Radiother Oncol：乳腺磁共振检查有助于评价患者是否合适接受部分乳腺短程照射

将乳腺核磁共振（MRI）检查作为乳腺癌患者评估和治疗方案的组成部分这一观点一直存在争议。有一些观点认为乳腺核磁共振检查能使外科治疗方案最优 化，其他的观点则认为该检查的特异性较差，并且其高额的检查费用限制了该方法的广泛应用。来自美国Stanford肿瘤机构的Kathleen C. Horst等为了确定在女性患者队列中，在治疗前进行乳腺核磁共振检查的结果对进行部分乳腺短程照射（APBI）的价值而设计了相关研究，旨在确定在该类 患者中，乳腺核磁共振检查的最佳应用方式。他们的研究结果发表在Radiother Oncol 4月的期刊上。

在本研究中，评估受试者是否适合进行部分乳腺短程照射的依据是——体格检查、钼靶检查和超声检查的结果，继之以乳腺核磁共振检查，在完成了上述检查后才对受试者开始实施治疗。在本研究中，但凡乳腺核磁共振检查出现异常，研究者随即对病变进行活检。

在2002年至2011年期间，共有180名女性符合进行部分乳腺短程照射的入选标准，随即她们在治疗前接受了乳腺核磁共振（这些受试者的中位年龄为59 岁）。在这些患者中，有126例（70%）肿瘤为浸润性乳腺癌（合并或不合并导管原位癌），另有54例（30%）肿瘤为单纯的导管原位癌。乳腺核磁共振检 查证实了在109名患者中的单一病灶性病变。在19名受试者中则存在多灶性病变，3名患者中存在多中心病灶。有5名受试者通过核磁共振检查发现了对侧病 变。在45名患者中出现了假阳性病变（25%）。研究者发现在绝经前受试者和肿瘤>2的受试者中，采用乳腺核磁共振检查更容易发现多灶性/多中心病 变。但是研究者没有发现多灶性/多中心病变和乳腺密度、肿瘤组织学特征、肿瘤级别、ER状态或Her2/Neu表达之间存在联系，但是研究者认为，由于受 试者例数较少，所以即使上述指标之间存在临床意义但也会因样本例数不够而不能得到统计学显著差异的结果。在180受试者中有152人（84.4%）成功完 成了乳房肿瘤切除术和部分乳腺短程照射，而6.7%的受试者则接受了乳房切除术。

本研究结果提示，乳腺核磁共振检查能够帮助额外确定适合进行部分乳腺短程照射治疗的患者（12%）。对于绝经前和肿瘤>2cm的患者而言，采用乳腺核磁共振检查更容易发现多灶性/多中心性病变。

与乳腺相关的拓展阅读：

• ASO：受累淋巴结比值可作为乳腺癌重要预后因素
• Lancet Oncol：帕妥珠单抗、曲妥珠单抗和多烯紫杉醇方案可作为HER2阳性的转移性乳腺癌患者的标准治疗方案
• JCO：紫杉醇/吉西他滨维持化疗可改善转移性乳腺癌患者生存
• Medpage：他莫西芬或可预防乳腺癌
• AACR2013：他汀类药物可显著降低乳腺癌死亡率
• Ann Surg：肥胖乳腺癌患者术前抗生素预防可降低手术部位感染发生率
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Defining an optimal role for breast magnetic resonance imaging when evaluating patients otherwise eligible for accelerated partial breast irradiation.
BACKGROUND AND PURPOSE
Pre-treatment breast magnetic resonance imaging (MRI) findings in a cohort of women prospectively evaluated for accelerated partial breast irradiation (APBI) are reviewed and characterized to determine the optimal use of MRI in these patients.
MATERIALS AND METHODS
Candidates initially deemed eligible for a prospective APBI trial based on physical examination, mammography, and ultrasound (US) were further evaluated with breast MRI before treatment. All abnormal MRI findings were biopsied.
RESULTS
Between 2002 and 2011, 180 women who met inclusion criteria for APBI underwent breast MRI prior to treatment (median age=59; range 38-86). 126 tumors (70%) were invasive carcinomas with or without associated DCIS, while 54 (30%) were pure DCIS. Breast MRI confirmed unifocal disease in 109 patients with 111 cancers (60.5% of MRI cohort). Multifocal disease was identified in 19 patients (10.5% of MRI cohort), while multicentric disease was present in 3 patients (1.6% of MRI cohort). Five patients (4%) had an MRI-detected contralateral cancer. False positive MRI findings were seen in 45 patients (25% of MRI cohort). Pre-menopausal patients and patients with tumors >2cm were more likely to have MRI-detected multifocal/multicentric disease. While there was no statistically significant correlation between multifocal/multicentric disease and breast density, tumor histology, grade, ER status, or Her2/Neu expression, numbers in each category were small, suggesting a lack of statistical power to detect differences that may be clinically meaningful. One hundred and fifty-two of the 180 patients (84.4%) successfully completed lumpectomy and APBI, while 6.7% of the cohort underwent mastectomy.
CONCLUSIONS
Breast MRI identified additional disease in 12% of APBI candidates. Premenopausal women and patients with tumors >2cm were more likely to have MRI-detected multifocal/multicentric disease.