Hlawatsch Alexander, Teifke Andrea, Schmidt Marcus, Thelen Manfred
Department of Radiology, Johannes Gutenberg University Hospital, Langenbeckstr. 1, 55131 Mainz, Germany.
AJR Am J Roentgenol. 2002 Dec;179(6):1493-501. doi: 10.2214/ajr.179.6.1791493.
The purposes of our study were to compare the diagnostic value of whole-breast sonography and MR imaging as adjunctive techniques to mammography and to determine whether MR imaging should be used routinely in the preoperative assessment of patients with suspected breast cancer.
. One hundred four women (age range, 34-84 years; mean age, 60 years) with findings highly suggestive of malignancy in the breast were examined with mammography, sonography, and dynamic MR imaging before undergoing surgery. All visualized suspicious lesions were correlated histologically. The diagnostic relevance of sonographic and MR imaging findings was compared with the diagnostic value of the findings of clinical examination and mammography alone.
. Twenty-seven tumors showed multifocal or multicentric invasive growth at pathology. Of these 27, 48% were correctly diagnosed via mammography alone; 63%, via the combination of mammography and sonography; and 81%, via MR imaging. Nine of the index tumors were invisible on mammography but were detected on sonography. Use of sonography benefited 13 patients and produced two studies with false-positive findings. Use of MR imaging benefited seven patients and produced eight studies with false-positive findings. In summary, 93% of all patients gained no advantage from MR imaging. Relevant additional findings were significantly more frequent in patients with dense breasts.
Although MR imaging is most sensitive for the detection of small tumors, routine preoperative MR imaging appears to be unnecessary for most patients if a combination of mammography and whole-breast sonography is used. Additional MR imaging can be restricted to problematic cases in women with dense breast parenchyma.
我们研究的目的是比较全乳超声和磁共振成像（MR成像）作为乳腺X线摄影辅助技术的诊断价值，并确定MR成像是否应常规用于疑似乳腺癌患者的术前评估。
104名年龄在34至84岁之间（平均年龄60岁）、乳腺检查结果高度提示恶性肿瘤的女性在手术前行乳腺X线摄影、超声和动态MR成像检查。所有可视化的可疑病变均进行组织学对照。将超声和MR成像结果的诊断相关性与单纯临床检查和乳腺X线摄影结果的诊断价值进行比较。
27个肿瘤在病理检查中显示多灶性或多中心浸润性生长。在这27个肿瘤中，仅通过乳腺X线摄影正确诊断的占48%；通过乳腺X线摄影和超声联合诊断的占63%；通过MR成像诊断的占81%。9个索引肿瘤在乳腺X线摄影中不可见，但在超声检查中被检测到。超声检查使13名患者受益，产生了两项假阳性结果的研究。MR成像使7名患者受益，产生了八项假阳性结果的研究。总之，93%的患者未从MR成像中获益。在乳腺致密的患者中，相关的额外发现明显更常见。
尽管MR成像对小肿瘤的检测最敏感，但如果联合使用乳腺X线摄影和全乳超声，对于大多数患者而言，术前常规进行MR成像似乎没有必要。额外的MR成像可仅限于乳腺实质致密的女性中的疑难病例。
