Role of Breast Magnetic Resonance Imaging in the Preoperative Assessment and Its Impact on Surgical Management of Patients with Newly Diagnosed Breast Cancer
KCH Lau, CY Lui, LMF Tee, YHA Tsang, KKT Pak, M Ying, CM Chan, HS Lam
Hong Kong J Radiol 2011;14:218-28
Objective: To determine the role of breast magnetic resonance imaging in the preoperative assessment of patients with newly diagnosed breast cancer and its impact on surgical management.
Methods: In all, 22 patients with recently diagnosed breast cancer underwent preoperative magnetic resonance imaging and subsequent surgery or biopsy between 1 January 2010 and 30 June 2011. Patients with a change from initial planned surgical treatment to final surgical treatment based on additional mammographically occult magnetic resonance imaging findings were identified.
Results: Additional magnetic resonance imaging findings were found in 10 (45%) of the 22 patients; in eight there were additional suspicious lesions, and in two more extensive local disease became evident. In seven (32%) of the patients, there was a change in the initial planned surgical management owing to additional ipsilateral magnetic resonance imaging findings. One (5%) of the patients had contralateral surgery due to detection of synchronous contralateral cancer, and in five others additional suspicious lesions were only noted on magnetic resonance imaging that were confirmed to be malignant, giving a positive predictive value of 63%. In two (9%) of the 22 patients, the index tumours appeared significantly larger on magnetic resonance imaging than in mammograms, which changed the initial planned surgical management from breast conservation to mastectomy; there being less than one month between mammography and magnetic resonance imaging. For these two patients, calculated average tumour size underestimation on mammograms was 15.9 cm3 (range, 11.9 - 19.9 cm3). Another 23% (5/22) had additional mammographically occult cancers diagnosed by magnetic resonance imaging, with 18% having additional site(s) of ipsilateral cancer and 5% having unsuspected contralateral cancer.
Conclusion: Breast magnetic resonance imaging is a valuable tool in determining surgical management and detecting additional mammographically occult cancers in newly diagnosed breast cancer patients.
中文摘要
乳腺磁共振（MRI）對於新診斷乳癌在術前評估中的角色及 對其手術治療的影響
劉仲恒、呂振英、鄭文輝、曾彥豪、白錦姿、英偉亮、陳志梅、林漢城
目的：探討乳腺MRI對於新診斷乳癌在術前評估中的角色及其對手術治療的影響。
方法：2010年1月1日至2011年6月30日期間，22名新診斷乳腺癌患者進行術前MRI及其後的手術或活 檢，在其中找出因MRI檢查而額外發現隱性乳癌，並因此改變手術治療模式的病例。
結果：22位新診斷乳癌患者中，10例（46%）MRI檢查有額外結果，其中8例為新發現的可疑病灶， 另2例的局部病灶變得更明顯。7例（32%）由於有額外的同側MRI結果而改變最初的手術治療模 式。1例（5%）因發現有對側乳癌而要進行對側手術。另5例在MRI上發現額外的可疑病灶，後證實 為腫瘤，陽性預測值為63%。22位患者中，2例（9%）在乳腺鉬靶檢查後不足一個月進行MRI，發 現腫瘤在MRI上明顯地比乳腺鉬靶所顯示的大，因此治療模式由最初的保乳治療改為乳房切除。在 這兩名患者中，乳腺鉬靶得出的腫瘤大小比真實的平均少了15.9 cm3（介乎11.9至19.9 cm3）。另5例 （23%）的MRI結果發現有隱性乳癌，其中18%有額外同側癌，5%有新發現對側癌。
結論：乳腺MRI對於新診斷乳癌患者在決定手術治理模式以及檢測額外隱性乳癌方面都很重要。