Prediction value of breast MRI in ipsilateral breast tumor recurrence after breast-conserving surgery and distant metastasis following secondary surgery
Prediction value of breast MRI in ipsilateral breast tumor recurrence after breast-conserving surgery and distant metastasis following secondary surgery
Objective:To examine the prognostic value of magnetic resonance imaging(MRI)characteristics for ipsilateral breast tumor recurrence(IBTR)patients following breast-conserving surgery(BCS)and the risk of distant metastasis following secondary surgery in patients with IBTR.Methods:A retrospective analysis was conducted on 6 807 breast cancer patients who underwent BCS in Fudan University Shanghai Cancer Center between January 2010 and December 2018.Among them,67 cases experienced IBTR and underwent preoperative MRI examination at our institution.Using a 1∶2 ratio,they were matched with 134 control patients without recurrence based on age,clinical stage,and fibro glandular density.Univariate analysis was used to compare the MRI characteristics and clinical pathological data of the two groups.Multivariate logistic regression was performed to identify independent factors for IBTR.Furthermore,among the 67 patients with IBTR,47 patients underwent secondary surgery and had MR images of the recurrent tumor.The median follow-up time was 22.0 months(range from 1.9 to 101.1 months),with 15 cases developing distant metastasis and 32 cases without distant metastasis.Univariate and multivariate Cox regression analyses were conducted to determine independent predictive factors associated with distant metastasis following secondary surgery.Results:Univariate analysis revealed a significant association between histological grade,negative margin distance,molecular subtype,receipt of postoperative adjuvant radiotherapy,background parenchymal enhancement(BPE),lesion enhancement type,suspicion of involvement of the nipple skin on preoperative MRI,and postoperative IBTR(P＜0.05).Additionally,multivariate logistic regression analysis demonstrated that high BPE,non-mass lesions,nipple or skin thickening with indentation,molecular subtypes of human epidermal growth factor receptor 2(HER2)+ and triple-negative breast cancer,as well as not receiving radiotherapy after surgery,were independent risk factors for IBTR.Among the 47 patients who underwent secondary surgery and had MRI images of the recurrent tumor,univariate and multivariate Cox regression analysis indicated that negative HER2 status and high BPE levels on preoperative MRI were associated with a higher risk of distant metastasis after secondary surgery.Conclusion:Preoperative MRI provides valuable assistance in the auxiliary clinical management and prognostic prediction of patients undergoing breast-conserving surgery and experiencing IBTR.High BPE,non-mass lesions,and nipple or skin thickening with indentation on preoperative MRI indicate a high risk of local recurrence after breast-conserving surgery.In addition,high BPE on MRI of recurrent lesions is associated with the occurrence of distant metastasis after secondary surgery.
关键词
乳腺癌/磁共振成像/保乳手术/同侧乳腺肿瘤复发/二次手术/风险评估
Key words
Breast cancer/Magnetic resonance imaging/Breast-conserving surgery/Ipsilateral breast tumor recurrence/Secondary surgery/Risk assessment
维普
万方数据