仅表现为微钙化的原位及浸润性导管癌的对比增强乳腺X线特征：有助于预测低估情况吗？
Contrast-Enhanced Mammographic Features of In Situ and Invasive Ductal Carcinoma Manifesting Microcalcifications Only: Help to Predict Underestimation?
作者信息
Cheung Yun-Chung, Chen Kueian, Yu Chi-Chang, Ueng Shir-Hwa, Li Chia-Wei, Chen Shin-Cheh
机构信息
Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Medical College of Chang Gung University, 5 Fuxing St., Guishan, Taoyuan 333, Taiwan.
Division of Breast Surgery, Department of Surgery, Chang Gung Memorial Hospital, Medical College of Chang Gung University, 5 Fuxing St., Guishan, Taoyuan 333, Taiwan.
出版信息
Cancers (Basel). 2021 Aug 30;13(17):4371. doi: 10.3390/cancers13174371.
BACKGROUND
The contrast-enhanced mammographic features of ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC) manifesting microcalcifications only on mammograms were evaluated to determine whether they could predict IDC underestimation.
METHODS
We reviewed patients who underwent mammography-guided biopsy on suspicious breast microcalcifications only and received contrast-enhanced spectral mammography (CESM) within 2 weeks before the biopsy. Those patients who were proven to have cancers (DCIS or IDC) by biopsy and subsequently had surgical treatment in our hospital were included for analysis. The presence or absence, size, morphology and texture of enhancement on contrast-enhanced spectral mammography were reviewed by consensus of two radiologists.
RESULTS
A total of 49 patients were included for analysis. Forty patients (81.6%) showed enhancement, including 18 (45%) DCIS and 22 (55%) IDC patients. All nine unenhanced cancers were pure DCIS. Pure DCIS showed 72.22% nonmass enhancement and 83.33% pure ground glass enhancement. IDC showed more mass (72.2% vs. 27.8%) and solid enhancements (83.33% vs. 16.67%). The cancer and texture of enhancement were significantly different between pure DCIS and IDC, with moderate diagnostic performance for the former (-value < 0.01, AUC = 0.66, sensitivity = 93%, specificity = 39%) and the latter (-value < 0.01, AUC = 0.74, sensitivity = 65%, specificity = 83%). Otherwise, pure DCIS showed a significant difference in enhanced texture compared with upgraded IDC and IDC ( = 0.0226 and 0.0018, respectively).
CONCLUSIONS
Nonmass and pure ground glass enhancements were closely related to pure DCIS, and cases showing mass and unpurified solid enhancements should be suspected as IDC. Unenhanced DCIS with microcalcifications only has a low DCIS upgrade rate. The CESM-enhanced features could feasibly predict IDC underestimation.
背景
评估仅在乳房X线片上表现为微钙化的导管原位癌（DCIS）和浸润性导管癌（IDC）的对比增强乳房X线特征，以确定它们是否能预测IDC低估情况。
方法
我们回顾了仅对可疑乳腺微钙化进行乳房X线引导活检且在活检前2周内接受对比增强光谱乳房X线摄影（CESM）的患者。纳入那些经活检证实患有癌症（DCIS或IDC）且随后在我院接受手术治疗的患者进行分析。由两名放射科医生共同评估对比增强光谱乳房X线摄影上增强的有无、大小、形态和质地。
结果
共纳入49例患者进行分析。40例（81.6%）显示有增强，包括18例（45%）DCIS患者和22例（55%）IDC患者。所有9例未增强的癌症均为纯DCIS。纯DCIS显示72.22%为非肿块样增强，83.33%为纯磨玻璃样增强。IDC显示更多肿块（72.2%对27.8%）和实性增强（83.33%对16.67%）。纯DCIS和IDC之间的癌症及增强质地存在显著差异，前者诊断性能中等（P值<0.01，AUC = 0.66，敏感性 = 93%，特异性 = 39%），后者（P值<0.01，AUC = 0.74，敏感性 = 65%，特异性 = 83%）。此外，纯DCIS与升级后的IDC和IDC相比，增强质地存在显著差异（分别为P = 0.0226和0.0018）。
结论
非肿块样和纯磨玻璃样增强与纯DCIS密切相关，表现为肿块和非纯化实性增强的病例应怀疑为IDC。仅伴有微钙化的未增强DCIS的DCIS升级率较低。CESM增强特征可有效预测IDC低估情况。
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