Kamal Rasha M, Helal Maha H, Mansour Sahar M, Haggag Marwa A, Nada Omniya M, Farahat Iman G, Alieldin Nelly H
1 Women's Imaging Unit, Department of Radiology, Kasr ElAiny Hospital, Cairo University, Egypt.
2 Women's Imaging Unit, Department of Radiology, National Cancer Institute, Cairo University, Egypt.
Br J Radiol. 2016 Aug;89(1064):20160157. doi: 10.1259/bjr.20160157. Epub 2016 Jun 21.
: To assess the feasibility of using the MRI breast imaging reporting and data system (BI-RADS) lexicon morphology descriptors to characterize enhancing breast lesions identified on contrast-enhanced spectral mammography (CESM).
: The study is a retrospective analysis of the morphology descriptors of 261 enhancing breast lesions identified on CESM in 239 patients. We presented the morphological categorization of the included lesions into focus, mass and non-mass. Further classifications included (1) the multiplicity for "focus" category, (2) the shape, margin and internal enhancement for "mass" category and (3) the distribution and internal enhancement for "non-mass" category. Each morphology descriptor was evaluated individually (irrespective of all other descriptors) by calculating its sensitivity, specificity, positive-predictive value (PPV) and negative-predictive value (NPV) and likelihood ratios (LRs).
: The study included 68/261 (26.1%) benign lesions and 193/261 (73.9%) malignant lesions. Intensely enhancing foci, whether single (7/12, 58.3%) or multiple (2/12, 16.7%), were malignant. Descriptors of "irregular"-shape (PPV: 92.4%) and "non-circumscribed" margin (odds ratio: 55.2, LR positive: 4.77; p-value: <0.001) were more compatible with malignancy. Internal mass enhancement patterns showed a very low specificity (58.0%) and NPV (40.0%). Non-mass enhancement (NME) was detected in 81/261 lesions. Asymmetrical NME in 81% (n = 52/81) lesions was malignant lesions and internal enhancement patterns indicative of malignancy were the heterogeneous and clumped ones.
: We can apply the MRI morphology descriptors to characterize lesions on CESM, but with few expectations. In many situations, irregular-shaped, non-circumscribed masses and NME with focal, ductal or segmental distribution and heterogeneous or clumped enhancement are the most suggestive descriptors of malignant pathologies.
: (1) The MRI BI-RADS lexicon morphology descriptors can be applied in the characterization of enhancing lesions on CESM with a few exceptions. (2) Multiple bilateral intensely enhancing foci should not be included under the normal background parenchymal enhancement unless they are proved to be benign by biopsy. (3) Mass lesion features that indicated malignancy were irregular-shaped, spiculated and irregular margins and heterogeneous internal enhancement patterns. The rim enhancement pattern should not be considered as a descriptor of malignant lesions unless CESM is coupled with an ultrasound examination.
评估使用MRI乳腺影像报告和数据系统（BI-RADS）词汇形态学描述符来表征在对比增强光谱乳腺造影（CESM）上发现的强化乳腺病变的可行性。
本研究是对239例患者在CESM上发现的261个强化乳腺病变的形态学描述符进行的回顾性分析。我们将纳入病变的形态学分类为局灶性、肿块性和非肿块性。进一步分类包括：（1）“局灶性”类别的数量；（2）“肿块性”类别的形状、边缘和内部强化；（3）“非肿块性”类别的分布和内部强化。通过计算每个形态学描述符的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和似然比（LR），对每个形态学描述符进行单独评估（不考虑所有其他描述符）。
该研究包括68/261（26.1%）个良性病变和193/261（73.9%）个恶性病变。强化明显的局灶，无论是单个（7/12，58.3%）还是多个（2/12，16.7%），均为恶性。“不规则”形状（PPV：92.4%）和“非环形”边缘（优势比：55.2，阳性LR：4.77；p值：<0.001）的描述符与恶性肿瘤更相符。肿块内部强化模式的特异性（58.0%）和NPV（40.0%）非常低。在261个病变中检测到81个非肿块强化（NME）。81%（n = 52/81）病变中的不对称NME为恶性病变，提示恶性的内部强化模式为不均匀和聚集性。
我们可以应用MRI形态学描述符来表征CESM上的病变，但期望不高。在许多情况下，形状不规则、边缘不清的肿块以及具有局灶性、导管性或节段性分布且强化不均匀或聚集的NME是恶性病变最具提示性的描述符。
（1）MRI BI-RADS词汇形态学描述符可用于表征CESM上的强化病变，但有少数例外。（2）除非经活检证明为良性，否则双侧多个强化明显的局灶不应包含在正常背景实质强化范围内。（3）提示恶性的肿块病变特征为形状不规则、有毛刺和边缘不规则以及内部强化模式不均匀。除非CESM与超声检查相结合，否则边缘强化模式不应被视为恶性病变的描述符。
