背景:乳腺癌患者的乳头保留乳房切除术(NSM)越来越多。然而,最佳术后监测尚未确定.
方法:一个前瞻性维护的数据库确定了在2007-2021年间接受NSM的原位癌和浸润性癌患者。收集术后乳房监测和干预的临床数据。进行MRI监测的患者与仅进行临床乳腺检查(CBE)的患者的肿瘤特征进行了比较。复发,和生存。
结果:对399例患者共进行了483例NSM。255例(63.9%)浸润性导管癌,31(7.8%)浸润性小叶癌,92(23.1%)DCIS,6(1.5%)混合导管和小叶癌,其他9人(2.3%),和6(1.5%)未知。术后,仅接受CBE随访的有265例(66.4%)患者和134例(33.6%)患者有监测MRI。在中位随访33个月时,20例患者(5.0%)出现乳腺内复发,6例(1.5%)腋窝复发,28例(7.0%)远处复发。CBE组检测到14例(53.8%)LRR,MRI组检测到12例(46.2%)(P=0.16)。总生存率(OS)为99%,单独使用CBE与MRI的患者之间的OS没有差异(P=0.46)。与单独CBE相比,MRI与更高的活检率相关(15.8%vs.7.8%,P=0.01)。
结论:与单独的CBE相比,在NSM之后使用筛查性MRI可获得更高的活检率,且总生存率无差异.
BACKGROUND: Nipple sparing mastectomy (NSM) is increasingly being performed for patients with breast cancer. However, optimal postoperative surveillance has not been defined.
METHODS: A prospectively maintained database identified patients with in-situ and invasive cancer who underwent NSM between 2007-2021. Clinical data on postoperative breast surveillance and interventions were collected. Patients who had MRI surveillance versus clinical breast exam (CBE) alone were compared with respect to tumor characteristics, recurrence, and survival.
RESULTS: A total of 483 NSMs were performed on 399 patients. 255 (63.9%) patients had invasive ductal carcinoma, 31 (7.8%) invasive lobular carcinoma, 92 (23.1%) DCIS, 6 (1.5%) mixed ductal and lobular carcinoma, 9 (2.3%) others, and 6 (1.5%) unknown. Postoperatively, 265 (66.4%) patients were followed with CBE alone and 134 (33.6%) had surveillance MRIs. At a median follow-up of 33 months, 20 patients (5.0%) developed in-breast recurrence, 6 patients had (1.5%) an axillary recurrence, and 28 with (7.0%) distant recurrence. 14 (53.8%) LRR were detected in the CBE group and 12 (46.2%) were detected in the MRI group (P = .16). Overall survival (OS) was 99%, with no difference in OS between patients who had CBE alone versus MRI (P = .46). MRI was associated with higher biopsy rates compared to CBE alone (15.8% vs. 7.8%, P = .01).
CONCLUSIONS: Compared to CBE alone, the use of screening MRI following NSM results in higher rate of biopsy and no difference in overall survival.