مقایسه‌ی اندازه‌ی کارسینوم پستان بر اساس بررسی پاتولوژیک نمونه‌ی ماستکتومی یا لامپکتومی با اندازه‌ی گزارش‌شده در سونوگرافی و ماموگرافی

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 استادیار، گروه آسیب‌شناسی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 دانشجوی پزشکی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقاله پژوهشی




مقدمه: از عوامل مهم در تعیین پیش‌آگهی و برنامه‌ی درمانی بیماران مبتلا به سرطان پستان، اندازه‌ی تومور است. هدف ما در این مطالعه، مقایسه‌ی سایز تخمین زده شده در روش‌های تصویربرداری رایج از جمله سونوگرافی و ماموگرافی با سایز تعیین شده در نمونه‌ی پاتولوژی بود.
روش‌ها: در این مطالعه‌ی مقطعی، 287 نمونه‌ی پاتولوژی سرطان پستان بیمارستان امید اصفهان از سال 1394 تا 1398 وارد مطالعه شدند. اختلاف بین سایز تومور در روش‌های تصویربرداری و گزارش پاتولوژی داده‌ها محاسبه شد و در سه دسته‌ی Concordant، Overestimation و Underestimation طبقه‌بندی شدند. تأثیر فاکتورهای مختلف از جمله سن، نوع تومور، سایز و ساب‌تایپ مولکولی تومور در دقت هر کدام از روش‌های تصویربرداری ارزیابی شد.
یافته‌ها: در گزارش‌های سونوگرافی و ماموگرافی به ترتیب 58/3 و 51/7 درصد تخمین درست (Concordant)، 30/6 و 31 درصد تخمین کوچکتر (Underestimation) و 11/1 و 17/2 درصد تخمین بزرگتر (Overestimation) گزارش شدند که نشان می‌دهد، تفاوت معنی‌داری بین دقت ماموگرافی و سونوگرافی در تخمین سایز تومور وجود ندارد. دیده شد با افزایش سایز تومور میزان Underestimation توسط سونوگرافی و ماموگرافی بیشتر می‌شود. در تومورهای زیر 20 میلی‌متر، و تومورهای HER2- سونوگرافی دقت بیشتری در تخمین سایز تومور دارد. همچنین ماموگرافی سایز تومورهای Luminal A را نسبت به سونوگرافی بزرگتر تخمین می‌زند.
نتیجه‌گیری: دقت سونوگرافی و ماموگرافی در تخمین سایز تومور تقریباً برابر بوده اما عواملی مانند T stage تومور، وجود یا نبود HER2، ساب‌تایپ مولکولی در این مسأله تأثیرگذارند.

کلیدواژه‌ها

عنوان مقاله [English]

Comparison of Breast Tumor Size Measurement Using Ultrasound and Mammography with Pathologic Report Following Mastectomy or Lumpectomy

نویسندگان [English]

  • Behnoosh Mohammadi-Jazi 1
  • Pardis Makhmali 2
1 Assistant Professor, Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Medical Student, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Background: One of the most important factors in determining prognosis and therapeutic plan in patients with breast cancer is tumor size. Our aim in this study was to compare the estimated tumor size in two common imaging modalities, ultrasound and mammography with pathologic assessment.
Methods: In this cross sectional study, we analyzed 287 patients with breast cancer diagnosis whose pathologic specimen was reported in pathology department of Omid hospital (Isfahan, Iran) from March 2015 to March 2020. The difference in tumor size were evaluated based on imaging and pathological reports. Then, we classified them in three groups as concordant, underestimated, and overestimated for which the effect of various factors such as age, tumor type, T stage and molecular subtype on accuracy of each modality was assessed.
Findings: Concordance rate was 58.3% in ultrasonography and 51.7% in mammography. Ultrasonography and mammography respectively underestimated the tumor size in 30.6% and 31%, and overestimated in 11.1% and 17.2% of cases indicating no statistically significant difference between the two modalities. Ultrasonography and mammography underestimate large tumors more commonly than small tumors. For tumors smaller than 20 mm and HER2- tumors, ultrasonography is more accurate than mammography. Also, mammography estimates the size of Luminal A tumors compared to ultrasound.
Conclusion: There was no significant difference between the accuracy of ultrasonography and mammography measurement of tumor size, but inherent factors such as T stage, her2 expression and molecular subtype influence this issue.

کلیدواژه‌ها [English]

  • Breast density
  • Breast neoplasms
  • Mastectomy
  • Mammography
  • Ultrasonography

مراجع

  1. Harbeck N, Penault-Llorca F, Cortes J, Gnant M, Houssami N, Poortmans P, et al. Breast cancer. Nat Rev Dis Primers 2019; 5(1): 66.
  2. Lukasiewicz S, Czeczelewski M, Forma A, Baj J, Sitarz R, Stanislawek A. Breast cancer-epidemiology, risk factors, classification, prognostic markers, and current treatment strategies-an updated review. Cancers (Basel) 2021; 13(17): 4287.
  3. Leddy R, Irshad A, Metcalfe A, Mabalam P, Abid A, Ackerman S, et al. Comparative accuracy of preoperative tumor size assessment on mammography, sonography, and MRI: Is the accuracy affected by breast density or cancer subtype? J Clin Ultrasound 2016; 44(1): 17-25.
  4. Stein RG, Wollschlager D, Kreienberg R, Janni W, Wischnewsky M, Diessner J, et al. The impact of breast cancer biological subtyping on tumor size assessment by ultrasound and mammography - a retrospective multicenter cohort study of 6543 primary breast cancer patients. BMC Cancer 2016; 16: 459.
  5. Feig SA. Breast masses. Mammographic and sonographic evaluation. Radiol Clin North Am 1992; 30(1): 67-92.
  6. Yang WT, Lam WW, Cheung H, Suen M, King WW, Metreweli C. Sonographic, magnetic resonance imaging, and mammographic assessments of preoperative size of breast cancer. J Ultrasound Med 1997; 16(12): 791-7.
  7. Fornage BD, Toubas O, Morel M. Clinical, mammographic, and sonographic determination of preoperative breast cancer size. Cancer 1987; 60(4): 765-71.
  8. Pisano ED, Gatsonis C, Hendrick E, Yaffe M, Baum JK, Acharyya S, et al. Diagnostic performance of digital versus film mammography for breast-cancer screening. N Engl J Med 2005; 353(17): 1773-83.
  9. Madjar H, Ladner HA, Sauerbrei W, Oberstein A, Prömpeler H, Pfleiderer A. Preoperative staging of breast cancer by palpation, mammography and high-resolution ultrasound. Ultrasound Obstet Gynecol 1993; 3(3): 185-90.
  10. Sezgın G, Apaydın M, Etıt D, Atahan MK. Tumor size estimation of the breast cancer molecular subtypes using imaging techniques. Med Pharm Rep 2020; 93(3): 253-9.
  11. Azhdeh S, Kaviani A, Sadighi N, Rahmani M. Accurate estimation of breast tumor size: A comparison between ultrasonography, mammography, magnetic resonance imaging, and associated contributing factors. Eur J Breast Health 2021; 17(1): 53-61.
  12. Daniel OK, Lim SM, Kim JH, Park HS, Park S, Kim SI. Preoperative prediction of the size of pure ductal carcinoma in situ using three imaging modalities as compared to histopathological size: does magnetic resonance imaging add value? Breast Cancer Res Treat 2017; 164(2): 437-44.
  13. Katz B, Raker C, Edmonson D, Gass J, Stuckey A, Rizack T. Predicting breast tumor size for pre-operative planning: Which imaging modality is best?
    Breast J 2017; 23(1): 52-8.
  14. Gruber IV, Rueckert M, Kagan KO, Staebler A, Siegmann KC, Hartkopf A, et al. Measurement of tumour size with mammography, sonography and magnetic resonance imaging as compared to histological tumour size in primary breast cancer. BMC Cancer 2013; 13(1): 328.
  15. Ramirez SI, Scholle M, Buckmaster J, Paley RH, Kowdley GC. Breast cancer tumor size assessment with mammography, ultrasonography, and magnetic resonance imaging at a community based multidisciplinary breast center. Am Surg 2012; 78(4): 440-6.
  16. Verma R, Mathur R, Raikwar R, Kaushal M, Miishra H, Shukla R, et al. Comparison of clinical assessment, mammography and ultrasound in pre-operative estimation of primary breast cancer size: a practical approach. Internet J Surg 2007; 16: 12.
  17. Heusinger K, Löhberg C, Lux MP, Papadopoulos T, Imhoff K, Schulz-Wendtland R, et al. Assessment of breast cancer tumor size depends on method, histopathology and tumor size itself*. Breast Cancer Res Treat 2005; 94(1): 17-23.
  18. Grimsby GM, Gray R, Dueck A, Carpenter S, Stucky CC, Aspey H, et al. Is there concordance of invasive breast cancer pathologic tumor size with magnetic resonance imaging? Am J Surg 2009; 198(4): 500-4.
  19. Onesti JK, Mangus BE, Helmer SD, Osland JS. Breast cancer tumor size: correlation between magnetic resonance imaging and pathology measurements. Am J Surg 2008; 196(6): 844-48; discussion 9-50.
  20. Luparia A, Mariscotti G, Durando M, Ciatto S, Bosco D, Campanino PP, et al. Accuracy of tumour size assessment in the preoperative staging of breast cancer: comparison of digital mammography, tomosynthesis, ultrasound and MRI. Radiol Med 2013; 118(7): 1119-36.
  21. Lai HW, Chen DR, Wu YC, Chen CJ, Lee CW, Kuo SJ, et al. Comparison of the diagnostic accuracy of magnetic resonance imaging with sonography in the prediction of breast cancer tumor size: A concordance analysis with histopathologically determined tumor size. Ann Surg Oncol 2015; 22(12): 3816-23.
  22. Bosch AM, Kessels AG, Beets GL, Rupa JD, Koster D, van Engelshoven JM, et al. Preoperative estimation of the pathological breast tumour size by physical examination, mammography and ultrasound: a prospective study on 105 invasive tumours. Eur J Radiol 2003; 48(3): 285-92.
  23. Cuesta Cuesta AB, Martin Rios MD, Noguero Meseguer MR, Garcia Velasco JA, de Matias Martinez M, Bartolome Sotillos S, et al. Accuracy of tumor size measurements performed by magnetic resonance, ultrasound and mammography, and their correlation with pathological size in primary breast cancer. Cir Esp (Engl Ed) 2019; 97(7): 391-6.
  24. Şendur HN, Cerit MN, Gültekin S, Cindil E, Aslan AA, Erdal ZS, et al. Accuracy in tumor size measurements: Comparison of digital mammography, digital breast tomosynthesis and synthetic
    Clin Imaging 2021; 69: 115-9.
  25. Shin HC, Han W, Moon HG, Yom CK, Ahn SK, You JM, et al. Limited value and utility of breast MRI in patients undergoing breast-conserving cancer surgery. Ann Surg Oncol 2012; 19(8): 2572-9.
  26. Mann RM, Bult P, Van Laarhoven HWM, Span PN, Schlooz M, Veltman J, et al. Breast cancer size estimation with MRI in BRCA mutation carriers and other high risk patients. Eur J Radiol 2013; 82(9): 1416-22.
  27. Lopez JK, Bassett LW. Invasive lobular carcinoma of the breast: spectrum of mammographic, US, and MR imaging findings. Radiographics 2009; 29(1): 165-76.
  28. Pritt B, Ashikaga T, Oppenheimer RG, Weaver DL. Influence of breast cancer histology on the relationship between ultrasound and pathology tumor size measurements. Mod Pathol 2004; 17(8): 905-10.
  29. Cortadellas T, Argacha P, Acosta J, Rabasa J, Peiró R, Gomez M, et al. Estimation of tumor size in breast cancer comparing clinical examination, mammography, ultrasound and MRI-correlation with the pathological analysis of the surgical specimen. Gland Surg 2017; 6(4): 330-5.
  30. Cho N. Molecular subtypes and imaging phenotypes of breast cancer. Ultrasonography 2016; 35(4): 281-8.
  31. Rashmi S, Kamala S, Murthy SS, Kotha S, Rao YS, Chaudhary KV. Predicting the molecular subtype of breast cancer based on mammography and ultrasound findings. Indian J Radiol Imaging 2018; 28(3):
    354-61.
مجله دانشکده پزشکی اصفهان
دوره 40، شماره 681
هفته 1 مهرماه
مهر 1401
صفحه 578-586

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  • تاریخ دریافت: 06 مهر 1401
  • تاریخ پذیرش: 06 مهر 1401

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