“胸前区水肿”是恶性乳腺肿瘤的一种形态学征象吗？

Is "prepectoral edema" a morphologic sign for malignant breast tumors?

作者信息

Kaiser Clemens G, Herold Michael, Baltzer Pascal A T, Dietzel Matthias, Krammer Julia, Gajda Mieczyslaw, Camara Oumar, Schoenberg Stefan O, Kaiser Werner A, Wasser Klaus

机构信息

Department of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim-University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.

Department of Diagnostic and Interventional Radiology I, Friedrich-Schiller-University Hospital Jena, Jena, Germany.

出版信息

Acad Radiol. 2015 Jun;22(6):684-9. doi: 10.1016/j.acra.2015.01.009. Epub 2015 Mar 14.

DOI:10.1016/j.acra.2015.01.009

PMID:25784323

Abstract

RATIONALE AND OBJECTIVES

A variety of morphologic and kinetic signs of benign or malignant breast lesions contribute to a final diagnosis and differential diagnosis in magnetic resonance (MR) mammography (MRM). As a new sign, prepectoral edema (PE) in patients without any history of previous biopsy, operation, radiation, or chemotherapy was detected during routine breast MR examinations. The purpose of this study was to retrospectively evaluate the role of this morphologic sign in the differential diagnosis of breast lesions.

MATERIALS AND METHODS

Between January 2005 and October 2006, a total of 1109 consecutive MRM examinations have been performed in our institution. In this study, only patients who would later be biopsied or operated in our own hospital were included. They had no previous operation, biopsy, intervention, chemotherapy, hormone replacement therapy, or previous mastitis. In total, 162 patients with 180 lesions were included, histologically correlated later-on by open biopsy (124 patients and 136 lesions) or core biopsy (38 patients and 44 lesions). The evaluations were performed by four experienced radiologists in consensus.

RESULTS

One hundred eighty evaluated lesions included 104 malignant lesions (93 invasive and 11 noninvasive cancers) and 76 benign lesions. PE was detected in 2.6% of benign lesions (2 of 76), in none of the Ductal cacinoma in situ (DCIS) cases (0 of 11), and in 25.8% of malignant lesions (24 of 93; P < .000). PE was found significantly more frequently in presence of malignant tumors >2 cm in diameter (48.5%, 17 of 35 vs. 13.8%, 8 of 58; P < .001). PE was not statistically associated to malignant tumor type, presence or absence of additional DCIS, and number of lesions. This resulted in the following diagnostic parameters for PE as an indicator for malignancy: sensitivity of 19.3%, specificity of 97.3%, positive predictive value (PPV) of 92.3%, negative predictive value of 48%, and accuracy of 57.7%.

CONCLUSIONS

In case of occurrence, the "PE sign" seems to be a specific indicator for malignant tumors with a high PPV, independent from its entity.

摘要

原理与目的

乳腺良恶性病变的多种形态学和动力学特征有助于乳腺磁共振成像（MRM）的最终诊断和鉴别诊断。作为一种新的特征，在常规乳腺MR检查中发现，在无任何既往活检、手术、放疗或化疗史的患者中出现了胸肌前水肿（PE）。本研究的目的是回顾性评估这一形态学特征在乳腺病变鉴别诊断中的作用。

材料与方法

2005年1月至2006年10月，我院共连续进行了1109例乳腺MRM检查。本研究仅纳入了后来在我院接受活检或手术的患者。他们既往无手术、活检、介入治疗、化疗、激素替代治疗或乳腺炎病史。总共纳入了162例患者的180个病变，之后通过开放活检（124例患者和136个病变）或粗针活检（38例患者和44个病变）进行组织学关联。评估由四位经验丰富的放射科医生共同完成。

结果

180个评估病变中包括104个恶性病变（93个浸润性癌和11个非浸润性癌）和76个良性病变。76个良性病变中有2.6%（2个）检测到PE，导管原位癌（DCIS）病例中无一例（11个中的0个）检测到PE，93个恶性病变中有25.8%（24个）检测到PE（P <.000）。在直径>2 cm的恶性肿瘤中，PE的发现频率显著更高（48.5%，35个中的17个 vs. 13.8%，58个中的8个；P <.001）。PE与恶性肿瘤类型、是否存在额外的DCIS以及病变数量无统计学关联。这得出了以下将PE作为恶性肿瘤指标的诊断参数：敏感性为19.3%，特异性为97.3%，阳性预测值（PPV）为92.3%，阴性预测值为48%，准确性为57.7%。