Giess Catherine S, Chikarmane Sona A, Sippo Dorothy A, Birdwell Robyn L
1 Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115.
2 Present address: Massachusetts General Hospital, Boston, MA.
AJR Am J Roentgenol. 2017 Jun;208(6):1378-1385. doi: 10.2214/AJR.16.16751. Epub 2017 Mar 7.
The purpose of this study was to determine the clinical utility of breast MRI for diagnosing malignancy in women with equivocal mammographic findings but no symptoms.
Retrospective review of an institutional MRI database of 7332 contrast-enhanced breast MRI examinations from January 1, 2009, through December 31, 2012, yielded the records of 296 (4.0%) examinations of 294 women without symptoms who underwent MRI for mammographic findings uncertain at diagnostic evaluation. Imaging findings, histopathologic results, and patient demographics were obtained from the electronic medical record.
The mean patient age was 55 years (range, 29-83 years). Mammographic lesion type (n = 294) included 89 focal asymmetries, 76 asymmetries, 64 masses, 44 architectural distortions, 17 surgical scar versus lesion, and four miscellaneous lesions. Diagnostic ultrasound, performed on 286 of 294 (97.3%) lesions at mammographic evaluation, showed an ultrasound correlate in 37 (12.9%) lesions, equivocal correlate in 48 (16.8%), and no ultrasound correlate in 201 (70.3%). MRI examination of 294 index lesions showed a correlate in 133 (45.2%) and no correlate in 161 (54.8%). Forty of 294 (13.6%) index lesions were malignant, 37 (92.5%) with an MRI correlate and three (7.5%) without an MRI correlate. Among 250 patients who underwent biopsy or had 2 or more years of imaging stability, the sensitivity, specificity, negative predictive value, and positive predictive value of breast MRI for malignancy were 92.5%, 62.4%, 97.8%, and 31.9%. Forty-four of 294 (15.0%) patients had lesions incidentally found at MRI; 7 of 41 (17.1%) lesions that were biopsied or were stable for at least 1 year were malignant.
Problem-solving breast MRI for inconclusive mammographic findings helps identify malignancies with high sensitivity and a high negative predictive value.
本研究旨在确定乳腺MRI在诊断乳腺钼靶检查结果不明确但无症状女性恶性肿瘤方面的临床应用价值。
回顾性分析2009年1月1日至2012年12月31日期间机构MRI数据库中7332例乳腺对比增强MRI检查记录，筛选出294例无症状女性的296例（4.0%）检查记录，这些女性因乳腺钼靶检查结果在诊断评估中不确定而接受了MRI检查。从电子病历中获取影像学表现、组织病理学结果和患者人口统计学信息。
患者平均年龄为55岁（范围29 - 83岁）。乳腺钼靶病变类型（n = 294）包括89例局灶性不对称、76例不对称、64例肿块、44例结构扭曲、17例手术瘢痕与病变对比以及4例其他病变。在乳腺钼靶评估时，对294例病变中的286例（97.3%）进行了诊断性超声检查，其中37例（12.9%）病变超声有对应表现，48例（16.8%）表现不明确，201例（70.3%）无超声对应表现。对294例索引病变进行MRI检查，其中133例（45.2%）有对应表现，161例（54.8%）无对应表现。294例索引病变中有40例（13.6%）为恶性，其中37例（92.5%）有MRI对应表现，3例（7.5%）无MRI对应表现。在250例接受活检或有2年或更长时间影像学稳定的患者中，乳腺MRI对恶性肿瘤的敏感性、特异性、阴性预测值和阳性预测值分别为92.5%、62.4%、97.8%和31.9%。294例（15.0%）患者在MRI检查时偶然发现病变；41例经活检或至少1年稳定的病变中有7例（17.1%）为恶性。
针对乳腺钼靶检查结果不明确的问题解决型乳腺MRI有助于以高敏感性和高阴性预测值识别恶性肿瘤。
