術前進行乳房MRI與較少腫瘤復發有關
作者：Norra MacReady
出處：WebMD醫學新聞
May 10, 2010 (加州聖地牙哥) — 義大利羅馬La Sapienza大學的Valeria Dominelli醫師在美國倫琴射線學會2010年會中宣稱，原發性乳房腫瘤病患術前進行磁振造影(MRI)，可以預防對側腫瘤和局部同側腫瘤復發。
第一作者、Dominelli醫師表示，在對預定進行手術治療復發乳癌的49名婦女的回溯分析中，術前接受顯影劑加強MRI婦女的對側腫瘤和同側腫瘤比率顯著較低。
Dominelli醫師表示，這些發現認為，術前局部MRI分期可以顯著減少追蹤期間的同側復發和對側癌症，這可能是因為醫師可以更佳地評估疾病範圍。
至少有一名未參與此研究的專家呼籲更謹慎的方式。西雅圖癌症照護聯盟影像主任、華盛頓大學放射科教授Constance Lehman醫師表示，對於乳癌婦女是否使用MRI仍然有許多爭議。
Dominelli醫師研究中的病患來自於2007年1月至2009年1月間的150名乳癌復發婦女，所有案例曾手術成功地移除整個初發腫瘤，組織邊緣沒有病灶，所有病患在術後接受了類似的整體治療，全部都接受乳房MRI追蹤，以評估任何復發範圍。
Dominelli醫師表示，在初次原發性腫瘤治療之後7-47個月，有49名婦女發生復發，其中，10名接受術前MRI (A組)，其中3例，MRI發現其他影像檢查未發現的多處或多中心病灶，39名未接受術前MRI(B組)的婦女，有2人在術中發現其他病灶。
為了移除最初的腫瘤，A 組中有6名婦女(60%)進行乳房切除術、3人(30%)進行部份乳房切除術、1人(10%)進行乳房腫瘤切除術。B組婦女中，8人(21%)進行乳房切除術、27人(69%)進行部份乳房切除術、4人(10%)進行乳房腫瘤切除術。
追蹤期間，14%的A 組婦女發生同側局部復發，12%發生「異時性對側腫瘤(metachronous contralateral carcinoma)」，相對的，B組的局部同側復發以及異時性對側腫瘤比率分別是86%和88%(P< .001)，Dominelli醫師表示，這表示最初的分期可能不正確。
在一篇探討顯影劑強化磁振乳房攝影(contrast-enhanced MR mammography，CE-MRM)用於計劃進行初次乳癌手術的研究中，Dominelli醫師等人發現，CE-MRM偵測到其他影像方法發現的所有病灶，164名病患中有34人(21%)還發現額外的51個疑似病灶，導致32名病患(20%)改變治療方式，Dominelli醫師表示，總體而言，應建議使用乳房MRI作為乳癌病患之疾病範圍的更精準評估。
Lehman醫師指出，這兩篇研究都支持使用術前乳房MRI，但是我們需要更多有關它用於此類病患之實際價值的術後資料。
Dominelli醫師與Lehman醫師皆宣告沒有相關財務關係。
美國倫琴射線協會(ARRS)2010年會。發表於2010年5月6日。
Preoperative Breast MRI Associated With Fewer Tumor Recurrences
By Norra MacReady
Medscape Medical News
May 10, 2010 (San Diego, California) — Magnetic resonance imaging (MRI) before surgery for a primary breast tumor can prevent contralateral tumors and local ipsilateral recurrences, Valeria Dominelli, MD, from the University of Rome "La Sapienza," in Italy, announced here at the American Roentgen Ray Society 2010 Annual Meeting.
In a retrospective analysis of 49 women slated for surgery to treat recurrent breast cancer, the rate of contralateral carcinoma and ipsilateral recurrent carcinoma was significantly lower among patients who had undergone preoperative contrast-enhanced MRI, said Dr. Dominelli, lead author of the study.
These findings suggest that "preoperative local MR staging allows a significant reduction in ipsilateral recurrences and contralateral cancer at follow-up," most likely because clinicians can better evaluate the extent of the disease, said Dr. Dominelli.
At least one expert not involved in this research urged a more cautious approach. "There is still a good deal of debate over whether MRI should be used in women with breast cancer," said Constance Lehman, MD, professor of radiology at the University of Washington, and director of imaging at the Seattle Cancer Care Alliance.
The patients in Dr. Dominelli's study were part of a larger group of 150 women evaluated for breast cancer recurrence between January 2007 and January 2009. In all cases, surgery had successfully removed the entire initial tumor, and histologic margins were free of disease. All of the patients underwent similar systemic treatment after surgery, and all underwent follow-up breast MRI to evaluate the extent of any relapse.
Recurrences occurred in 49 women from 7 to 47 months after treatment of the initial primary carcinoma. Of those, 10 had undergone preoperative MRI (group?A). In 3 of those cases, MRI revealed multifocal or multicentric disease not detected by other imaging modalities, Dr. Dominelli said. In 2 of the 39 women who had not undergone preoperative MRI (group?B), additional disease foci were found during surgery.
To remove the initial tumor, 6 of the women in group?A (60%) underwent mastectomy, 3 (30%) underwent quadrantectomy, and 1 (10%) underwent lumpectomy. Among women in group?B, 8 (21%) underwent mastectomy, 27 (69%) underwent quadrantectomy, and 4 (10%) underwent lumpectomy.
At follow-up, 14% of the women in group?A had developed ipsilateral local recurrences, and 12% had developed metachronous contralateral carcinoma. In contrast, local ipsilateral recurrences and metachronous contralateral carcinomas were found in 86% and 88%, respectively, of the women in group?B (P?< .001). "This suggests that initial staging probably was not correctly done," Dr. Dominelli said.
In a related study on the use of contrast-enhanced MR mammography (CE-MRM) in planning initial breast cancer surgery, Dr. Dominelli and her colleagues found that CE-MRM detected all the lesions found by other imaging methods, plus 51 additional suspicious lesions in 34 of 164 patients (21%), leading to a change in treatment for 32 of those patients (20%). All in all, said Dr. Dominelli, breast MRI "should be recommended" for more precise evaluation of disease extent in patients with breast cancer.
"Both of these studies lend support for the use of preoperative breast MRI, but we need more postoperative data about its true value in these patients," Dr. Lehman added.
Dr. Dominelli and Dr. Lehman have disclosed no relevant financial relationships.
American Roentgen Ray Society (ARRS) 2010 Annual Meeting. Presented May 6, 2010.
