术前乳腺MRI的其他发现：二次乳腺断层合成成像的价值
Additional findings at preoperative breast MRI: the value of second-look digital breast tomosynthesis.
作者信息
Clauser Paola, Carbonaro Luca A, Pancot Martina, Girometti Rossano, Bazzocchi Massimo, Zuiani Chiara, Sardanelli Francesco
机构信息
Institute of Diagnostic Radiology, Department of Medical and Biological Sciences, University of Udine, Azienda Ospedaliero-Universitaria, "S.Maria della Misericordia", Udine, Italy,
出版信息
Eur Radiol. 2015 Oct;25(10):2830-9. doi: 10.1007/s00330-015-3720-5. Epub 2015 Apr 23.
OBJECTIVES
To evaluate second-look digital breast tomosynthesis (SL-DBT) for additional findings (AFs) at preoperative MRI compared with second-look ultrasound (SL-US).
METHODS
We included 135 patients with breast cancer who underwent digital mammography (DM), DBT, US, and MRI at two centres. MR images were retrospectively evaluated to find AFs, described as focus, mass, or non-mass; ≤10 mm or >10 mm in size; BI-RADS 3, 4, or 5. DM and DBT exams were reviewed looking for MRI AFs; data on SL-US were collected. Reference standard was histopathology or ≥12-month negative follow-up. Fisher exact test and McNemar test were used.
RESULTS
Eighty-four AFs were detected in 53/135 patients (39%, 95%CI 31-48%). A correlate was found for 44/84 (52%, 95%CI 41-63%) at SL-US, for 20/84 (24%, 95%CI 11-28%) at SL-DM, for 42/84 (50%, 95%CI 39-61%) at SL-DBT, for 63/84 (75%, 95%CI 64-84%) at SL-DBT, and/or SL-US, the last rate being higher than for SL-US only, overall (p < 0.001), for mass or non-mass, ≤ or >10 mm, BI-RADS 4 or 5, or malignant lesions (p < 0.031). Of 21 AFs occult at both SLs, 17 were malignant (81%, 95%CI 58-94%).
CONCLUSIONS
When adding SL-DBT to SL-US, AFs detection increased from 52% to 75%. MR-guided biopsy is needed for the remaining 25%.
KEY POINTS
• Detection rate of MRI AFs using SL-US was 52% • Adding SL-DBT, the detection rate of MRI AFs significantly increased to 75%. • Over 80% of the remaining 25% MRI AFs were malignant. • MR-guided biopsy should be used when SL-US and SL-DBT are inconclusive.
目的
评估与二次超声检查（SL-US）相比，二次数字乳腺断层合成检查（SL-DBT）用于术前磁共振成像（MRI）的额外发现（AFs）。
方法
我们纳入了135例在两个中心接受数字乳腺X线摄影（DM）、DBT、超声和MRI检查的乳腺癌患者。对MR图像进行回顾性评估以发现AFs，分为焦点、肿块或非肿块；大小≤10mm或>10mm；乳腺影像报告和数据系统（BI-RADS）分类为3、4或5。回顾DM和DBT检查以寻找MRI的AFs；收集SL-US的数据。参考标准为组织病理学检查或至少12个月的阴性随访结果。采用Fisher精确检验和McNemar检验。
结果
在53/135例患者（39%，95%可信区间31%-48%）中检测到84个AFs。在SL-US中发现44/84个（52%，95%可信区间41%-63%）AFs有对应物，在SL-DM中为20/84个（24%，95%可信区间11%-28%），在SL-DBT中为42/84个（50%，95%可信区间39%-61%），在SL-DBT和/或SL-US中为63/84个（75%，95%可信区间64%-84%），最后一个比例高于仅SL-US的情况，总体上（p<0.001），对于肿块或非肿块、≤或>10mm、BI-RADS 4或5或恶性病变（p<0.031）。在两次SL检查中均隐匿的21个AFs中，17个为恶性（81%，95%可信区间58%-94%）。
结论
当在SL-US基础上增加SL-DBT时，AFs的检测率从52%提高到75%。其余25%的情况需要进行MR引导下活检。
关键点
• 使用SL-US对MRI的AFs检测率为52% • 增加SL-DBT后，MRI的AFs检测率显著提高到75%。• 其余25%的MRI的AFs中超过80%为恶性。• 当SL-US和SL-DBT结果不明确时应采用MR引导下活检。
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