Department of Radiology, University of Chicago, Chicago, Illinois, USA.
Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Miyagi, Japan.
J Magn Reson Imaging. 2017 Dec;46(6):1738-1747. doi: 10.1002/jmri.25694. Epub 2017 Mar 10.
To evaluate the diagnostic value of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) for patients with atypical ductal hyperplasia (ADH) in predicting malignant upgrade.
3T DCE-MRI was performed for 17 patients with ADH (median age 52, range 42-76) proven by stereotactic biopsy (n = 15), and ultrasound-guided biopsy (n = 2) from January 2011 to April 2015. All patients underwent surgical excision after the MRI. Two radiologists prospectively reviewed the MRI to determine the presence or absence of suspicious findings at the site of biopsy, and evaluated the MR features of any lesion present according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon. MRI findings and clinical information were correlated with the final surgical pathology by multivariate analysis.
Nine of 17 lesions were upgraded to malignancy. MRI demonstrated suspicious nonmass enhancement (NME) at the site of biopsy in all upgraded patients. The median size was 19.5 mm (range, 9-44 mm). In the eight patients without upgrade, no enhancement (n = 2), linear enhancement along the biopsy track (n = 4), thin rim enhancement around hematoma (n = 1), and a focal NME (n = 1) were seen. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRI findings were 100, 87.5, 90, and 100%, respectively. Multivariate analysis revealed that the presence of suspicious enhancement on MRI was the most significant predictor of upgrade to malignancy (P = 0.0006) CONCLUSION: Our study revealed a high NPV of DCE-MRI for patients with ADH in terms of malignant upgrade at subsequent surgery. This suggests that patients with ADH without suspicious enhancement on DCE-MRI might be followed with DCE-MRI rather than undergoing surgical excision.
1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1738-1747.
评估动态对比增强（DCE）磁共振成像（MRI）对非典型导管增生（ADH）患者的诊断价值，预测恶性升级。
2011 年 1 月至 2015 年 4 月，对 17 例经立体定向活检（n=15）和超声引导活检（n=2）证实为 ADH 的患者进行了 3T DCE-MRI 检查。所有患者在 MRI 后均行手术切除。两名放射科医生前瞻性地回顾了 MRI，以确定活检部位是否存在可疑发现，并根据乳腺成像报告和数据系统（BI-RADS）词汇评估任何存在病变的 MRI 特征。通过多变量分析将 MRI 结果和临床信息与最终手术病理相关联。
17 个病变中有 9 个升级为恶性。所有升级患者的活检部位均显示可疑非肿块强化（NME）。中位数大小为 19.5mm（范围，9-44mm）。在 8 例未升级的患者中，未见强化（n=2），线性强化沿活检轨迹（n=4），血肿周围薄边强化（n=1），局灶性 NME（n=1）。MRI 发现的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为 100%、87.5%、90%和 100%。多变量分析显示，MRI 上存在可疑强化是恶性升级的最显著预测因子（P=0.0006）。
我们的研究显示，对于 ADH 患者，DCE-MRI 对后续手术恶性升级具有较高的阴性预测值。这表明，DCE-MRI 无可疑强化的 ADH 患者可能可以通过 DCE-MRI 随访，而不是手术切除。
1 技术功效：第 2 阶段。J.磁共振成像。2017；46：1738-1747。
