磁共振成像乳腺体积测量在乳腺癌保留乳头乳晕的乳房切除术后假体乳房重建手术中的应用

The application of magnetic resonance imaging-based mammary gland volumetry for breast reconstruction with silicone gel prothesis following nipple-sparing mastectomy in breast cancer

目的探究磁共振成像(MRI)测量乳房体积及腺体体积在保留乳头乳晕的乳房切除(NSM)术后行假体乳房重建中的临床意义。方法根据入选标准选取2018年9月至2019年6月于华中科技大学同济医学院附属同济医院收治的乳腺癌患者,均拟行NSM术后假体乳房重建。术前行MRI检查评估肿瘤距离乳头乳晕复合体及皮肤的距离,并计算出乳房体积及腺体体积指导假体大小选择。比较乳房MRI测量体积、腺体MRI测量体积、术中标本称重与放置假体体积的数据,利用Prism 8.0软件进行分析,两样本均值比较应用配对t检验,P<0.05为差异具有统计学意义。利用线性回归分析2组数据之间的线性相关性,决定系数R2>0.8为相关性好。结果共纳入15例乳腺癌患者,年龄28~45岁,平均35.5岁。其中单侧13例,双侧2例。临床分期中0期、Ⅰ期、Ⅱ期的患者分别为8例、5例、2例。术前肿瘤边缘距离乳头乳晕复合体的距离为(3.1±0.8)cm。1例患者术后出血,及时经原切口再次手术,术后患者恢复良好。所有患者均出现乳头、乳晕感觉障碍或减退,未出现感染、血清肿、包膜挛缩、假体破裂、假体移位等并发症。术后随访4~12个月,所有乳房外观基本对称,未出现肿瘤复发或转移,患者均满意。术前乳房MRI测量体积、腺体MRI测量体积、术中标本称重与放置假体体积分别为(471.10±45.60)ml、(244.60±29.14)ml、(243.60±31.16)g、(244.30±16.63)ml。乳房MRI测量体积与术中标本称重之间比较差异有统计学意义(t=10.37,P<0.001),而腺体MRI测量体积与术中标本称重之间比较差异无统计学意义(t=0.20,P=0.847)。同样,乳房MRI测量体积与放置假体体积之间比较差异有统计学意义(t=5.19,P<0.001),而腺体MRI测量体积与放置假体体积之间比较差异无统计学意义(t=1.74,P=0.104)。腺体MRI测量体积与术中标本称重的决定系数(R2=0.98),高于乳房MRI测量体积与术中标本称重的决定系数(R2=0.82)。同样,腺体MRI测量体积与放置假体体积的决定系数(R2=0.71),高于乳房MRI测量体积与放置假体体积的决定系数(R2=0.54)。结论术前磁共振检查对保留乳头乳晕的乳房切除术后假体乳房重建手术具有指导作用,腺体MRI测量体积相对于乳房MRI测量体积更接近于术中标本称重及放置假体体积。

Objective This study aimed to explore the use of magnetic resonance imaging(MRI)to measure breast volume and gland volume to guide reconstruction of breast reconstruction with silicone gel prothesis following nipple-sparing mastectomy(NSM).Methods According to the inclusion criteria,the breast cancer patients admitted to Wuhan Tongji Hospital from September 2018 to June 2019 were selected to undergo breast reconstruction with prosthesis after NSM.Preoperative MRI were used to measure distance from the tumor to the nipple-areola complex and the skin,and estimate the volume of breast and mammary gland.The data of breast volume measured by MRI,gland volume measured by MRI,volume of prosthesis and specimen weight were compared.The data were analyzed using Prism 8.0 software.The paired student t-test was used to compare the difference of two groups.P<0.05 was considered statistically significant.Linear regression models were used to obtain coefficient of determination(R2),and R2>0.8 was considered statistically significant.Results A total of 15 breast cancer patients,aged 28-45 years,with a mean of 35.5 years,were included.There were 13 cases unilateral and 2 cases bilateral.The clinical stages of stage 0,ⅠandⅡwere 8,5 and 2 patients,respectively.The average distance o from tumor to nipple-areola complex was(3.1±0.8)cm.One patient suffered postoperative bleeding and was promptly reoperated through the original incision,and the patient recovered well after surgery.All patients felt sensory disturbance of the nipple and areola.There was no complication such as infection,seroma,capsular contracture,prosthesis rupture,and prosthesis shift.At 4-12 months postoperative follow-up,all breasts were basically symmetrical and no tumor recurrence or metastasis occurred,which satisfied the patients.The mean values of the volume of prosthesis,specimen weight,breast volume measured by MRI and gland volume measured by MRI were(471.10±45.60)ml,(244.60±29.14)ml,(243.60±31.16)g,(244.30±16.63)ml.There was significant difference between the breast volume measured by MRI and the specimen weight(t=10.37,P<0.001),while no statistical difference was found between gland volume measured by MRI and specimen weight(t=0.20,P=0.847).Similarly,there was significant difference between the breast volume measured by MRI and the volume of prosthesis(t=5.19,P<0.001),while no statistical difference was found between gland volume measured by MRI and the volume of prosthesis(t=1.74,P=0.104).The coefficient of determination between gland volume measured by MRI and specimen weight(R2=0.98)was higher than that of breast volume measured by MRI(R2=0.82).Similarly,the coefficient of determination between gland volume measured by MRI and the volume of prosthesis(R2=0.71)was higher than that of breast volume measured by MRI(R2=0.54).Conclusions Preoperative MRI can provide guidance to breast reconstruction with silicone gel prothesis following nipple-sparing mastectomy in breast cancer.The gland volume measured by MRI is closer to the specimen weight and the volume of prosthesis than the breast volume measured by MRI.