Qu Ning, Luo Yahong, Yu Tao
Department of Radiology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China.
Breast Care (Basel). 2020 Dec;15(6):619-627. doi: 10.1159/000506068. Epub 2020 Feb 25.
Challenges in differentiation between clinically noninflammatory granulomatous lobular mastitis (GLM) and noncalcified ductal carcinoma in situ (DCIS) remain.
To identify the dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) characteristics contributing to their differential diagnosis.
A total of 33 clinically noninflammatory GLM and 36 noncalcified DCIS were retrospectively analyzed in the study. Internal enhancement of a nonmass enhancement (NME) lesion was divided into clustered enhanced ring (absence/presence), and clustered enhanced ring (presence) was further classified as small and large ring based on the optimal cutoff value. The 5th Breast Imaging and Data System MRI descriptors were used for assessing the other DCE-MRI characteristics. Multivariate analysis including variables with significant differences in univariate analyses was conducted to identify the independent predictors. The discriminative abilities of different predictors and their combination were compared by area under the receiver-operating characteristic curves (AUCs).
An NME lesion was seen more commonly in clinically noninflammatory GLM than in noncalcified DCIS ( = 0.003). DCE-MRI characteristics with significant differences in univariate analyses included NME size, clustered enhanced ring (absence/presence), ring size, initial increase and kinetic characteristics for the differentiation between these two entities presenting as NME lesion. Clustered enhanced ring (presence) was further classified as small (≤7 mm) or large ring (>7 mm). Multivariate analysis revealed that internal enhancement and initial increase were identified as significant independent predictors, and the AUC of their combination achieved the highest value of 0.867 (95% CI, 0.748-0.943).
An NME lesion with a large ring is more highly suggestive of clinically noninflammatory GLM.
临床上非炎性肉芽肿性小叶性乳腺炎（GLM）与非钙化性导管原位癌（DCIS）的鉴别诊断仍存在挑战。
确定有助于两者鉴别诊断的动态对比增强磁共振成像（DCE-MRI）特征。
本研究回顾性分析了33例临床非炎性GLM和36例非钙化性DCIS。将非肿块强化（NME）病变的内部强化分为簇状强化环（无/有），基于最佳截断值将簇状强化环（有）进一步分为小环和大环。采用第5版乳腺影像报告和数据系统MRI描述符评估其他DCE-MRI特征。进行多变量分析，纳入单变量分析中有显著差异的变量，以确定独立预测因素。通过受试者操作特征曲线下面积（AUC）比较不同预测因素及其组合的判别能力。
临床上非炎性GLM中NME病变比非钙化性DCIS中更常见（P = 0.003）。单变量分析中有显著差异的DCE-MRI特征包括NME大小、簇状强化环（无/有）、环大小、初始强化和动力学特征，用于鉴别这两种表现为NME病变的实体。簇状强化环（有）进一步分为小环（≤7 mm）或大环（>7 mm）。多变量分析显示，内部强化和初始强化被确定为显著的独立预测因素，其组合的AUC达到最高值0.867（95%CI，0.748 - 0.943）。
大环的NME病变更高度提示临床非炎性GLM。
