Wiratkapun Cholatip, Duke Deirdre, Nordmann Amy S, Lertsithichai Panuwat, Narra Vamsidhar, Barton Premsri T, Hildebolt Charles F, Bae Kyongtae T
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
Acad Radiol. 2008 May;15(5):618-25. doi: 10.1016/j.acra.2007.10.016.
To retrospectively determine the value of magnetic resonance imaging (MRI)-directed breast ultrasonography (US) in the evaluation of indeterminate or suspicious lesions identified on contrast-enhanced, breast MRI.
A total of 395 patients presenting for breast MRI during a 4-year period was retrospectively reviewed. Seventy-one patients were recommended for MRI-directed US for further characterization of indeterminate or suspicious breast lesions detected on MRI. Fifty-five patients (all female; age 31-80 years) had US. Their MRI and US were reviewed and tested for correlations with histologic results or long term follow-up. Logistic regression analyses were used to test for associations between MRI lesion characteristics and US detection rate.
US identified 46 of 97 (47%) lesions depicted at MRI from 55 patients (47 [85%] of these patients had histories of breast malignancies). Twelve cancers were found from the 97 lesions (12%). Biopsy was avoidable in 10 lesions (10%). The detection rate with US was slightly higher with "mass" (55% [23/42]) lesions described in MRI than "non-mass" lesions or lymph nodes (42% [23/55]). There was a significant positive association (odd ratio = 1.23: 95% CI = 1.05-1.43, P = .01) between US detection rate and MRI mass lesion size. There was no statistical significance between US detection rate and the presence of malignancies; 42% (5/12) of MRI malignant lesions were not visualized with US.
MRI-directed US reduced the number of biopsies required for indeterminate or suspicious MRI lesions. Nevertheless, the lesions which were biopsied had a low rate of malignancy.
回顾性确定磁共振成像（MRI）引导下的乳腺超声检查（US）在评估对比增强乳腺MRI上发现的不确定或可疑病变中的价值。
回顾性分析了4年间395例行乳腺MRI检查的患者。71例患者被推荐进行MRI引导下的US检查，以进一步明确MRI上发现的不确定或可疑乳腺病变。55例患者（均为女性；年龄31 - 80岁）接受了US检查。对她们的MRI和US检查结果进行回顾，并与组织学结果或长期随访进行相关性测试。采用逻辑回归分析来测试MRI病变特征与US检出率之间的关联。
US检查在55例患者的MRI上显示的97个病变中识别出46个（47%）（其中47例[85%]患者有乳腺恶性肿瘤病史）。97个病变中发现12例癌症（12%）。10个病变（10%）可避免活检。MRI描述为“肿块”的病变（55%[23/42]）的US检出率略高于“非肿块”病变或淋巴结（42%[23/55]）。US检出率与MRI肿块病变大小之间存在显著正相关（比值比 = 1.23；95%可信区间 = 1.05 - 1.43，P = 0.01）。US检出率与恶性肿瘤的存在之间无统计学意义；MRI恶性病变中有42%（5/12）未被US显示。
MRI引导下的US减少了不确定或可疑MRI病变所需的活检数量。然而，接受活检的病变恶性率较低。
