Petrillo Antonella, Fusco Roberta, Petrillo Mario, Triunfo Flavia, Filice Salvatore, Vallone Paolo, Setola Sergio Venanzio, Rubulotta Mariarosaria, Di Bonito Maurizio, Rinaldo Massimo, D'Aiuto Massimiliano, Brunetti Arturo
Radiology Unit, Department of Diagnostic Imaging, Radiant and Metabolic Therapy, "Istituto Nazionale Tumori Fondazione Giovanni Pascale - IRCCS", Naples, Italy.
Radiology Unit, Department of Diagnostic Imaging, Radiant and Metabolic Therapy, "Istituto Nazionale Tumori Fondazione Giovanni Pascale - IRCCS", Naples, Italy.
Clin Breast Cancer. 2017 Jun;17(3):e127-e134. doi: 10.1016/j.clbc.2016.12.007. Epub 2016 Dec 29.
The purpose of this study was to evaluate the added value of breast magnetic resonance imaging (MRI) in preoperative diagnosis of ductal carcinoma in situ (DCIS). We reviewed our institution database of 3499 consecutive patients treated for breast cancer.
A total of 362 patients with histologically proven DCIS were selected from the institutional database. Of these, 245 (67.7%) preoperatively underwent conventional imaging (CI) (mammography/ultrasonography) (CI group), and 117 (32.3%) underwent CI and dynamic MRI (CI + MRI group). The pathology of surgical specimens served as a reference standard. The Mann-Whitney U, χ test, and Spearman correlation coefficient were performed.
The CI + MRI group showed a sensitivity of 98.5% with an increase of 10.1% compared with the CI group to detect pure DCIS. Dynamic MRI identified 19.7% (n = 13) additional pure DCIS compared with CI. In the CI + MRI group, a single (1.5%) false negative was reported, whereas in the CI group, 11 (11.6%) false negatives were reported. Moreover, the CI + MRI group showed a sensitivity of 98.0% to detect DCIS + small invasive component. In this group, dynamic MRI identified 21.6% (n = 11) additional DCIS and a single (2.0%) false negative compared with the CI group, whereas in the CI group, 7 (4.7%) false negatives were reported. MRI and histopathologically measured lesion sizes, Breast Imaging Reporting and Data System MRI assessment categories, and enhancement signal intensity curve types showed a significant correlation. The MRI detection rate of DCIS increased significantly with increasing nuclear grade.
Preoperative breast MRI showed a better accuracy then CI in preoperative diagnosis for both pure DCIS and DCIS + small invasive component with a precise assessment of lesion size. This can provide a more appropriate management of DCIS patients.
本研究旨在评估乳腺磁共振成像（MRI）在导管原位癌（DCIS）术前诊断中的附加价值。我们回顾了本机构连续治疗的3499例乳腺癌患者的数据库。
从机构数据库中选取362例经组织学证实为DCIS的患者。其中，245例（67.7%）术前接受了传统成像（CI）（乳腺钼靶/超声）（CI组），117例（32.3%）接受了CI和动态MRI（CI + MRI组）。手术标本的病理结果作为参考标准。进行了曼-惠特尼U检验、χ检验和斯皮尔曼相关系数分析。
CI + MRI组检测纯DCIS的灵敏度为98.5%，与CI组相比提高了10.1%。与CI相比，动态MRI发现了19.7%（n = 13）额外的纯DCIS。在CI + MRI组中，报告了1例假阴性（1.5%），而在CI组中，报告了11例假阴性（11.6%）。此外，CI + MRI组检测DCIS + 微小浸润成分的灵敏度为98.0%。在该组中，与CI组相比，动态MRI发现了21.6%（n = 11）额外的DCIS和1例假阴性（2.0%），而在CI组中，报告了7例假阴性（4.7%）。MRI和组织病理学测量的病变大小、乳腺影像报告和数据系统MRI评估类别以及增强信号强度曲线类型显示出显著相关性。DCIS的MRI检测率随着核分级的增加而显著提高。
术前乳腺MRI在纯DCIS和DCIS + 微小浸润成分的术前诊断中显示出比CI更高的准确性，并能精确评估病变大小。这可为DCIS患者提供更合适的治疗方案。
