术前MRI检查在乳腺导管原位癌保乳手术的临床应用研究

doi:10.16139/j.1007-9610.2023.04.015

摘要/Abstract

摘要：

目的：评估乳腺导管原位癌(ductal carcinoma in situ, DCIS）病人术前乳腺磁共振成像(magnetic resonance imaging, MRI)检查与保乳手术成功率及预后之间的关系。方法：回顾性分析上海交通大学乳腺癌病历数据库中2009年1月至2017年1月接受保乳手术的DCIS病人。将术前接受MRI检查的病人组定义为MRI组，未接受MRI检查的为非MRI组。结果：共纳入210例DCIS病人，MRI组和非MRI组分别有167例和43例。MRI与非MRI组接受保乳手术的首次手术切缘阴性率相似（91.0%比97.7%，P=0.142）。最终保乳手术的成功率差异也无统计学意义（95.2%比100.0%，P=0.143）。在预后方面，MRI与非MRI组10年局部区域复发(4.8%比2.3%，P=0.426)和乳腺癌相关死亡率(0.9%比0.5%，P=0.668)差异无统计学意义。结论：DCIS病人术前乳腺MRI检查对保乳手术切缘阴性率、保乳成功率及预后均无影响。

关键词: 乳腺癌, 导管原位癌, 磁共振成像, 保乳手术, 预后

Abstract:

Objective: To evaluate the relationship between preoperative magnetic resonance imaging (MRI) examination and the success rate and prognosis of breast-conserving surgery in ductal carcinoma in situ (DCIS) patients. Methods: Patients with DCIS received surgery between January 2009 and January 2017 in the breast cancer medical record database of Shanghai Jiao Tong University were retrospectively analyzed. Patients who received preoperative MRI was defined as MRI group, who did not receive preoperative MRI was defined as non-MRI group. Results: A total of 210 DCIS patients were included, of which 167 cases in the MRI group and 43 cases in the non-MRI group, respectively. Initial negative resection margin rates were similar between MRI and non-MRI groups undergoing breast-conserving surgery (91.0% vs. 97.7%, P=0.142). There was also no significant difference in the success rate of breast-conserving surgery between MRI and non MRI groups (95.2% vs. 100.0%, P=0.143). In terms of prognosis, there was no significant difference in 10-year loco-regional recurrence rate (4.8% vs. 2.3%, P=0.426) and breast cancer related mortality (0.9% vs. 0.5%, P=0.668) between MRI and non-MRI groups. Conclusions: Preoperative breast MRI examination in patients with DCIS had no effect on the rate of negative resection margin, success rate of breast preservation and the prognosis of the patients.

Key words: Breast cancer, Ductal carcinoma in situ, Magnetic resonance imaging, Breast-conserving surgery, Prognosis

中图分类号:

R737.9

杨奕, 杨兴霞, 金思励, 张旭, 朱娟英, 陈小松. 术前MRI检查在乳腺导管原位癌保乳手术的临床应用研究[J]. 外科理论与实践, 2023, 28(04): 378-382.

YANG Yi, YANG Xingxia, JIN Sili, ZHANG Xu, ZHU Juanying, CHEN Xiaosong. Clinical application of preoperative MRI examination in breast-conserving surgery for ductal carcinoma in situ[J]. Journal of Surgery Concepts & Practice, 2023, 28(04): 378-382.

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Characteristics	Non-MRI	MRI	Total	P
Age (years)				0.397
<40	7(3.3)	27(12.9)	34(16.2)
40~59	25(11.9)	112(53.3)	137(65.2)
≥60	11(5.2)	28(13.3)	39(18.6)
Family history of breast cancer				0.132
No	43(20.5)	155(73.8)	198(94.3)
Yes	0	12(5.7)	12(5.7)
Manifestation at diagnosis				0.607
Mass	30(14.3)	123(58.6)	153(72.9)
Calcification	6(2.8)	26(12.4)	32(15.2)
Others	7(3.3)	18(8.6)	25(11.9)
Tumor size (cm)				0.873
≤1.5	28(13.3)	114(54.3)	142(67.6)
1.6~4.0	14(6.7)	48(22.8)	62(29.5)
> 4.0	1(0.5)	5(2.4)	6(2.9)
Lesion patterns				0.691
Unifocal	42(20.0)	158(75.2)	200(95.2)
Multifocal	1(0.5)	9(4.3)	10(4.8)
Comedo necrosis				1.000
No	43(20.5)	165(78.5)	208(99.0)
Yes	0	2(1.0)	2(1.0)
Nuclear grade				0.139
Ⅰ	22(10.5)	62(29.5)	84(40.0)
Ⅱ	13(6.2)	78(37.1)	91(43.3)
Ⅲ	8(3.8)	27(12.9)	35(16.7)
ER status				0.400
Positive	9(4.3)	26(12.4)	35(16.7)
Negative	34(16.2)	141(67.1)	175(83.3)
PR status				0.592
Positive	12(5.7)	40(19.0)	52(24.7)
Negative	31(14.8)	127(60.5)	158(75.3)
HER2 status (IHC)				0.424
0~1+	27(12.9)	88(41.9)	115(54.8)
2+	11(5.2)	48(22.9)	59(28.1)
3+	5(2.4)	31(14.7)	36(17.1)
Ki-67				0.229
≤14%	26(12.4)	117(55.7)	143(68.1)
>14%	17(8.1)	50(23.8)	67(31.9)

Characteristics	Non-MRI	MRI
Ipsilateral breast tumor recurrence	1	8
Contralateral breast cancer	0	2
Regional lymph node metastasis	0	1
Distant metastasis	1	0
Death
Breast cancer-related	1	1
Others causes	2	0