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中华消化病与影像杂志(电子版)

中华消化病与影像杂志(电子版) ›› 2019, Vol. 09 ›› Issue (01) : 27 -31. doi: 10.3877/cma.j.issn.2095-2015.2019.01.007

所属专题： 专题评论； 文献；

临床研究

倾向性评分匹配评估术前MRI对乳腺浸润性小叶癌患者手术方案的影响
李占平1,†(), 王海2, 柴秀芳3   
  1. 1. 100083　北京市上地医院外科
    2. 100039　北京市中西医结合医院外科
    3. 100039　北京市中西医结合医院放射科
  • 收稿日期:2019-01-04 出版日期:2019-02-01
  • 通信作者: 李占平

Effect of preoperative MRI on surgery program of patients with breast invasive lobular carcinoma by propensity score matching

Zhanping Li1,†(), Hai Wang2, Xiufang Chai3   

  1. 1. Department of Surgery, Beijing Shangdi Hospital, Beijing 100083, China
    2. Department of Surgery, Beijing Hospital of Integrated Traditional Chinese and Western Medicine, Beijing 100039, China
    3. Department of Radiology, Beijing Hospital of Integrated Traditional Chinese and Western Medicine, Beijing 100039, China
  • Received:2019-01-04 Published:2019-02-01
  • Corresponding author: Zhanping Li
  • About author:
    Corresponding author: Li Zhanping, Email:
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引用本文：

李占平, 王海, 柴秀芳. 倾向性评分匹配评估术前MRI对乳腺浸润性小叶癌患者手术方案的影响[J]. 中华消化病与影像杂志(电子版), 2019, 09(01): 27-31.

Zhanping Li, Hai Wang, Xiufang Chai. Effect of preoperative MRI on surgery program of patients with breast invasive lobular carcinoma by propensity score matching[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2019, 09(01): 27-31.

目的

通过使用倾向性评分匹配来评估MRI检查对乳腺浸润性小叶癌患者治疗方法的影响，研究术前乳腺MRI成像与浸润性小叶癌(invasive lobular carcinoma，ILC)患者手术结果之间的关系。

方法

回顾性分析2006年1月至2016年12月，北京市中西医结合医院及北京市上地医院接受手术治疗的210例ILC患者。61.9%的患者(130/210)接受了MRI检查。统计乳腺X线摄影和超声检查未检出病灶的MR检出率，并分析了患者的治疗过程。在倾向性评分匹配后，1∶1匹配患者34例，患者的基本特征及肿瘤特征等14种变量在接受术前MRI成像的患者(MRI组)和未接受术前MRI成像的患者(对照组)的差异性趋近一致。比较手术结果。

结果

在MRI组130例患者中，34.6%的患者(45/130)发现了隐匿病变；62.2%的患者(28/45)存在恶性病变。24.6%的患者(32/130)由于术前MRI检查，手术方案发生了变化，91.1%(41/45)的手术结果符合病理。在倾向性评分匹配分析中，乳腺MR成像与较低的再次手术发生率相关，其优势比(Odd Ratio，OR)为0.135，P<0.05。首次乳房切除术(OR＝0.736，P＝0.663)和最终乳房切除术(OR＝0.691，P＝0.141)相似，与术前乳腺MRI成像结果间未存在统计学相关。

结论

术前MRI检查可用于检测隐匿的恶性肿瘤，并可显著降低重复手术的发生率，且不会增加ILC患者的乳房切除率。

关键词: 浸润性小叶癌, 磁共振成像, 倾向性评分匹配
Objective

To evaluate the effect of magnetic resonance imaging(MRI)examination on the treatment of patients with breast invasive lobular carcinoma(ILC)by using propensity score matching, and to study the relationship between preoperative breast MRI and the surgical outcomes of ILC patients.

Methods

The clinical and imaging data of 210 patients with ILC who underwent surgery from January 2006 to December 2016 were retrospectively analyzed who had been admitted to Beijing Hospital of Integrated Traditional Chinese and Western Medicine and Beijing Shangdi Hospital.61.9% of patients(130/210)underwent MRI examination.The MR detection rate of undetected lesions in mammography and ultrasonography was calculated and the patients′ treatment processes were analyzed.After the propensity scores matching, 34 patients with 1∶1 matched ratio, the differences among 14 basic characteristics and tumor characteristics in patients undergoing preoperative MRI(MRI group)and patients without preoperative MRI(control group)became consistent.Then the surgical results were compared.

Results

Of the 130 patients in the MRI group, 34.6%(45/130)had occult lesions; 62.2%(28/45)had malignant lesions.In 24.6% of patients(32/130), the surgical plan changed due to preoperative MRI examination, and 91.1%(41/45)of the results were consistent with pathology.In the propensity score matching analysis, breast MRI was associated with a lower incidence of re-operation, with an odds ratio(OR)of 0.135, P<0.05.The first mastectomy(OR=0.736, P=0.663)was similar to the final mastectomy(OR=0.691, P=0.141)and there was no statistical correlation with preoperative breast MRI.

Conclusion

Preoperative MRI can be used to detect occult malignancies and significantly reduce the incidence of recurrent surgery without increasing the rate of mastectomy in patients with ILC.

Key words: Invasive lobular carcinoma, Magnetic resonance imaging, Propensity score matching
表1 未匹配与匹配患者的基本特征
变量 未匹配患者 倾向性评分匹配患者
对照组(n＝80) MR组(n＝130) P值 对照组(n＝17) MR组(n＝17) P值
浸润性小叶癌确诊年龄(岁) 51.2±9.2(34～78) 48.6±6.9(33～77) 0.06 49.7±13.0(34～78) 48.6±8.8(33～77) 0.51
绝经[例(%)] 42(52.5%) 75(57.7%) 0.06 10(58.8%) 11(64.7%) 0.22
已婚育[例(%)] 77(96.3%) 123(94.6%) 0.31 16(94.1%) 15(88.2%) 0.23
使用口服避孕药[例(%)] 9(11.3%) 15(11.5%) 0.36 2(11.8%) 2(11.8%) 1
乳腺癌病史[例(%)] 2(2.5%) 4(3.1%) 0.74 2(11.8%) 2(11.8%) 1
乳腺癌家族史[例(%)] 10(12.5%) 11(8.5%) 0.52 2(11.8%) 2(11.8%) 1
致密性乳腺[例(%)] 58(72.5%) 105(80.8%) 0.01 13(76.5%) 13(76.5%) 1
病理分级2级以上[例(%)] 43(53.8%) 66(50.8%) 0.49 9(52.9%) 9(52.9%) 1
淋巴结受累[例(%)] 25(31.3%) 40(30.8%) 0.8 5(29.4%) 5(29.4%) 1
淋巴管受侵[例(%)] 9(11.3%) 10(7.7%) 0.51 2(11.8%) 2(11.8%) 1
雌激素受体阳性[例(%)] 55(68.8%) 92(70.8%) 0.01 12(70.6%) 12(70.6%) 1
孕激素受体阳性[例(%)] 47(58.8%) 77(59.2%) 0.02 9(52.9%) 9(52.9%) 1
人表皮生长因子受体-2阳性[例(%)] 7(8.8%) 12(9.2%) 0.71 2(11.8%) 2(11.8%) 1
肿瘤大小(mm) 27.9±16.2(1～87) 26.3±16.6(1～108) 0.98 27.7±14.9(1～87) 27.8±17.4(1～108) 0.91
表2 基于MR表现改变手术方案
改变 合理改变 过度治疗
手术范围扩大 11 1
保乳改全切 13 0
双侧乳房切除 4 3
总计 28(87.5) 4(12.5%)
表3 未匹配患者手术结果
手术结果 对照组(n＝80) MR组(n＝130) P值
首次切除 26(32.5%) 46(35.4%) 0.316
重复手术 14(17.5%) 4(3.1%) <0.001
最终切除 40(50.0%) 80(61.5%) 0.031
表4 倾向性评分匹配后患者手术结果
手术结果 OR 95% CI P值
下限 上限
首次切除 0.74 0.523 1.64 0.663
重复手术 0.14 0.049 0.36 <0.05
最终切除 0.7 0.433 1.24 0.141
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