Pediconi Federica, Catalano Carlo, Padula Simona, Roselli Antonella, Moriconi Enrica, Dominelli Valeria, Pronio Anna Maria, Kirchin Miles A, Passariello Roberto
Department of Radiological Sciences, University of Rome La Sapienza, V.le Regina Elena, 324, Rome, 00161, Italy.
Breast Cancer Res Treat. 2007 Nov;106(1):65-74. doi: 10.1007/s10549-006-9472-9. Epub 2007 Jan 3.
Diagnostic imaging in women with suspected breast cancer should accurately detect and diagnose malignant tumors and facilitate the correct choice of therapy. Contrast-enhanced magnetic resonance mammography (CE-MRM) is potentially the imaging modality of choice for accurate patient management decisions.
A total of 164 women with suspected breast cancer based on clinical examination, conventional mammography and/or ultrasound each underwent preoperative bilateral CE-MRM using an axial 3D dynamic T1-weighted gradient-echo sequence and gadobenate dimeglumine as contrast agent. Images were evaluated by two readers in consensus. Histological evaluation of detected lesions was performed on samples from core biopsy or surgery. Determinations were made of the sensitivity, accuracy and positive predictive value of CE-MRM compared to mammography/ultrasound for the detection of malignant lesions and of the impact of CE-MRM for surgical decision-making.
Conventional mammography/ultrasound detected 175 lesions in the 164 evaluated patients. CE-MRM revealed 51 additional lesions in 34/164 patients; multifocal and multicentric cancer was detected in 7 and 4 additional patients, respectively, contralateral foci in 21 additional patients and pectoral muscle infiltration in 2 additional patients. CE-MRM also confirmed the absence or benignity of 3 and 1 lesions suspected of malignancy on mammography/ultrasound. The sensitivity and accuracy for malignant lesion detection and identification was 100% and 93.4%, respectively, for CE-MRM compared to 77.3% and 72.1% for mammography/ultrasound, respectively. Patient management was altered for 32/164 (19.5%) patients as a result of CE-MRM.
CE-MRM positively impacts patient management decisions and should be performed in all women with suspected breast cancer based on clinical examination, mammography and/or ultrasound.
疑似乳腺癌女性的诊断性成像应准确检测和诊断恶性肿瘤，并有助于正确选择治疗方法。对比增强磁共振乳腺成像（CE-MRM）可能是用于准确进行患者管理决策的首选成像方式。
共有164名基于临床检查、传统乳腺X线摄影和/或超声检查疑似患有乳腺癌的女性，术前均接受了双侧CE-MRM检查，使用轴向3D动态T1加权梯度回波序列，并以钆贝葡胺作为造影剂。图像由两名阅片者共同评估。对通过粗针活检或手术获取的样本进行检测病变的组织学评估。确定CE-MRM相对于乳腺X线摄影/超声检查在检测恶性病变方面的敏感性、准确性和阳性预测值，以及CE-MRM对手术决策的影响。
在164名接受评估的患者中，传统乳腺X线摄影/超声检查检测到175个病变。CE-MRM在34/164名患者中发现了另外51个病变；分别在另外7名和4名患者中检测到多灶性和多中心性癌症，在另外21名患者中检测到对侧病灶，在另外2名患者中检测到胸肌浸润。CE-MRM还证实了乳腺X线摄影/超声检查怀疑为恶性的3个和1个病变不存在或为良性。与乳腺X线摄影/超声检查分别为77.3%和72.1%相比，CE-MRM检测和识别恶性病变的敏感性和准确性分别为100%和93.4%。由于CE-MRM，32/164（19.5%）名患者的治疗管理发生了改变。
CE-MRM对患者管理决策有积极影响，对于所有基于临床检查、乳腺X线摄影和/或超声检查疑似患有乳腺癌的女性都应进行该项检查。
