浸润性小叶癌与导管癌的磁共振乳腺成像：811例患者的系统比较显示，无论类型如何，诊断准确性都很高。

Magnetic resonance mammography of invasive lobular versus ductal carcinoma: systematic comparison of 811 patients reveals high diagnostic accuracy irrespective of typing.

作者信息

Dietzel Matthias, Baltzer Pascal A, Vag Tibor, Gröschel Tobias, Gajda Mieczyslaw, Camara Oumar, Kaiser Werner A

机构信息

Institutesof Diagnostic and Interventional Radiology, Friedrich-Schiller University of Jena, Germany.

出版信息

J Comput Assist Tomogr. 2010 Jul;34(4):587-95. doi: 10.1097/RCT.0b013e3181db9f0e.

DOI:10.1097/RCT.0b013e3181db9f0e

PMID:20657229

Abstract

OBJECTIVE

Invasive lobular (ILC) and ductal carcinomas (IDC) are the most frequent subtypes of breast cancer. Diagnosis of ILC is often challenging. This study was conducted to (1) evaluate dynamic and morphologic profiles and to (2) compare the diagnostic accuracy of IDC and ILC in magnetic resonance mammography (MRM).

METHODS

Our database consisted of all consecutive MRMs over a 12-year period (standardized protocol: T1-weighted fast low-angle shot; 0.1-mmol gadolinium-diethylenetriaminepentaacetate per kilogram of body weight; T2-weighted turbo spin-echo, 1.5 T; histological verification after MRM), which were evaluated by experienced (>500 MRMs) radiologists in consensus, applying 17 predefined descriptors. All the patients gave written consent; this study was approved by the local institutional review board. Extracting all the ILCs (n = 108), IDCs (n = 347), and benign lesions (n = 436) from the database, the data set of the study was created.In ILC and IDC diagnostic accuracy of single descriptors was calculated and compared separately (chi test). Using all the descriptors, a combined binary logistic regression analysis was applied to calculate the overall diagnostic accuracy for ILC and IDC. The corresponding areas under the curve were compared.

RESULTS

ILC and IDC, showed wash-in and an irregular shape without difference (P = 1.0 and P = 0.4). Wash-out was more typical of IDC (72.6%; ILC, 57.4%; P = 0.007). Perifocal edema was diagnosed more frequently in IDC (45.5%; P = 0.05). For overall accuracy, the areas under the curve were 0.929 for ILC and 0.939 for IDC (P = 0.5).

CONCLUSIONS

The dynamic and morphologic profiles of ILC and IDC were overlapping, and minor differences between both subgroups could be identified. Accordingly, the overall diagnostic accuracy of MRM was high and without difference between both subtypes of breast cancer.

摘要

目的

浸润性小叶癌（ILC）和导管癌（IDC）是乳腺癌最常见的亚型。ILC的诊断往往具有挑战性。本研究旨在（1）评估动态和形态学特征，并（2）比较磁共振乳腺造影（MRM）中IDC和ILC的诊断准确性。

方法

我们的数据库包括12年间所有连续的MRM检查（标准化方案：T1加权快速低角度激发序列；每千克体重注射0.1 mmol钆喷酸葡胺；T2加权快速自旋回波序列，1.5 T；MRM检查后进行组织学验证），由经验丰富（>500例MRM检查）的放射科医生进行共识评估，应用17个预定义的描述符。所有患者均签署了书面知情同意书；本研究获得了当地机构审查委员会的批准。从数据库中提取所有ILC（n = 108）、IDC（n = 347）和良性病变（n = 436），创建了本研究的数据集。分别计算并比较ILC和IDC中单个描述符的诊断准确性（卡方检验）。使用所有描述符，应用二元逻辑回归分析计算ILC和IDC的总体诊断准确性。比较相应的曲线下面积。

结果

ILC和IDC均表现为快速强化和不规则形态，无差异（P = 1.0和P = 0.4）。廓清在IDC中更常见（72.6%；ILC为57.4%；P = 0.007）。IDC中周围水肿的诊断更为频繁（45.5%；P = 0.05）。总体准确性方面，ILC的曲线下面积为0.929，IDC为0.939（P = 0.5）。