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

doi:10.3877/cma.j.issn.2095-2015.2019.01.007

Abstract

Abstract:

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

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.

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Figures/Tables 4

References 21

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变量	未匹配患者			倾向性评分匹配患者
变量	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

变量	未匹配患者			倾向性评分匹配患者
变量	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

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%)

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%)

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

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