标准乳腺 MRI 与专用腋窝 MRI 对评估淋巴结阴性和淋巴结阳性乳腺癌的诊断性能比较。
Diagnostic performance of standard breast MRI compared to dedicated axillary MRI for assessment of node-negative and node-positive breast cancer.
机构信息
Department of Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.
出版信息
Eur Radiol. 2020 Aug;30(8):4212-4222. doi: 10.1007/s00330-020-06760-6. Epub 2020 Mar 27.
OBJECTIVES
To investigate whether breast MRI has comparable diagnostic performance as dedicated axillary MRI regarding assessment of node-negative and node-positive breast cancer.
METHODS
Forty-seven patients were included. All had undergone both breast MRI and dedicated axillary MRI, followed by surgery. All included breast MRI exams had complete field of view (FOV) of the axillary region. First, unenhanced T2-weighted (T2W) and subsequent diffusion-weighted (DW) images of both MRI exams were independently analyzed by two breast radiologists using a confidence scale and compared to histopathology. ADC values were measured by two researchers independently. Diagnostic performance parameters were calculated on a patient-by-patient basis.
RESULTS
T2W breast MRI had the following diagnostic performance: sensitivity of 50.0% and 62.5%, specificity of 92.3%, PPV of 57.1% and 62.5%, NPV of 90.0% and 92.3%, and AUC of 0.72 for reader 1 and 0.78 for reader 2. T2W dedicated axillary MRI had the following diagnostic performance: sensitivity of 37.5% and 62.5%, specificity of 82.1% and 92.3%, PPV of 44.6% and 50.0%, NPV of 87.8% and 91.4%, and AUC of 0.65 for reader 1 and 0.73 for reader 2. In both evaluations, addition of DW images resulted in comparable diagnostic performance. For both breast MRI and dedicated axillary MRI, there was no significant difference between mean ADC values of benign and malignant lymph nodes.
CONCLUSIONS
T2W breast MRI with complete FOV of the axillary region has comparable diagnostic performance as T2W dedicated axillary MRI regarding assessment of node-negative and node-positive breast cancer. Optimization of T2W breast MRI protocol by including a complete FOV of the axillary region can, therefore, be recommended in clinical practice.
KEY POINTS
• Breast MRI with complete field of view of the axillary region has comparable diagnostic performance as dedicated axillary MRI regarding assessment of node-negative and node-positive breast cancer. • Optimization of breast MRI protocol by including a complete field of view of the axillary region is recommended in clinical practice. • For both breast MRI and dedicated axillary MRI, DW imaging (including ADC measurements) is of no added value.
目的
探讨乳腺 MRI 评估淋巴结阴性和阳性乳腺癌时，其诊断性能是否与专用腋窝 MRI 相当。
方法
共纳入 47 例患者，所有患者均接受乳腺 MRI 和专用腋窝 MRI 检查，随后行手术治疗。所有纳入的乳腺 MRI 检查均完整包含腋窝区域的视野（FOV）。首先，两名乳腺放射科医生使用置信度评分对两种 MRI 检查的未增强 T2 加权（T2W）和随后的弥散加权（DW）图像进行独立分析，并与组织病理学进行比较。由两名研究人员分别测量 ADC 值。基于患者的基础上计算诊断性能参数。
结果
T2W 乳腺 MRI 的诊断性能如下：读者 1 的敏感度为 50.0%和 62.5%，特异度为 92.3%，PPV 为 57.1%和 62.5%，NPV 为 90.0%和 92.3%，AUC 为 0.72；读者 2 的敏感度为 50.0%和 62.5%，特异度为 92.3%，PPV 为 57.1%和 62.5%，NPV 为 90.0%和 92.3%，AUC 为 0.78。T2W 专用腋窝 MRI 的诊断性能如下：读者 1 的敏感度为 37.5%和 62.5%，特异度为 82.1%和 92.3%，PPV 为 44.6%和 50.0%，NPV 为 87.8%和 91.4%，AUC 为 0.65；读者 2 的敏感度为 37.5%和 62.5%，特异度为 82.1%和 92.3%，PPV 为 44.6%和 50.0%，NPV 为 87.8%和 91.4%，AUC 为 0.73。在这两种评估中，添加 DW 图像后，诊断性能相当。对于乳腺 MRI 和专用腋窝 MRI，良性和恶性淋巴结的平均 ADC 值之间无显著差异。
结论
完整包含腋窝 FOV 的 T2W 乳腺 MRI 在评估淋巴结阴性和阳性乳腺癌方面与 T2W 专用腋窝 MRI 具有相当的诊断性能。因此，在临床实践中，可以推荐优化 T2W 乳腺 MRI 方案，包括完整的腋窝 FOV。
关键点
完整包含腋窝 FOV 的乳腺 MRI 在评估淋巴结阴性和阳性乳腺癌方面与专用腋窝 MRI 具有相当的诊断性能。
在临床实践中，推荐优化包括完整腋窝 FOV 的乳腺 MRI 方案。
对于乳腺 MRI 和专用腋窝 MRI，DW 成像（包括 ADC 测量值）均无附加价值。
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