术前乳腺 MRI 诊断为 BI-RADS 类别 3、4 和 5 的乳腺癌患者病变：对管理的影响。

BI-RADS category 3, 4, and 5 lesions identified at preoperative breast MRI in patients with breast cancer: implications for management.

机构信息

Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.

出版信息

Eur Radiol. 2020 May;30(5):2773-2781. doi: 10.1007/s00330-019-06620-y. Epub 2020 Jan 31.

DOI:10.1007/s00330-019-06620-y

PMID:32006168

Abstract

OBJECTIVES

To investigate outcomes and retrospectively evaluate characteristics of additional lesions initially assessed as BI-RADS category 3, 4, and 5 at preoperative MRI to determine appropriate follow-up management.

METHODS

We retrospectively reviewed 429 lesions other than primary cancer initially assessed as BI-RADS category 3, 4, and 5 at preoperative MRI in 391 patients with breast cancer from March 2012 to December 2013. We investigated their malignancy rate and outcome according to BI-RADS category assessments. We also analyzed clinical and imaging characteristics of each lesion. Pathological results and imaging follow-up of at least 2 years were used as reference standards.

RESULTS

Of 429 lesions in 391 patients (mean 48.1 years ± 9.4), the malignancy rate of BI-RADS 3, 4, and 5 lesions was 1.4% (3/213), 17.8% (38/214), and 50% (1/2), respectively. Of BI-RADS 3 lesions or BI-RADS 4 or 5 lesions that were followed up after benign-concordant biopsy (n = 114), two contralateral masses (2/306, 0.7%) were diagnosed as malignancy at 13.3 and 33.2 months after initial detection, within a median follow-up of 63.3 months. None of the NME or foci or lesions followed up after benign-concordant biopsy had a delayed diagnosis of malignancy. Of the 391 patients, 97.4% (381/391) received at least one type of adjuvant therapy.

CONCLUSION

The incidence of delayed cancer diagnosis among additionally detected lesions other than primary cancer is very low and short-term follow-up is unnecessary. Contralateral masses which were not confirmed by biopsy may need annual follow-up.

KEY POINTS

• 1.4% (3/213) of BI-RADS 3 lesions were malignant including 2 delayed diagnoses after 13.2 months and 33.2 months, and 17.8% (38/214) of BI-RADS 4 lesions and 50% (1/2) of BI-RADS 5 lesions were malignant. • The incidence of delayed diagnosis from additional MRI-detected lesions was very low (0.7%, 2/306) during follow-up, which were all T1N0 contralateral cancer. • Annual follow-up might be adequate for preoperative MRI-detected BI-RADS 3 lesions and BI-RADS 4 lesions followed up after benign-concordant biopsy.

摘要

目的

研究术前 MRI 评估为 BI-RADS 类别 3、4 和 5 的附加病变的结局，并回顾性评估其特征，以确定适当的随访管理方法。

方法

我们回顾性分析了 2012 年 3 月至 2013 年 12 月期间 391 例乳腺癌患者中 429 个除原发性癌症以外的术前 MRI 评估为 BI-RADS 类别 3、4 和 5 的病变。我们根据 BI-RADS 类别评估调查了它们的恶性肿瘤发生率和结果。我们还分析了每个病变的临床和影像学特征。以至少 2 年的病理结果和影像学随访作为参考标准。

结果

在 391 例患者（平均年龄 48.1±9.4 岁）的 429 个病变中，BI-RADS 3、4 和 5 病变的恶性肿瘤发生率分别为 1.4%（3/213）、17.8%（38/214）和 50%（1/2）。在接受良性一致活检后随访的 BI-RADS 3 病变或 BI-RADS 4 或 5 病变（n=114）中，2 个对侧肿块（306 个中的 2 个，0.7%）在初始检测后 13.3 和 33.2 个月时诊断为恶性肿瘤，中位随访时间为 63.3 个月。在接受良性一致活检后随访的无新病灶或新出现的病灶或病变中，无一例发生恶性肿瘤的延迟诊断。在 391 例患者中，97.4%（381/391）接受了至少一种辅助治疗。

结论

除原发性癌症外，新发现的附加病变延迟诊断癌症的发生率非常低，无需进行短期随访。未通过活检证实的对侧肿块可能需要每年随访。

关键点

BI-RADS 3 病变中有 1.4%（3/213）为恶性，包括 2 例在 13.2 个月和 33.2 个月时的延迟诊断，BI-RADS 4 病变中有 17.8%（38/214）为恶性，BI-RADS 5 病变中有 50%（1/2）为恶性。
在随访期间，新发现的附加 MRI 检测到的病变中，延迟诊断的发生率非常低（0.7%，2/306），均为 T1N0 对侧癌。
对于术前 MRI 检测为 BI-RADS 3 病变和良性一致活检后随访的 BI-RADS 4 病变，每年随访可能足够。