Huang Monica L, Speer Megan, Dogan Basak E, Rauch Gaiane M, Candelaria Rosalind P, Adrada Beatriz E, Hess Kenneth R, Yang Wei T
1 Department of Diagnostic Radiology, Section of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030.
2 Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX.
AJR Am J Roentgenol. 2017 Apr;208(4):916-922. doi: 10.2214/AJR.16.16576. Epub 2017 Jan 31.
The follow-up of breast lesions with imaging-concordant benign histopathology results on MRI-guided vacuum-assisted biopsy (VAB) is not currently standardized. We determined the false omission rate of breast MRI-guided VAB with benign histopathology (negative results) to assess whether breast MRI follow-up is needed.
The medical records of patients who underwent 9-gauge breast MRI-guided VAB during 2007-2012 were reviewed retrospectively. Lesions with imaging-concordant benign histopathology results from MRI-guided VAB and surgery or 2 years or more of imaging follow-up were included. The false omission rate (1 - negative predictive value; [number of false-negative results / number of negative results]) of MRI-guided VAB was calculated.
One hundred sixty-nine lesions were included, and 135 had only imaging follow-up (mammography follow-up: range, 17-107 months [median, 52 months]; MRI follow-up: range, 5-95 months [median, 35 months]). Of the 135 lesions with only imaging follow-up, 48 had mammography only (range, 26-86 months; median, 52 months), and 87 had mammography (range, 17-107 months; median, 52 months) and MRI (range, 5-95 months; median, 35 months). Thirty-four lesions had surgical correlation, and there were no cases of imaging-surgical discordance. Four malignancies were later diagnosed in the same breast in which MRI-guided VAB had been performed. One (0.6%) malignancy was invasive ductal carcinoma at 1 cm from the MRI-guided VAB site; it was mammographically detected 24 months after MRI-guided VAB. The other three malignancies developed 4 cm or more from the site of MRI-guided VAB: one ductal carcinoma in situ (DCIS) detected on mammography 12 months after MRI-guided VAB, one DCIS detected on MRI 24 months after MRI-guided VAB, and one Paget disease lesion detected at physical examination 32 months after MRI-guided VAB.
Breast MRI-guided VAB has a low false omission rate. MRI follow-up of lesions with concordant benign MRI-guided VAB histopathology results may not be warranted.
目前，对于磁共振成像（MRI）引导下真空辅助活检（VAB）病理结果为影像学一致的良性病变的随访尚无统一标准。我们测定了MRI引导下VAB病理结果为良性（阴性结果）时的漏诊率，以评估是否需要进行乳腺MRI随访。
回顾性分析2007年至2012年期间接受9号MRI引导下乳腺VAB患者的病历。纳入MRI引导下VAB及手术病理结果为影像学一致的良性病变，或接受了2年及以上影像学随访的病变。计算MRI引导下VAB的漏诊率（1-阴性预测值；[假阴性结果数/阴性结果数]）。
共纳入169个病变，其中135个仅接受了影像学随访（乳腺X线摄影随访：范围17-107个月[中位数52个月]；MRI随访：范围5-95个月[中位数35个月]）。在这135个仅接受影像学随访的病变中，48个仅接受了乳腺X线摄影随访（范围26-86个月；中位数52个月），87个同时接受了乳腺X线摄影（范围17-107个月；中位数52个月）和MRI随访（范围5-95个月；中位数35个月）。34个病变有手术相关性，未出现影像学与手术结果不一致的情况。在进行MRI引导下VAB的同一侧乳房中，后来诊断出4例恶性肿瘤。1例（0.6%）为浸润性导管癌，距离MRI引导下VAB部位1 cm；在MRI引导下VAB后24个月通过乳腺X线摄影检测到。另外3例恶性肿瘤发生在距离MRI引导下VAB部位4 cm或更远的地方：1例导管原位癌（DCIS）在MRI引导下VAB后12个月通过乳腺X线摄影检测到，1例DCIS在MRI引导下VAB后24个月通过MRI检测到，1例佩吉特病病变在MRI引导下VAB后32个月通过体格检查发现。
MRI引导下乳腺VAB漏诊率较低。对于MRI引导下VAB病理结果为影像学一致的良性病变，可能无需进行MRI随访。
