用于早期乳腺癌保乳治疗后残余肿瘤评估的术中仰卧位乳腺磁共振成像。

IF 5.6 Q1 ONCOLOGY
Jirarat Jirarayapong, Leah H Portnow, Jayender Jagadeesan, Dylan C Kwait, Zhou Lan, Thanh U Barbie, Melissa A Mallory, Leah Kim, Mehra Golshan, Eva C Gombos
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Diagnostic accuracy of isMRI findings in identifying residual tumor at resection margins was assessed using histopathology of shave margin specimens as the reference standard. Performance metrics of isMRI and re-excision rates were analyzed at per-participant and per-margin levels. Results Forty participants (median age, 58.5 years; range, 40-76 years) with 44 breast cancers (36 unifocal and four multifocal) underwent BCT, all with a single lumpectomy site. Margin assessment using isMRI yielded accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 80%, 50%, 93%, 75%, and 81% per participant, respectively; and 93%, 52%, 97%, 65%, and 96% per margin. Second re-excision was avoided in two of six (33%) participants with true-positive isMRI readings, decreasing the final re-excision rate from 18% to 13%. 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引用次数: 0

摘要

目的评价术中仰卧位MRI (isMRI)对保乳治疗(BCT)术后残留肿瘤负荷的诊断价值。材料和方法本单机构前瞻性研究(2012年4月- 2022年12月)纳入了43例连续0-II期乳腺癌患者。三名患有多中心疾病的参与者被排除在最终分析之外。术前标准俯卧位MRI检查后进行术前仰卧位MRI检查,比较肿瘤大小和到乳头、胸壁和皮肤的距离。乳房肿瘤切除术后,在手术室用3-T isMRI评估充满盐水的手术腔是否有残留肿瘤。以切除边缘标本的组织病理学作为参考标准,评估isMRI检查结果在确定切除边缘残余肿瘤方面的诊断准确性。isMRI的性能指标和再切除率在每个参与者和每个边缘水平上进行分析。结果40例(中位年龄58.5岁;年龄在40-76岁之间),44例乳腺癌(36例单灶性和4例多灶性)接受了BCT,均为单个乳房肿瘤切除部位。使用isMRI进行边缘评估的准确性、敏感性、特异性、阳性预测值和阴性预测值分别为80%、50%、93%、75%和81%;利润率分别是93% 52% 97% 65% 96%6名isMRI读数为真阳性的参与者中有2名(33%)避免了第二次再切除,将最终再切除率从18%降低到13%。6例isMRI假阴性病例的组织病理学显示浸润性癌残留,均小于0.3 cm,或中至高级别导管原位癌。结论isMRI对BCT术后残留肿瘤的术中评估具有良好的准确性,可指导同一手术中有针对性的切缘清除。关键词:乳腺,核磁共振成像,核磁共振动态增强,肿瘤学,本文可获得补充材料。©rsna, 2025。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Intraoperative Supine Breast MRI for Residual Tumor Assessment after Breast-Conserving Therapy in Early-Stage Breast Cancer.

Purpose To evaluate the diagnostic performance of intraoperative supine MRI (isMRI) in identifying residual tumor burden immediately after breast-conserving therapy (BCT). Materials and Methods This single-institution prospective study (April 2012-December 2022) included 43 consecutive participants with stage 0-II breast cancer. Three participants with multicentric disease were excluded from the final analysis. Preoperative supine MRI was performed after standard preoperative prone MRI to compare tumor sizes and distances to the nipple, chest wall, and skin. After lumpectomy, the saline-filled surgical cavity was assessed for residual tumor at 3-T isMRI in the operating suite. Diagnostic accuracy of isMRI findings in identifying residual tumor at resection margins was assessed using histopathology of shave margin specimens as the reference standard. Performance metrics of isMRI and re-excision rates were analyzed at per-participant and per-margin levels. Results Forty participants (median age, 58.5 years; range, 40-76 years) with 44 breast cancers (36 unifocal and four multifocal) underwent BCT, all with a single lumpectomy site. Margin assessment using isMRI yielded accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 80%, 50%, 93%, 75%, and 81% per participant, respectively; and 93%, 52%, 97%, 65%, and 96% per margin. Second re-excision was avoided in two of six (33%) participants with true-positive isMRI readings, decreasing the final re-excision rate from 18% to 13%. Histopathology of six false-negative isMRI cases revealed residual invasive carcinomas, all smaller than 0.3 cm, or intermediate-to-high grade ductal carcinoma in situ. Conclusion Intraoperative assessment for residual tumor after BCT using isMRI demonstrated promising accuracy to guide targeted margin clearance within the same operation. Keywords: Breast, MR-Imaging, MR-Dynamic Contrast Enhanced, Oncology Supplemental material is available for this article. © RSNA, 2025.

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