Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.
Eur J Radiol. 2013 Oct;82(10):1731-7. doi: 10.1016/j.ejrad.2013.05.002. Epub 2013 Jun 3.
The purpose of the study was to evaluate the sensitivity of breast MRI in the detection of pure DCIS and to analyze the influence of lesion type and nuclear grade.
58 consecutive patients with pathologically proven pure DCIS and preoperatively performed breast MRI were retrospectively reviewed and analyzed. Sensitivities in the detection of DCIS were calculated for MRI and mammography (Mx). Influence of MRI lesion type and nuclear grading on DCIS diagnosis was evaluated.
MRI detected pure DCIS with a sensitivity of 79.3%. The sensitivity of Mx was lower (69%), but the difference was not statistically significant (p=0.345). 46.2% of the DCIS presented as enhancing mass and 53.8% as non-mass-like enhancement (NMLE). None of the masses but 21.4% (n=6) of the NMLE were underestimated as probably benign (BI-RADS 3). MRI measured lesion sizes showed a moderate correlation (r=0.74) with histopathologically measured lesion sizes. MRI detection rate of DCIS decreased significantly (p=0.0458) with increasing nuclear grade. Calculated sensitivities were 100% for low-grade DCIS, 84.6% for intermediate-grade DCIS, and 66.7% for high-grade DCIS.
In this study MRI could detect pure DCIS more sensitively than Mx. Despite of missing statistically significance preoperative MRI seems to be helpful in patients with DCIS who are eligible for breast conservation. This applies in particular to patients with non-high-grade DCIS because those were significantly more often positive on MRI and significantly more often negative on Mx. Misinterpretation occurs especially in cases of NMLE and high-grade DCIS and therefore a correlation with Mx is also recommended.
本研究旨在评估乳腺 MRI 在检测单纯 DCIS 中的敏感性，并分析病变类型和核分级的影响。
回顾性分析 58 例经病理证实为单纯 DCIS 且术前行乳腺 MRI 的连续患者。计算 MRI 和乳腺 X 线摄影（Mx）对 DCIS 的检出率。评估 MRI 病变类型和核分级对 DCIS 诊断的影响。
MRI 检测单纯 DCIS 的敏感性为 79.3%。Mx 的敏感性较低（69%），但差异无统计学意义（p=0.345）。46.2%的 DCIS 表现为强化肿块，53.8%为非肿块样强化（NMLE）。NMLE 中无一肿块（21.4%，n=6）被低估为可能良性（BI-RADS 3）。MRI 测量的病变大小与组织病理学测量的病变大小呈中度相关（r=0.74）。MRI 对 DCIS 的检出率随核分级的增加而显著降低（p=0.0458）。计算的敏感性分别为低级别 DCIS 为 100%，中级别 DCIS 为 84.6%，高级别 DCIS 为 66.7%。
在本研究中，MRI 比 Mx 更能敏感地检测出单纯 DCIS。尽管术前 MRI 缺乏统计学意义，但对于有保乳适应证的 DCIS 患者似乎有帮助。这尤其适用于非高级别 DCIS 患者，因为这些患者在 MRI 上阳性的比例明显更高，在 Mx 上阴性的比例明显更高。错误解读尤其发生在 NMLE 和高级别 DCIS 病例中，因此也建议与 Mx 相关联。
