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

摘要

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. GTVMRI was defined as tumor volume based on preoperative MRI scans, while GTVMRI+1 was defined as GTVMRI plus a 1. 0-cm margin. GTVES was defined as the volume of excised specimen, while GTVPAT was defined as the pathological volume of the specimen. GTVTB 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 GTVMRI , GTVMRI+1 , GTVPAT, GTVES, and GTVTB 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 GTVMRI and GTVPAT , between GTVMRI+1 and GTVES , and between GTVES and GTVTB ( P=0. 188, 0. 07, 0. 264). Neither GTVES nor GTVTB was correlated with GTVMRI(P=0. 071, 0. 378) or GTVMRI+1(P=0. 068, 0. 375). GTVTB was positively correlated with GTVES(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.%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GTVMRI,其边界外扩1.0 cm得到GTVMRI+1.测量切除标本体积并测量和计算病理体积,分别定义为GTVES和GTVPAT.在定位CT图像上基于术腔边界金属夹勾画GTV,并定义为GTVTB.Friedman检验,Wilcoxon法两两比较,Spearman等级相关分析.结果 GTVMRI、GTVMRI+1、GTVPAT、GTVES、GTVTB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.GTVMRI与GTVPAT、GTVMRI+1与GTVES、GTVTB与GTVES差异均无统计学意义(P=0.188、0.07、0.264).GTVTB、GTVES与GTVMRI均无相关性(P=0.378、0.071),GTVTB、GTVES与GTVMRI+1也均无相关性(P=0.375、0.068),而GTVTB与GTVES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.