保乳术前肿瘤MRI体积与术后标本体积及基于金属夹勾画术腔体积比较研究

doi:10.3760/cma.j.issn.1004-4221.2016.12.009

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摘要

目的探讨保乳患者术前MRI肿瘤体积与术后标本测量体积及基于金属夹勾画的瘤床体积间的差异性与相关性。方法 2014—2015年间 50例乳腺癌保乳患者入组。基于术前MRI勾画GTV并定义为 GTV_MRI,其边界外扩1.0 cm得到 GTV_MRI+1。测量切除标本体积并测量和计算病理体积,分别定义为GTV_ES 和 GTV_PAT。在定位CT图像上基于术腔边界金属夹勾画GTV,并定义为GTV_TB。Friedman检验,Wilcoxon法两两比较,Spearman等级相关分析。结果 GTV_MRI、GTV_MRI+1、GTV_PAT、GTV_ES、GTV_TB中位数(范围)分别为0.97(0.01~6.88)、12.58(3.90~34.13)、0.97(0.01~2.36)、15.46(1.15~70.69)、19.24(4.72~54.33) cm³。GTV_MRI与GTV_PAT、GTV_MRI+1与 GTV_ES、GTV_TB与GTV_ES差异均无统计学意义(P=0.188、0.07、0.264)。GTV_TB、GTV_ES与 GTV_MRI均无相关性(P=0.378、0.071), GTV_TB、GTV_ES与 GTV_MRI+1也均无相关性(P=0.375、0.068),而GTV_TB与GTV_ES呈正相关(r=0.488,P=0.004)。结论在非影像引导情况下,保乳治疗的患者基于触诊范围行局部肿瘤切除术时,切除标本体积及基于金属夹勾画的术腔体积与基于术前MRI图像所勾画与构建的肿瘤体积均无相关性。

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	张爱苹
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	王玮
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	陈兆秋
	穆殿斌
	邵倩

关键词 ：磁共振成像, 保乳术, 切除标本, 术腔体积, 乳腺肿瘤

Abstract：

Objective To explore the gross tumor volume (GTV) difference and correlation between preoperative magnetic resonance imaging (MRI), postoperative specimen, and lumpectomy cavity based on surgical clips. Methods Fifty patients with breast cancer undergoing breast-conserving surgery were enrolled as subjects from 2014 to 2015. GTV_MRI was defined as tumor volume based on preoperative MRI scans, while GTV_MRI+1 was defined as GTV_MRI plus a 1.0-cm margin. GTV_ES was defined as the volume of excised specimen, while GTV_PAT was defined as the pathological volume of the specimen. GTV_TB was defined as tumor volume based on lumpectomy cavity localized by surgical clips on computed tomography images. Comparison between any two GTVs was made by Friedman test and Wilcoxon test. A correlation analysis was made by Spearman rank correlation. Results The median values of GTV_MRI, GTV_MRI+1, GTV_PAT, GTV_ES, and GTV_TB were 0.97(0.01-6.88), 12.58(3.90-34.13), 0.97(0.01-2.36), 15.46(1.15-70.69), and 19.24(4.72-54.33) cm³, respectively. There were no significant differences between GTV_MRI and GTV_PAT, between GTV_MRI+1 and GTV_ES, and between GTV_ES and GTV_TB (P=0.188, 0.07, 0.264). Neither GTV_ES nor GTV_TB was correlated with GTV_MRI(P=0.071, 0.378) or GTV_MRI+1(P=0.068, 0.375). GTV_TB was positively correlated with GTV_ES (r=0.488, P=0.004). Conclusions For patients undergoing breast-conserving therapy, during lumpectomy guided by palpation rather than imaging, neither the volume of excised specimen nor lumpectomy cavity based on surgical clips are correlated with tumor volume based on preoperative MRI.

Key words： Magnetic resonance imaging Breast conservation therapy Excised specimen Lumpectomy cavity Primary tumor

收稿日期: 2016-03-10

基金资助:

山东省医药卫生科技发展计划项目(2013WS0346)

通讯作者: 李建彬,Email:lijianbin@msn.com

引用本文:

张爱苹,李建彬,王玮等. 保乳术前肿瘤MRI体积与术后标本体积及基于金属夹勾画术腔体积比较研究[J]. 中华放射肿瘤学杂志, 2016, 25(12): 1314-1318.

Zhang Aiping,Li Jianbin,Wang Wei et al. Gross tumor volume delineation in patients undergoing breast – conserving surgery:a comparative study of preoperative magnetic resonance imaging, postoperative specimen, and lumpectomy cavity based on surgical clips[J]. Chinese Journal of Radiation Oncology, 2016, 25(12): 1314-1318.

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http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.issn.1004-4221.2016.12.009 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2016/V25/I12/1314

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