MRI评价腺体-脂肪界面乳腺癌对瘤周脂肪侵犯及保乳术的价值

MRI evaluation of peritumoral fat invasion and breast-conserving surgery in breast cancer with gland-fat interface

目的探讨MRI评价腺体-脂肪界面乳腺癌对瘤周脂肪侵犯及保乳手术方式的价值。方法选取经病理确诊的253例浸润性乳腺癌(invasive breast carcinoma,IBC)患者,术前MRI检查肿瘤位于腺体-脂肪界面;分析皮下瘤周脂肪消退/萎缩、缺失,瘤周脂肪纤维化、水肿的MRI影像,评价瘤周脂肪侵犯与保乳术式选择的关系。结果33.2%的病例肿瘤直接侵犯皮肤结构,与皮肤间脂肪组织缺失;22.1%的病例轻度脂肪侵犯,44.7%的病例重度脂肪侵犯。74.3%的病例瘤周脂肪内观察到纤维化影像,85例MRI显示与肿瘤垂直索条影,41例显示沿肿瘤轮廓弧形索条影,62例两者均有。39.9%的病例显示重度、17.4%的病例显示轻度瘤周脂肪内水肿。71例腺体-脂肪界面乳腺癌中68例保乳成功,82.4%的病例为轻度脂肪侵犯,17.6%的病例为重度脂肪侵犯,27.9%的病例显示瘤周脂肪纤维化,38.2%的病例瘤周脂肪水肿。保乳手术方式主要是肿物切除及区段切除术。结论MRI是评价腺体-脂肪界面乳腺癌对瘤周脂肪侵犯的有效方法,对指导保乳手术有价值。

Objective To evaluate the value of MRI in the evaluation of peritumoral fat invasion and breast-conserving surgery in breast cancer with gland-fat interface.Methods 253 cases of invasive breast cancer diagnosed by pathology in our hospital were retrospectively analyzed.Malignant tumour was located at the gland-fat interface with preoperative MRI examination.The regression/atrophy and loss of peritumoral fat were analyzed,and the MRI images of peritumoral fat fibrosis,edema and the relationship between peritumoral fat invasion and breast-conserving surgery were evaluated.Results In 33.2%of cases,skin structure was directly invaded,and the adipose tissue between tumor and skin was lost.22.1%and 44.7%exhibited mild or severe fat invasion.Fibrosis images were observed in 74.3%cases of peritumoral fat,MRI showed vertical cable strip shadow with tumor in 85 cases,arc cord shadow along tumor contour was found in 41 cases and both in 62 cases.39.9%cases showed severe,17.4%cases showed mild edema in peritumoral fat,and 42.7%cases showed no edema in peritumoral fat.Among 71 cases of glandular-fat interface breast cancer,68 cases were successful in breast preservation,82.4%were mild and 17.6%were severe fat invasion,27.9%cases showed peritumoral fat fibrosis and 38.2%cases had peritumoral fat edema.Mass and segmental resection were the main methods of breast conserving surgery.Conclusion MRI is an effective method to evaluate the invasion of peritumoral fat in breast cancer with gland-fat interface,which provides evidence for breast-conserving surgery.