Linda Anna, Zuiani Chiara, Londero Viviana, Bazzocchi Massimo
Department of Radiology, Azienda Ospedaliero-Universitaria, Via Colugna 50, 33100 Udine, Italy.
Breast. 2008 Feb;17(1):51-7. doi: 10.1016/j.breast.2007.06.004. Epub 2007 Aug 20.
The purpose of the study was to evaluate the outcome of initially only magnetic resonance mammography (MRM)-detected breast lesions as a function of radiologic features, history of breast cancer and lesion size. We evaluated core needle biopsy (CNB) (148) and follow-up (25) results of 173 initially only MRM-detected lesions-142 with and 31 without "second-look" correlate, as a function of (1) radiologic features (sonographic correlate, MRI BI-RADS category); (2) history of breast cancer; (3) MRM indication in case of history of breast neoplasm; (4) side and size of synchronous cancer; (5) lesion diameter. (1) Overall malignancy rate was 28.3% (49/173); significantly higher among lesions with a sonographic correlate (46/142), than among those without (3/31) (p=0.014). Frequencies of malignancy for MRI BI-RADS categories 2, 3, 4 and 5, were 0% (0/1), 5.4% (4/73), 26.1% (17/65) and 82.3% (28/34), respectively. (2) Malignancy rate was significantly higher in case of history of breast carcinoma (40/118 versus 9/55; p=0.027); in particular, of 42 MRI BI-RADS category 3 lesions in women with history of breast cancer and of 31 in patients without history, 3 (7%) and 1 (3%) proved to be malignant, respectively (non-significant). (3) Malignancy was more frequent when MRM was performed for pre-operative assessment than for follow-up (30/78 versus 10/40; non-significant). (4) Malignancy rate increased in presence of ipsilateral (19/35 versus 11/43; p=0.018), large (cut-off 6 mm: 30/75 versus 0/3, non-significant; 11 mm: 28/61 versus 2/17, p=0.011; 16 mm: 24/48 versus 6/30, p=0.015; 21 mm: 14/21 versus 16/57, p=0.004) primary tumors. (5) The frequency of malignancy was significantly higher in lesions equal to or larger than 6, 11 and 16 mm, compared with smaller lesions (6 mm: 45/136 versus 4/37, p=0.007; 11 mm: 21/51 versus 28/122, p=0.025; 16 mm: 12/24 versus 37/149, p=0.021). Radiologic features, history of breast cancer and large diameter are associated with high likelihood of malignancy in case of initially only MRM-detected lesions. Nevertheless, biopsy might be spared just for MRI BI-RADS 3 lesions in patients without history of breast carcinoma.
本研究的目的是评估最初仅通过磁共振乳腺成像（MRM）检测到的乳腺病变的结果，该结果是放射学特征、乳腺癌病史和病变大小的函数。我们评估了173例最初仅通过MRM检测到的病变的粗针活检（CNB）（148例）和随访（25例）结果，其中142例有“二次检查”相关性，31例无“二次检查”相关性，评估内容包括：（1）放射学特征（超声相关性、MRI BI-RADS分类）；（2）乳腺癌病史；（3）有乳腺肿瘤病史时的MRM指征；（4）同步癌的部位和大小；（5）病变直径。（1）总体恶性率为28.3%（49/173）；有超声相关性的病变（46/142）中的恶性率显著高于无超声相关性的病变（3/31）（p=0.014）。MRI BI-RADS分类为2、3、4和5的恶性频率分别为0%（0/1）、5.4%（4/73）、26.1%（17/65）和82.3%（28/34）。（2）有乳腺癌病史的患者恶性率显著更高（40/118对9/55；p=0.027）；特别是，有乳腺癌病史的女性中42例MRI BI-RADS分类为3的病变和无乳腺癌病史的患者中31例此类病变，分别有3例（7%）和1例（3%）被证实为恶性（无统计学意义）。（3）为术前评估进行MRM时恶性情况比随访时更常见（30/78对10/40；无统计学意义）。（4）存在同侧（19/35对11/43；p=0.018）、大（截断值6mm：30/75对0/3，无统计学意义；11mm：28/61对2/17，p=0.011；16mm：24/48对6/30，p=0.015；21mm：14/21对16/57，p=0.004）原发性肿瘤时恶性率增加。（5）与较小病变相比，直径等于或大于6mm、11mm和16mm的病变中恶性频率显著更高（6mm：45/136对4/37，p=0.007；11mm：21/51对28/122，p=0.025；16mm：12/24对37/149，p=0.021）。放射学特征、乳腺癌病史和大直径与最初仅通过MRM检测到的病变中恶性可能性高相关。然而，对于无乳腺癌病史的患者，可能仅对MRI BI-RADS 3类病变可不进行活检。
