年轻女性乳腺癌保乳术前动态增强磁共振成像检查的必要性

The essentiality of dynamic contrast enhanced magnetic resonance imaging examination before breast-conserving surgery in breast cancer patients with young women

目的探讨年轻女性乳腺癌保乳术前动态增强磁共振成像（MRI）检查的必要性。方法回顾性分析经手术病理证实的30例年轻女性（〈40岁）乳腺癌患者术前动态增强MRI及钼靶x线资料，观察乳腺癌病灶的检出率、数目、大小、侵犯范围和腋窝淋巴结转移情况，参照乳腺癌保乳术所需条件与术后病理结果进行比较，分析动态增强MRI评估保乳术的准确性。结果动态增强MRI乳腺癌检出率为100．00％（30／30），高于钼靶x线的73．33％（22／30），差异有统计学意义（P=0．002）。动态增强MRI测量肿瘤最大径为（3．55±1．50）cm，钼靶x线为（3．38±1．70）cm，术后病理为（3．51±1．20）cm，动态增强MRI测量肿瘤最大径较钼靶x线与术后病理结果更接近。动态增强MRI额外病灶检出8个，高于钼靶x线的4个，差异有统计学意义（P〈0．05）。动态增强MRI示肿瘤侵犯周围组织22例，钼靶X线示9例，术后病理证实19例，动态增强MRI示肿瘤侵犯周围组织例数与术后病理结果比较差异无统计学意义（P=0．598）；钼靶x线示肿瘤对周围组织侵犯例数与术后病理结果比较差异有统计学意义（P=0．010）。动态增强MRI示腋窝淋巴结转移127枚，钼靶x线示48枚，与术后病理结果91枚比较差异均有统计学意义（P=0．026、0．034）。钼靶x线示广泛微钙化情况优于动态增强MRI（7例比0例），差异有统计学意义（P=0．001）。术后病理证实12例可行保乳术，动态增强MRI示11例可行保乳术，钼靶x线示8例可行保乳术，动态增强MRI符合情况高于钼靶x线，但两者比较差异无统计学意义（P=0．132）。结论动态增强MRI能为年轻女性乳腺癌患者是否适合行保乳术提供较全面和准确的信息，术前应用动态增强MRI评价年轻女性乳腺癌患者行保乳术是可行的。

Objective To explore the essentiality of dynamic contrast enhanced magnetic resonance imaging （DCE-MRI） examination before breast-conserving surgery （BCS） in breast cancer patients with young women. Methods The data of DCE-MRI and mammography X-ray in 30 breast cancer patients with young women （ 〈 40 years old） who received surgery with pathology-proven were retrospectively analyzed. The detection rate of breast lesion, number, size, extent of invasive and lymph node metastasis of preoperative were observed. The DCE-MRI was assessed accuracy of BCS in accordance with indications for BCS and histopathology results. Results The breast cancer detection rate of DCE-MRI was significantly higher than mammography X-ray [ 100.00%（30/30） vs. 73.33%（22/30） ,P = 0.002]. The maximum tumor diameter of DCE-MRI was （3.55 ＋ 1.50） cm,mammography X-ray was （3.38 ＋ 1.70） cm,postoperative pathology was （3.5l -＋ 1.20） cm,and DCE-MRI was closer to postoperative pathology than mammography X-ray. The discovery of additional lesions of DCE-MRI was more than mammography X-ray （P 〈 0.05 ）. The surrounding tissue invasion of DCE-MRI was detected in 22 cases,mammography X-ray was in 9 cases,postoperative pathology was in 19 cases, there was no significant difference between DCE-MRI and postoperative pathology （P = 0.598 ）, there was significant difference between mammography X-ray and postoperative pathology （P-- 0.010）. The number of axillary fossa lymph node metastasis of DCE-MRI was in 127, mammography X-ray was in 48, compared with postoperative pathology （91 ）, there was significant difference （P = 0.026,0.034）. The detection of microcalcification of mammography X-ray was better than DCE-MRI （7 cases vs. 0 case, P = 0.001 ）. The number of BCS of postoperative pathology was in 12 cases,DCE-MR1 was in 11 cases, mammography X-ray was in 8 cases, DCE-MRI was higher than mammography X-ray,but there was no significant difference （P = 0.132）. Conclusion DCE-MRI provides comprehensive and accurate information for breast cancer patients with young women for BCS ,and it is feasible to assess them using DCE-MRI preoperative for BCS.