侵襲性小葉癌患者の切除マージン陽性と関連した術前の磁気共鳴画像所見

Preoperative Magnetic Resonance Imaging Features Associated with Positive Resection Margins in Patients with Invasive Lobular Carcinoma.

• Jiyoung Yoon
• Eun Kyung Kim
• Min Jung Kim
• Hee Jung Moon
• Jung Hyun Yoon
• Vivian Y Park

抄録

目的:

乳房温存手術を受けた浸潤性小葉癌（ILC）患者における術前の磁気共鳴画像（MRI）所見と切除マージンの状態との関連を検討する。

OBJECTIVE: To investigate preoperative magnetic resonance imaging (MRI) findings associated with resection margin status in patients with invasive lobular carcinoma (ILC) who underwent breast-conserving surgery.

材料および方法:

術前MRIを受けたILC患者100人を対象とした。MRI（腫瘍の大きさ、多焦点性、増強病変の種類、非大量増強（NME）の分布、背景の実質増強の程度）と臨床病理学的特徴（年齢、病理学的腫瘍の大きさ、管腔癌（DCIS）または小葉癌の有無、リンパ節転移の有無、エストロゲン受容体/プロゲステロン受容体/ヒト上皮成長因子受容体2型の状態）を解析した。切除縁が陽性の場合は、インクを塗った表面に浸潤性のがんまたはDCISが存在すると定義した。ロジスティック回帰分析を行い、切除縁陽性と関連する術前および術後の変数を決定した。

MATERIALS AND METHODS: One hundred and one patients with ILC who underwent preoperative MRI were included. MRI (tumor size, multifocality, type of enhancing lesion, distribution of non-mass enhancement [NME], and degree of background parenchymal enhancement) and clinicopathological features (age, pathologic tumor size, presence of ductal carcinoma [DCIS] or lobular carcinoma , presence of lymph node metastases, and estrogen receptor/progesterone receptor/human epidermal growth factor receptor type 2 status) were analyzed. A positive resection margin was defined as the presence of invasive cancer or DCIS at the inked surface. Logistic regression analysis was performed to determine pre- and postoperative variables associated with positive resection margins.

結果:

101人の患者のうち、21人（20.8％）が陽性の切除余白を示した。単変量解析では、NME、多焦点性、腋窩リンパ節転移、および病理学的腫瘍の大きさが切除縁陽性と関連していた。術前MRI所見については、多変量解析では、多焦点性（オッズ比[OR]=3.977、=0.009）およびNME（OR =2.741、=0.063）が切除縁陽性と関連していたが、NMEは境界線上の有意性を示した。

RESULTS: Among the 101 patients, 21 (20.8%) showed positive resection margins. In the univariable analysis, NME, multifocality, axillary lymph node metastasis, and pathologic tumor size were associated with positive resection margins. With respect to preoperative MRI findings, multifocality (odds ratio [OR] = 3.977, = 0.009) and NME (OR = 2.741, = 0.063) were associated with positive resection margins in the multivariable analysis, although NME showed borderline significance.

結論:

ILC患者では、多焦点性と術前乳房MRI上のNMEの存在が切除縁の陽性と関連していた。

CONCLUSION: In patients with ILC, multifocality and the presence of NME on preoperative breast MRI were associated with positive resection margins.

Copyright © 2020 The Korean Society of Radiology.