Department of Radiology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Can Assoc Radiol J. 2018 Aug;69(3):240-247. doi: 10.1016/j.carj.2018.03.003. Epub 2018 Jun 27.
The study sought to investigate the role of breast magnetic resonance imaging (MRI) in patients diagnosed with atypical ductal hyperplasia (ADH) at core needle biopsy (CNB).
The breast MRI database at our centre was queried for studies performed between January 2010 and December 2016 for the clinical indication of ADH diagnosed at CNB. Medical files were reviewed for demographic data, clinical information, and radiology and pathology reports. Pathological results of the surgical specimens were considered the gold standard for comparison with breast MRI findings. In women not undergoing excision, at least 2 years of follow-up was used to ascertain the benign nature of the finding.
Fifty patients were included in the study. Thirty-one (62%) patients had surgical excision of the ADH lesion, and 7 (23%) were upgraded to malignancy. Breast MRI accurately identified 6 of the 7 cases. Six of the 12 women (50%) with positive MRI findings at the biopsy site were upgraded to malignancy on surgical pathology, compared with only 1 of 19 (5%) with negative MRI findings. Forty-nine percent of the women with a negative MRI did not undergo surgical excision of the ADH lesion, compared with 8% of the women with a positive MRI (P = .009), with no cancer diagnosed during follow-up. The sensitivity, specificity, negative predictive value, and positive predictive value of breast MRI for predicting upgrade to malignancy were 86%, 83%, 97%, and 46%, respectively.
MRI may have a role in the management of women diagnosed with ADH on CNB, to minimize diagnostic excisional biopsies.
本研究旨在探讨在经核心针活检（CNB）诊断为非典型导管增生（ADH）的患者中，乳腺磁共振成像（MRI）的作用。
在我院的乳腺 MRI 数据库中，检索了 2010 年 1 月至 2016 年 12 月期间因 CNB 诊断为 ADH 而进行的临床研究。对病历进行了审查，以获取人口统计学数据、临床信息以及放射学和病理学报告。手术标本的病理结果被认为是与乳腺 MRI 结果进行比较的金标准。对于未进行切除的女性，至少进行 2 年的随访，以确定病变的良性性质。
共有 50 名患者纳入研究。31 名（62%）患者接受了 ADH 病变的手术切除，其中 7 名（23%）升级为恶性肿瘤。乳腺 MRI 准确识别了 7 例中的 6 例。在活检部位 MRI 结果阳性的 12 名女性中，有 6 名（50%）在外科病理检查中升级为恶性肿瘤，而 MRI 结果阴性的 19 名女性中，只有 1 名（5%）升级为恶性肿瘤。MRI 阴性的女性中有 49%未接受 ADH 病变的手术切除，而 MRI 阳性的女性中只有 8%（P=0.009），在随访期间未发现癌症。乳腺 MRI 预测升级为恶性肿瘤的灵敏度、特异性、阴性预测值和阳性预测值分别为 86%、83%、97%和 46%。
MRI 可能在管理经 CNB 诊断为 ADH 的女性患者方面发挥作用，以尽量减少诊断性切除活检。
