Jang Ja Yoon, Kim Sun Mi, Kim Jin Hwan, Jang Mijung, La Yun Bo, Lee Jong Yoon, Lee Soo Hyun, Kim Bohyoung
Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul Department of Radiology, Chungnam National University Hospital, Jung-gu, Daejeon Division of Biomedical Engineering, Hankuk University of Foreign Studies, Mohyeon-myeon, Cheoin-gu, Yongin-si, Gyeonggi-do, Korea.
Medicine (Baltimore). 2017 Mar;96(12):e6415. doi: 10.1097/MD.0000000000006415.
The aims of this study were to determine the malignancy rate of probably benign lesions that show an interval change on follow-up ultrasound and to evaluate the differences seen on imaging between benign and malignant lesions initially categorized as probably benign but with interval change on follow-up breast ultrasound.We retrospectively reviewed 11,323 lesions from ultrasound-guided core-biopsies performed between June 2004 and December 2014 and identified 289 lesions (266 patients) with an interval change from probably benign (Breast Imaging Reporting and Data System [BI-RADS] category 3) in the previous 2 years. Malignancy rates were compared according to the ultrasound findings and the characteristics of the interval changes, including changes in morphology and/or diameter.The malignancy rate for probably benign lesions that showed an interval change on follow-up ultrasound was 6.9% (20/289). The malignancy rate was higher for clustered cysts (33.3%) and irregular or noncircumscribed masses (12.7%) than for circumscribed oval masses (5%) or complicated cysts (5%) seen on initial ultrasound (P = 0.043). Fifty-five percent of the malignancies were found to be ductal carcinoma in situ and there was 1 case of lymph node metastasis among the patients with invasive disease in whom biopsy was delayed by 6 to 15 months. The extent of invasiveness was greater in missed cases. There was a significant difference in the maximal diameter change between the 20 malignant lesions and the 269 benign lesions (4.0 mm vs 2.7 mm, P = 0.002). The cutoff value for maximal diameter change per initial diameter was 39.0% for predicting malignancy (sensitivity 95%, specificity 53.5%). The malignancy rate for morphologically changed lesions was significantly higher than for morphologically stable lesions (13.6% vs 4.9%; P = 0.024)Our 6.9% of probably benign lesions that showed an interval change finally turned out to be malignancy was mostly DCIS. The sonographic features, interval changes in sonographic features, and lesion size might help in the recategorization of these lesions.
本研究的目的是确定在随访超声检查中出现间隔期变化的可能为良性病变的恶性率，并评估最初分类为可能良性但在随访乳腺超声检查中有间隔期变化的良性和恶性病变在影像学上的差异。我们回顾性分析了2004年6月至2014年12月期间超声引导下芯针活检的11323个病变，确定了289个病变（266例患者）在过去2年中从可能良性（乳腺影像报告和数据系统[BI-RADS]3类）出现了间隔期变化。根据超声检查结果和间隔期变化的特征（包括形态和/或直径的变化）比较恶性率。随访超声检查出现间隔期变化的可能为良性病变的恶性率为6.9%（20/289）。最初超声检查发现的成簇囊肿（33.3%）和不规则或边界不清的肿块（12.7%）的恶性率高于边界清楚的椭圆形肿块（5%）或复杂性囊肿（5%）（P = 0.043）。发现55%的恶性肿瘤为导管原位癌，在活检延迟6至15个月的浸润性疾病患者中有1例发生淋巴结转移。漏诊病例的浸润范围更大。20个恶性病变和269个良性病变的最大直径变化有显著差异（4.0mm对2.7mm，P = 0.002）。预测恶性肿瘤时，基于初始直径的最大直径变化的截断值为39.0%（敏感性95%，特异性53.5%）。形态学改变的病变的恶性率显著高于形态学稳定的病变（13.6%对4.9%；P = 0.024）。我们发现，最终被证明为恶性的出现间隔期变化的可能为良性病变中有6.9%主要是导管原位癌。超声特征、超声特征的间隔期变化和病变大小可能有助于对这些病变重新分类。
