Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States of America; Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, United States of America.
Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States of America.
Clin Imaging. 2021 Oct;78:171-178. doi: 10.1016/j.clinimag.2021.03.026. Epub 2021 Mar 31.
To review MRI findings of pure lobular neoplasia (LN) on MRI guided biopsy, evaluate surgical and clinical outcomes, and assess imaging findings predictive of upgrade to malignancy.
HIPAA compliant, IRB-approved retrospective review of our MRI-guided breast biopsy database from October 2008-January 2015. Biopsies yielding atypical lobular hyperplasia or lobular carcinoma in situ were included in the analysis; all biopsy slides were reviewed by a dedicated breast pathologist. Imaging indications, MRI findings, and histopathology were reviewed. Statistical analysis was performed using the two-tailed Fisher exact-test and the t-test, and 95% CIs were determined. A p < 0.05 was considered statistically significant.
Database search yielded 943 biopsies in 785 patients of which 65/943 (6.9%) reported LN as the highest risk pathologic lesion. Of 65 cases, 32 were found to have LN as the dominant finding on pathology and constituted the study population. All 32 findings were mammographically and sonographically occult. Three of 32 (9.3%) cases of lobular neoplasia were upgraded to malignancy, all LCIS (one pleomorphic and two classical). The most common MRI finding was focal, heterogenous non-mass enhancement with low T2 signal. No clinical features or imaging findings were predictive of upgrade to malignancy.
Incidence of pure lobular neoplasia on MRI guided biopsy is low, with comparatively low incidence of upgrade to malignancy. No imaging or clinical features are predictive of upgrade on surgical excision, therefore, prudent radiologic-pathologic correlation is necessary.
回顾磁共振成像引导下活检中纯小叶肿瘤（LN）的 MRI 表现，评估手术和临床结果，并评估预测恶性肿瘤升级的影像学表现。
符合 HIPAA 规定、IRB 批准的回顾性研究，对 2008 年 10 月至 2015 年 1 月期间我们的磁共振成像引导下乳腺活检数据库进行分析。分析包括活检结果为不典型小叶增生或小叶原位癌的病例；所有活检切片均由专门的乳腺病理学家进行复查。回顾了影像学表现、MRI 表现和组织病理学表现。使用双侧 Fisher 精确检验和 t 检验进行统计分析，并确定了 95%置信区间。p 值<0.05 被认为具有统计学意义。
数据库搜索共获得 785 例患者的 943 次活检，其中 65/943（6.9%）报告 LN 为最高风险的病理病变。在 65 例病例中，32 例在病理学上发现 LN 为主要发现，构成了研究人群。所有 32 例 LN 表现均为乳腺和超声隐匿性病变。32 例 LN 中有 3 例（9.3%）升级为恶性肿瘤，均为 LCIS（1 例多形性和 2 例经典型）。最常见的 MRI 表现为局灶性、异质性非肿块样强化伴低 T2 信号。没有临床特征或影像学表现可预测恶性肿瘤升级。
磁共振成像引导下活检中纯小叶肿瘤的发生率较低，恶性肿瘤升级的发生率也较低。没有影像学或临床特征可预测手术切除的升级，因此需要谨慎进行放射病理学相关性研究。
