1 Department of Diagnostic Imaging, Alpert Medical School of Brown University, Rhode Island Hospital, Main Bldg, 3rd Fl, 593 Eddy St, Providence, RI 02903.
AJR Am J Roentgenol. 2014 Sep;203(3):682-6. doi: 10.2214/AJR.13.11905.
The purpose of this article is to determine the underestimation rate of high-risk lesions diagnosed at MRI-guided breast biopsy.
This was a retrospective review of 446 MRI-guided breast biopsies from January 2006 through December 2010. Data were collected on examination indication, lesion size and type, and pathology results. Biopsies were performed with a 9-gauge vacuum-assisted device. Biopsy results of atypical ductal hyperplasia (ADH), papillary lesion, radial scar, lobular neoplasia, and atypia were identified and compared with final excisional pathology results. Underestimation rates were calculated and data were compared by patient and lesion characteristics using chi-square analysis.
Of the 446 MRI-guided biopsies, 96 (21.5%) were high-risk lesions. Forty-two of 96 lesions (44%) were masses, and 54 (56%) showed nonmass enhancement. Twenty of 96 lesions (20.8%) were ADH, nine (9.4%) were lobular neoplasia, 27 (28.1%) were papillary lesions, 20 (20.8%) were radial scar, and 20 (20.8%) were other atypias. Sixty-nine of 96 lesions (71.9%) had surgical excisional pathology results available. Sixteen of 69 (23.2%) lesions were upgraded to malignancy; 11 of the 16 (68.8%) were upgraded to ductal carcinoma in situ (DCIS) and five (31.2%) were upgraded to invasive carcinoma. The underestimation rate was 31.6% (6/19) for ADH, 5.9% (1/17) for papillary lesions, 23.1% (3/13) for radial scar, 28.6% (2/7) for lobular neoplasia, and 30.8% (4/13) for other atypias (p = 0.43). There was no statistically significant difference in underestimation rate by lesion type, size, or history of newly diagnosed breast cancer.
MRI-guided breast biopsy yielded high-risk lesions in 21.5% of cases, and the underestimation rate was 23.2%. No patient or lesion characteristics correlated with underestimation rate.
本文旨在确定 MRI 引导下乳腺活检诊断的高危病变的低估率。
这是对 2006 年 1 月至 2010 年 12 月间 446 例 MRI 引导下乳腺活检的回顾性分析。收集检查指征、病变大小和类型以及病理结果。活检采用 9 号空芯针真空辅助装置进行。识别不典型导管增生（ADH）、乳头状病变、放射状瘢痕、小叶肿瘤和非典型增生的活检结果，并与最终的切除病理结果进行比较。计算低估率，并通过卡方分析比较患者和病变特征的数据。
在 446 例 MRI 引导活检中，96 例（21.5%）为高危病变。96 个病变中有 42 个（44%）为肿块，54 个（56%）表现为非肿块强化。96 个病变中有 20 个（20.8%）为 ADH，9 个（9.4%）为小叶肿瘤，27 个（28.1%）为乳头状病变，20 个（20.8%）为放射状瘢痕，20 个（20.8%）为其他非典型病变。96 个病变中有 69 个（71.9%）有手术切除的病理结果。69 个病变中有 16 个（23.2%）升级为恶性病变；其中 11 个（68.8%）升级为导管原位癌（DCIS），5 个（31.2%）升级为浸润性癌。ADH 的低估率为 31.6%（6/19），乳头状病变为 5.9%（1/17），放射状瘢痕为 23.1%（3/13），小叶肿瘤为 28.6%（2/7），其他非典型病变为 30.8%（4/13）（p=0.43）。病变类型、大小或新诊断乳腺癌病史对低估率无统计学意义。
MRI 引导下乳腺活检的高危病变检出率为 21.5%，低估率为 23.2%。无患者或病变特征与低估率相关。
