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  • Title: [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].
    Author: Li XS, Song YL, Li DC, Zhu HX, Meng LM, Huang RR, Wang SL, Wang D, Fang H, Fan HX.
    Journal: Zhonghua Zhong Liu Za Zhi; 2017 Oct 23; 39(10):768-774. PubMed ID: 29061022.
    Abstract:
    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 ultrasonographic and mammographic 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 ultrasonographic 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 tumor-positive resection margins after breast conserving surgery in patients with early non-mass breast carcinoma. 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。.
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