Department of Medical Imaging, CHU Lapeyronie, 371 avenue du Doyen Gaston Giraud, 34295 Montpellier, France.
Radiology. 2012 Jul;264(1):40-50. doi: 10.1148/radiol.12111917. Epub 2012 Apr 20.
To retrospectively review the causes of false-negative results on prior magnetic resonance (MR) imaging studies in patients who developed breast cancer as revealed on a follow-up MR imaging study and to determine the presumptive causes of these false-negative findings.
Fifty-eight pairs of MR imaging studies from one institution were assessed, consisting of a prior study without a diagnosis of cancer and a diagnostic study with subsequent findings of 60 cancers in 58 women at MR imaging (mean interval between prior and diagnostic MR examinations, 13.8 months). Two radiologists reviewed in consensus, in a nonblinded fashion, each pair of MR studies, comparing the diagnostic and the prior MR imaging studies to evaluate the rate of false-negative findings. The prospective reports were then analyzed to classify false-negatives findings in breast enhancement of breast cancers not identified at the time of imaging, potentially misinterpreted, and mismanaged. False-negative results on prior MR studies were retrospectively reassessed to identify possibly reasons why cancers had been not recognized, potentially misinterpreted, or mismanaged.
Twenty-eight (47% [95% confidence interval {CI}: 34%, 59%]) of the 60 cancers were retrospectively diagnosed as Breast Imaging Reporting and Data System grade 3, 4, or 5 lesions. Analysis of the prospective reports showed that six lesions (10% [95% CI: 2%, 18%]) had been not identified at the time of diagnosis, 15 lesions (25% [95% CI: 14%, 36%]) were potentially misinterpreted, and seven lesions (12% [95% CI: 3%, 20%]) were mismanaged. The main causes of misinterpretation were smooth margins of a mass (n=4), stability in size (n=3), and location of a nonmass in a postsurgical area (n=5). Mismanagement was mainly due to inadequate correlations between MR imaging and ultrasonographic (US) features, with inaccurate sampling with US guidance in five cases.
In patients with breast cancer seen at MR imaging, retrospective evaluation of the prior MR imaging studies showed potential observer error in 47% of cases, resulting more from misinterpretation than from nonrecognition or mismanagement of cancers.
回顾先前磁共振成像（MR）检查结果为阴性但在后续 MR 成像检查中发现乳腺癌的患者中假阴性结果的原因，并确定这些假阴性发现的可能原因。
本研究回顾性分析了一家机构的 58 对 MR 成像研究，包括先前未诊断为癌症的研究和诊断性研究，共 58 例女性在诊断性 MR 成像中发现 60 例癌症（先前和诊断性 MR 检查之间的平均间隔为 13.8 个月）。两位放射科医生以非盲法共识的方式对每一对 MR 研究进行了回顾性评估，比较了诊断性和先前的 MR 成像研究，以评估假阴性发现的发生率。然后对前瞻性报告进行分析，以分类未在成像时发现的乳腺增强乳腺癌的假阴性发现，包括可能被误诊、漏诊和处理不当的情况。对先前 MR 研究的假阴性结果进行回顾性评估，以确定可能导致癌症未被识别、误诊或处理不当的原因。
60 例癌症中，28 例（47% [95%置信区间：34%，59%]）被回顾性诊断为乳腺影像报告和数据系统（Breast Imaging Reporting and Data System，BI-RADS）3、4 或 5 级病变。对前瞻性报告的分析显示，6 例病变（10% [95%置信区间：2%，18%]）在诊断时未被识别，15 例病变（25% [95%置信区间：14%，36%]）可能被误诊，7 例病变（12% [95%置信区间：3%，20%]）处理不当。误诊的主要原因是肿块边缘光滑（n=4）、大小稳定（n=3）和非肿块位于术后区域（n=5）。处理不当主要是由于 MR 成像与超声（ultrasonographic，US）特征之间的关联不足，5 例 US 引导下取样不准确。
在接受 MR 成像检查的乳腺癌患者中，对先前的 MR 成像研究进行回顾性评估显示，47%的病例存在潜在的观察者错误，主要是由于误诊，而非癌症的漏诊或处理不当。
