MR动态增强检查在评估乳腺肿块切除术后恶性残留中的临床价值

The clinical significance of dynamic contrast-enhanced MR of the breast in evaluating residuals after lumpectomy

目的:探讨对于乳腺肿块切除术后,病理检查提示恶性的患者,MR动态增强检查在评估癌灶残留中的临床应用价值。方法:对53例行单纯肿块切除术后病理提示恶性的患者,在2次手术前,行MR动态增强检查,MR诊断与2次手术后病理结果进行对照分析。结果:MR动态增强检查中,32%(17/53例)的乳腺内发现异常强化灶。肿块样强化8例,占47%,其中6例病理证实有癌灶残留(P<0.01);局灶性强化6例,占35%,其中1例病理证实有癌灶残留(P<0.01);导管样强化3例,占18%,其中2例病理证实有癌灶残留(P<0.05);MR动态增强检查中,68%(36/53)的乳腺内没有发现异常强化灶,其中33例病理证实无癌灶残留,占92%;3例病理证实有癌灶残留,占8%。MR动态增强检查的阳性预测值、阴性预测值分别为52%和92%。结论:MR动态增强检查可以较为准确地评估肿块切除术后的患乳内有无癌灶残留及其分布范围,为2次手术方案的制定提供重要参考,具有重要的临床应用价值。

Objective To assess the efficacy of dynamic contrast-enhanced（DCE） magnetic resonance imaging（MRI） of the breast in the detection of residual lesions of early stage breast carcinoma after lumpectomy.Methods 53 patients with breast masses confirmed to be malignant tumors by pathology after lumpectomy underwent the dynamic contrast-enhanced breast MR imaging and then further surgical treatment by lumpectomy. The DCE MRIbased diagnoses were compared to the results of pathological analyses after the second lumpectomy. Results 17（32%） cases were detected with abnormal enhancement. 8 cases presented mass-like enhancements, and 6 of them showed tumorous residuals（P〈0.01）. 6 presented focal enhancements, taking up 35% and one of them was confirmed pathologically to have tumorous residuals（P〈0.01）. 3 cases presented mass-like enhancement, taking up18% and 2 of them were confirmed with cancerous residuals. MR dynamic enhancement showed 68% of the them presented no abnormal enhancements in the breast and 33 of themhad no residual cancer, taking up 92%. 3 of them were confirmed with tumorous residuals, taking up 8%. The The positive predictive value and negative predictive value of DCE MR imaging for diagnosing residual malignant lesion were 52% and 92%, respectively.Conclusion The dynamic contrast-enhanced MRI of breast is helpful for evaluating residual malignant lesion after lumpectomy and affects positively subsequent treatment.