1 All authors: Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016.
AJR Am J Roentgenol. 2014 Jan;202(1):237-45. doi: 10.2214/AJR.13.10600.
The purposes of this study were to determine the frequency of underestimation of high-risk lesions at MRI-guided 9-gauge vacuum-assisted breast biopsy and to determine the imaging and demographic characteristics predictive of lesion upgrade after surgery.
We retrospectively reviewed consecutively detected lesions that were found only at MRI and biopsied under MRI guidance from May 2007 to April 2012. Imaging indications, imaging features, and histologic findings were reviewed. The Fisher exact test was used to assess the association between characteristics and lesion upgrade. Patients lost to follow-up or who underwent mastectomy were excluded, making the final study cohort 140 women with 151 high-risk lesions, 147 of which were excised.
A database search yielded the records of 1145 lesions in 1003 women. Biopsy yielded 252 (22.0%) malignant tumors, 184 (16.1%) high-risk lesions, and 709 (61.9%) benign lesions. Thirty of the 147 (20.4%) excised high-risk lesions were upgraded to malignancy. The upgrade rate was highest for atypical ductal hyperplasia, lobular carcinoma in situ, and radial scar. No imaging features were predictive of upgrade. However, there was a significantly higher risk that a high-risk lesion would be upgraded to malignancy if the current MRI-detected high-risk lesion was in the same breast as a malignant tumor previously identified in the remote history, a recently diagnosed malignant tumor, or a high-risk lesion previously identified in the remote history (p = 0.0001). The upgrade rate was significantly higher for women with a personal cancer history than for other indications combined (p = 0.0114).
The rate of underestimation of malignancy in our series was 20%. No specific imaging features were seen in upgraded cases. Surgical excision is recommended for high-risk lesions found at MRI biopsy and may be particularly warranted for women with a personal history of breast cancer.
本研究旨在确定 MRI 引导下 9 针真空辅助乳腺活检中高危病变低估的频率，并确定预测手术后病变升级的影像学和人口统计学特征。
我们回顾性分析了 2007 年 5 月至 2012 年 4 月期间仅在 MRI 上发现并在 MRI 引导下活检的连续检出病变。回顾了影像学表现、影像学特征和组织学发现。Fisher 确切检验用于评估特征与病变升级之间的关联。排除了失访或接受乳房切除术的患者，最终研究队列为 140 名女性，共 151 个高危病变，其中 147 个进行了切除。
数据库搜索得到了 1003 名女性中 1145 个病变的记录。活检发现 252 个（22.0%）恶性肿瘤、184 个（16.1%）高危病变和 709 个（61.9%）良性病变。切除的 147 个高危病变中有 30 个升级为恶性肿瘤。升级率最高的是不典型导管增生、小叶原位癌和放射状瘢痕。没有影像学特征可以预测升级。然而，如果当前 MRI 检测到的高危病变与先前在远处发现的恶性肿瘤、最近诊断出的恶性肿瘤或远处发现的高危病变位于同一乳房，那么高危病变升级为恶性肿瘤的风险显著增加（p = 0.0001）。有个人癌症史的女性升级率明显高于其他综合指征（p = 0.0114）。
在我们的系列中，低估恶性肿瘤的发生率为 20%。升级病例中未见特定的影像学特征。对于 MRI 活检发现的高危病变，建议进行手术切除，对于有个人乳腺癌史的女性，尤其如此。
