract: Objective To investigate the clinical value of breast magnetic resonance imaging (MRI) for breast cancer patients with breast conserving surgery (BCS). Methods The data of 236 patients with breast cancer confirmed by pathology were retrospectively analyzed, which included preoperative breast MRI, ultrasound, mammography and pathological information. Logistics regression analysis was used to analyze the relationship between preoperative imaging characteristics and pathological status of BCS margin after breast conserving surgery with SPSS software (version 22.0, Statacorp). Results The detection rates of breast lesions by MRI and mammography were 100% and 87.44% respectively. Ultrasound and mammography underestimated breast cancer with tumor size >2cm, while MRI overestimated breast cancer with tumor size ≤2 cm (P<0.05). The BCS margin was positive in 31 cases, of which 17 cases were positive in re-excision margin and 14 cases were negative. The success rate of breast conserving was 89.41%.The morphology and adjacent vascular signs of lesions on breast MRI,multiple lesions in ultrasound, pathological tumor size (Pathmd), HER-2 over-expression type(HR-), and HER-2 positive status were correlated with positive surgical margin(P<0.05). Multivariate analysis revealed that the “MASS & present” type, “NME” type, the present of adjacent multiple punctate vessel signs on breast MRI, and HER-2 over-expression type(HR-) were independent risk factor of positive surgical margin, OR(95%CI):39.472(9.835-158.421), P<0.001; 56.722(7.908-406.838), P<0.001; 24.076(4.979-116.413), P<0.001; 23.170(1.823-294.504), P=0.015. The success rate of breast conserving surgery in the low risk group without risk factors was 98.7%, which was significantly higher than that in the high-risk group with any risk factors of MRI (P<0.001). Conclusions MRI examination is one of the important methods for preoperative examination and evaluation of breast cancer. The “MASS & present” type, “NME” type, the present of adjacent multiple punctate vessel signs on breast MRI, and HER-2 over-expression type(HR-) are significantly associated with a positive resection margin in patients with breast cancer. The success rate of breast conserving surgery is high in breast cancer patients without risk factors.

Key words: breast, magnetic resonance imaging, breast cancer, breast conserving surgery, positive resection margin

中图分类号:

R737.9

杨阳, 康骅, 赵菁, 凌煜玮, 赵烨, 王亚军, 戎冬冬. 术前乳腺MRI对乳腺癌保乳手术切缘评估的回顾性分析[J]. 首都医科大学学报, 2020, 41(6): 943-953.

Yang Yang, Kang Hua, Zhao Jing, Ling Yuwei, Zhao Ye, Wang Yajun, Rong Dongdong. Retrospective analysis of preoperative breast MRI of breast cancer patients with breast conserving surgery[J]. Journal of Capital Medical University, 2020, 41(6): 943-953.

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