Nouri-Neuville M, de Rocquancourt A, Cohen-Zarade S, Chapellier-Canaud M, Albiter M, Hamy A-S, Giachetti S, Cuvier C, Espié M, de Kerviler É, de Bazelaire C
Radiology Department, hôpital Saint-Louis, U728 Inserm université Paris VII, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France.
Pathology Laboratory, hôpital Saint-Louis, U728 Inserm université Paris VII, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France.
Diagn Interv Imaging. 2014 Feb;95(2):197-211. doi: 10.1016/j.diii.2014.01.005. Epub 2014 Feb 10.
The term "second look" lesions in MRI refers to lesions detected by MRI that were not initially seen on mammography or ultrasound. The objectives of our study were to analyse the displacement of targets between MRI and ultrasound; to define discriminating BIRADS morphological criteria to predict benign or malignant character and better establish the indications of second look ultrasound and biopsy; and to analyse the agreement between ultrasound and MRI in terms of morphological criteria. A retrospective and monocentric review was performed of the records of consecutive patients with breast abnormalities (mass or non-mass) initially detected by MRI that were not initially seen on mammography or ultrasound. All patients with abnormalities found during the performance of second look ultrasound and biopsied were included in the study. All lesions were documented using the BIRADS lexicon for MRI and ultrasound. Of 100 included patients, 108 lesions were detected by MRI, found via second look ultrasound and biopsied between January 2008 and 2010. All of the included patients were followed-up for a variable period, from 2 to 5 years. Eighty-two upon 108 biopsied lesions (76%) were benign and 26/108 lesions (24%) were malignant. This study confirmed the switch from procubitus to decubitus essentially displaces the tumour in the antero-posterior direction. It showed that the risk factors were not reliable criteria for establishing an indication for second look ultrasound. This study also showed that circumscribed contours and a progressive enhancement curve (type I) for masses on MRI had the strongest negative predictive value of greater than 0.85. In ultrasound, the round or oval shape, circumscribed contours and the parallel orientation to the skin favoured benignity with a NPV of greater than 0.85. For masses, the study showed that the agreement in interpretation of the benign versus suspicious morphological criteria between the MRI and the ultrasound was very weak for the shape (Kappa=0.09) and weak for the contours (Kappa=0.23). Finally, the MRI overestimated the size of the targets compared to ultrasound (Student t-test, p=0.0001). The performance of second look ultrasound has to be performed after the detection of an abdnormality on MRI even for lesion classified BIRADS 3. The biopsy indications must be wide with insertion of a clip and a control MRI. Only this control allows to stop the investigation if the biopsied lesion is benign.
MRI中的“二次检查”病变是指MRI检测到的、最初在乳腺X线摄影或超声检查中未发现的病变。我们研究的目的是分析MRI与超声检查中目标的位移情况；确定鉴别性的BIRADS形态学标准，以预测病变的良性或恶性特征，并更好地确定二次检查超声和活检的适应证；分析超声与MRI在形态学标准方面的一致性。我们对连续的乳腺异常（肿块或非肿块）患者的记录进行了回顾性单中心研究，这些患者最初由MRI检测到，而在乳腺X线摄影或超声检查中未发现。所有在二次检查超声中发现异常并接受活检的患者均纳入研究。所有病变均使用BIRADS词典对MRI和超声进行记录。在纳入研究的100例患者中，2008年1月至2010年期间通过二次检查超声发现并活检了108个由MRI检测到的病变。所有纳入患者均进行了2至5年不等的随访。108个活检病变中，82个（76%）为良性，26个（24%）为恶性。本研究证实，从仰卧位转为俯卧位主要使肿瘤在前后方向上发生移位。研究表明，风险因素并非确定二次检查超声适应证的可靠标准。本研究还表明，MRI上肿块的边界清晰和渐进性强化曲线（I型）具有最强的阴性预测价值，大于0.85。在超声检查中，圆形或椭圆形、边界清晰以及与皮肤平行的方向提示良性，阴性预测值大于0.85。对于肿块，研究表明，MRI与超声在良性与可疑形态学标准解读方面，在形状上的一致性非常弱（Kappa=0.09），在边界方面较弱（Kappa=0.23）。最后，与超声相比，MRI高估了目标的大小（Student t检验，p=0.0001）。即使对于BIRADS 3类病变，在MRI检测到异常后也必须进行二次检查超声。活检适应证应放宽，需插入标记夹并进行对照MRI检查。只有通过这种对照检查，若活检病变为良性，才能停止进一步检查。
