PDF(Pubmed)
Abstract：
The use of preoperative breast magnetic resonance imaging (MRI) after the diagnosis of breast cancer by mammography and/or ultrasound is inconsistent.
After conducting a systematic review and meta-analysis comparing preoperative breast MRI versus no MRI, we reconvened to prepare a clinical practice guideline on this topic.
Based on the evidence that MRI improved recurrence, decreased the rates of reoperations (re-excisions or conversion mastectomy), and increased detection of synchronous contralateral breast cancer, we recommend that preoperative breast MRI should be considered on a case-by-case basis in patients diagnosed with breast cancer for whom additional information about disease extent could influence treatment. Based on stronger evidence, preoperative breast MRI is recommended in patients diagnosed with invasive lobular carcinoma for whom additional information about disease extent could influence treatment. For both recommendations, the decision to proceed with MRI would be conditional on shared decision-making between care providers and the patient, taking into account the benefits and risks of MRI as well as patient preferences. Based on the opinion of the Working Group, preoperative breast MRI is also recommended in the following more specific situations: (a) to aid in surgical planning of breast conserving surgery in patients with suspected or known multicentric or multifocal disease; (b) to identify additional lesions in patients with dense breasts; (c) to determine the presence of pectoralis major muscle/chest wall invasion in patients with posteriorly located tumours or when invasion of the pectoralis major muscle or chest wall is suspected; (d) to aid in surgical planning for skin/nipple-sparing mastectomies, autologous reconstruction, oncoplastic surgery, and breast conserving surgery with suspected nipple/areolar involvement; and (e) in patients with familial/hereditary breast cancer but who have not had recent breast MRI as part of screening or diagnosis.
After conducting a systematic review and meta-analysis comparing preoperative breast MRI versus no MRI, we reconvened to prepare a clinical practice guideline on this topic.
Based on the evidence that MRI improved recurrence, decreased the rates of reoperations (re-excisions or conversion mastectomy), and increased detection of synchronous contralateral breast cancer, we recommend that preoperative breast MRI should be considered on a case-by-case basis in patients diagnosed with breast cancer for whom additional information about disease extent could influence treatment. Based on stronger evidence, preoperative breast MRI is recommended in patients diagnosed with invasive lobular carcinoma for whom additional information about disease extent could influence treatment. For both recommendations, the decision to proceed with MRI would be conditional on shared decision-making between care providers and the patient, taking into account the benefits and risks of MRI as well as patient preferences. Based on the opinion of the Working Group, preoperative breast MRI is also recommended in the following more specific situations: (a) to aid in surgical planning of breast conserving surgery in patients with suspected or known multicentric or multifocal disease; (b) to identify additional lesions in patients with dense breasts; (c) to determine the presence of pectoralis major muscle/chest wall invasion in patients with posteriorly located tumours or when invasion of the pectoralis major muscle or chest wall is suspected; (d) to aid in surgical planning for skin/nipple-sparing mastectomies, autologous reconstruction, oncoplastic surgery, and breast conserving surgery with suspected nipple/areolar involvement; and (e) in patients with familial/hereditary breast cancer but who have not had recent breast MRI as part of screening or diagnosis.
摘要：
背景：在通过乳房X线检查和/或超声诊断乳腺癌后，术前使用乳腺磁共振成像（MRI）是不一致的。
方法：对术前乳腺MRI和无MRI进行系统评价和荟萃分析后，我们再次召开会议准备了关于这一主题的临床实践指南.
结果：基于MRI改善复发的证据，降低了再次手术（再次切除或转换乳房切除术）的比率，同时增加对侧乳腺癌的检测，我们建议,对于被诊断为乳腺癌的患者,应根据具体情况考虑术前乳腺MRI检查,这些患者的疾病程度的其他信息可能会影响治疗.基于更有力的证据,对于诊断为浸润性小叶癌的患者，建议术前进行乳腺MRI检查。对于这些患者，有关疾病程度的其他信息可能会影响治疗。对于这两项建议，进行MRI的决定将取决于护理提供者和患者之间的共同决策，考虑到MRI的益处和风险以及患者的偏好。根据工作组的意见，在以下更具体的情况下，还建议进行术前乳腺MRI检查：（a）协助疑似或已知的多中心或多灶性疾病患者的保乳手术的手术计划；（b）确定致密乳房患者的其他病变；（c）确定位于后部的肿瘤患者的胸大肌/胸壁侵犯的存在，或怀疑胸大肌/乳头侵犯的情况下，为乳房手术计划提供帮助；（d）自体重建,肿瘤整形手术,怀疑有乳头/乳晕受累的保乳手术;和(e)家族性/遗传性乳腺癌但近期未做乳腺MRI筛查或诊断的患者。
方法：对术前乳腺MRI和无MRI进行系统评价和荟萃分析后，我们再次召开会议准备了关于这一主题的临床实践指南.
结果：基于MRI改善复发的证据，降低了再次手术（再次切除或转换乳房切除术）的比率，同时增加对侧乳腺癌的检测，我们建议,对于被诊断为乳腺癌的患者,应根据具体情况考虑术前乳腺MRI检查,这些患者的疾病程度的其他信息可能会影响治疗.基于更有力的证据,对于诊断为浸润性小叶癌的患者，建议术前进行乳腺MRI检查。对于这些患者，有关疾病程度的其他信息可能会影响治疗。对于这两项建议，进行MRI的决定将取决于护理提供者和患者之间的共同决策，考虑到MRI的益处和风险以及患者的偏好。根据工作组的意见，在以下更具体的情况下，还建议进行术前乳腺MRI检查：（a）协助疑似或已知的多中心或多灶性疾病患者的保乳手术的手术计划；（b）确定致密乳房患者的其他病变；（c）确定位于后部的肿瘤患者的胸大肌/胸壁侵犯的存在，或怀疑胸大肌/乳头侵犯的情况下，为乳房手术计划提供帮助；（d）自体重建,肿瘤整形手术,怀疑有乳头/乳晕受累的保乳手术;和(e)家族性/遗传性乳腺癌但近期未做乳腺MRI筛查或诊断的患者。
