术前乳腺MRI对浸润性导管癌在针活检中有或没有DCIS成分：对MIPA研究中手术结果的影响

IF 4.7 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Radiology Pub Date : 2025-10-01 Epub Date: 2025-04-24 DOI:10.1007/s00330-025-11572-7

Andrea Cozzi, Giovanni Di Leo, Nehmat Houssami, Fiona J Gilbert, Thomas H Helbich, Marina Álvarez Benito, Corinne Balleyguier, Massimo Bazzocchi, Peter Bult, Massimo Calabrese, Julia Camps Herrero, Francesco Cartia, Enrico Cassano, Paola Clauser, Marcos F de Lima Docema, Catherine Depretto, Valeria Dominelli, Gábor Forrai, Rossano Girometti, Steven E Harms, Sarah Hilborne, Raffaele Ienzi, Marc B I Lobbes, Claudio Losio, Ritse M Mann, Stefania Montemezzi, Inge-Marie Obdeijn, Umit Aksoy Ozcan, Federica Pediconi, Katja Pinker, Heike Preibsch, José L Raya Povedano, Carolina Rossi Saccarelli, Daniela Sacchetto, Gianfranco P Scaperrotta, Margrethe Schlooz, Botond K Szabó, Donna B Taylor, Sıla Ö Ulus, Mireille Van Goethem, Jeroen Veltman, Stefanie Weigel, Evelyn Wenkel, Chiara Zuiani, Francesco Sardanelli

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In each subgroup, patients who underwent preoperative MRI (MRI groups) were matched 1:1 to those who did not (noMRI groups) according to eight confounding covariates. Surgical outcomes were compared with non-parametric statistics after calculating odds ratios (ORs).Results: Among 1051 patients with IDC + DCIS, 510 were retained after matching (255 in each group): in comparison to the noMRI group, the MRI group had significantly higher rates of first-line mastectomy (13.3% vs 6.3%; OR 2.30, p = 0.011) and of overall mastectomy (14.5% vs 7.5%; OR 2.11, p = 0.016), without significantly lowering the reoperation rate (9.4% vs 10.6%, OR 0.88, p = 0.768). Among 2459 patients with pure IDC, 1638 were retained after matching (819 in each group): the first-line mastectomy rate was not significantly higher in the MRI group (12.9% vs 12.1% in the noMRI group; OR 1.08, p = 0.654). 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引用次数: 0

摘要

目的：分析术前乳腺MRI对单纯浸润性导管癌（invasive ductal carcinoma， IDC）或伴原位癌(IDC +导管原位癌（ductal carcinoma in situ， DCIS）活检患者手术结果的影响。方法：从多中心国际前瞻性分析（MIPA）数据库中检索年龄在18-80岁、经针活检诊断为单纯IDC或IDC + DCIS的患者进行前期手术。在每个亚组中，根据8个混杂协变量，接受术前MRI的患者（MRI组）与未接受术前MRI的患者（noMRI组）按1:1匹配。计算优势比（or）后比较手术结果的非参数统计。结果：1051例IDC + DCIS患者中，匹配后保留510例（每组255例）：与noMRI组相比，MRI组的一线乳房切除术率显著高于noMRI组(13.3% vs 6.3%；OR 2.30, p = 0.011)和全乳切除术(14.5% vs 7.5%；OR 2.11, p = 0.016)，未显著降低再手术率（9.4% vs 10.6%, OR 0.88, p = 0.768）。2459例纯IDC患者中，匹配后保留1638例（每组819例）：MRI组一线乳房切除术率不显著高于noMRI组(12.9% vs 12.1%；OR 1.08, p = 0.654)。相反，再手术率明显较低(2.6% vs 7.9%；结论：在IDC + DCIS患者中，术前MRI并没有减少再手术和增加乳房切除术。相反，在纯IDC患者中，术前MRI减少了再手术，而不增加乳房切除术。术前乳腺MRI对针活检IDC患者手术结果的影响存在争议，缺乏大规模的研究。对于单纯的针活检IDC， MRI减少了再手术，没有增加乳房切除术；对于IDC + DCIS， MRI并没有减少再手术和增加乳房切除术。对于针活检时出现IDC的患者，术前是否进行乳房MRI检查应考虑到相关DCIS的存在，因为MRI对手术结果的益处仅在单纯IDC患者中观察到。

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Preoperative breast MRI for invasive ductal carcinoma with or without a DCIS component at needle biopsy: influence on surgical outcomes in the MIPA study.

Objectives: To analyse the impact of preoperative breast MRI on surgical outcomes of patients diagnosed with pure invasive ductal carcinoma (IDC) or IDC with an associated in situ component (IDC + ductal carcinoma in situ [DCIS]) at needle biopsy.

Methods: Patients aged 18-80 years referred for upfront surgery after a diagnosis of pure IDC or IDC + DCIS at needle biopsy were retrieved from the Multicenter International Prospective Analysis (MIPA) database. In each subgroup, patients who underwent preoperative MRI (MRI groups) were matched 1:1 to those who did not (noMRI groups) according to eight confounding covariates. Surgical outcomes were compared with non-parametric statistics after calculating odds ratios (ORs).

Results: Among 1051 patients with IDC + DCIS, 510 were retained after matching (255 in each group): in comparison to the noMRI group, the MRI group had significantly higher rates of first-line mastectomy (13.3% vs 6.3%; OR 2.30, p = 0.011) and of overall mastectomy (14.5% vs 7.5%; OR 2.11, p = 0.016), without significantly lowering the reoperation rate (9.4% vs 10.6%, OR 0.88, p = 0.768). Among 2459 patients with pure IDC, 1638 were retained after matching (819 in each group): the first-line mastectomy rate was not significantly higher in the MRI group (12.9% vs 12.1% in the noMRI group; OR 1.08, p = 0.654). Instead, the reoperation rate was significantly lower (2.6% vs 7.9%; OR 3.28 for avoiding reoperation, p < 0.001) with no increase in overall mastectomies (13.6% vs 13.7%: OR 0.99, p = 1.000).

Conclusions: In patients with IDC + DCIS, preoperative MRI did not reduce reoperations and increased mastectomies. Conversely, in patients with pure IDC, preoperative MRI reduced reoperations without increasing mastectomies.

Key points: Question The impact of preoperative breast MRI on surgical outcomes of patients with IDC at needle biopsy is controversial and lacks large-scale investigations. Findings For pure IDC at needle biopsy, MRI reduced reoperations without increasing mastectomies; for IDC + DCIS, MRI did not reduce reoperations and increased mastectomies. Clinical relevance In patients with IDC at needle biopsy, the decision to perform preoperative breast MRI should take into account the presence of associated DCIS, as the benefits of MRI on surgical outcomes were observed only in patients with pure IDC.

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来源期刊

European Radiology 医学-核医学

CiteScore

11.60

自引率

8.50%

发文量

874

审稿时长

2-4 weeks

期刊介绍： European Radiology (ER) continuously updates scientific knowledge in radiology by publication of strong original articles and state-of-the-art reviews written by leading radiologists. A well balanced combination of review articles, original papers, short communications from European radiological congresses and information on society matters makes ER an indispensable source for current information in this field. This is the Journal of the European Society of Radiology, and the official journal of a number of societies. From 2004-2008 supplements to European Radiology were published under its companion, European Radiology Supplements, ISSN 1613-3749.