Department of Radiology, Massachusetts General Hospital, 55 Fruit St, WAC 240, Boston, MA 02114.
AJR Am J Roentgenol. 2022 Jul;219(1):46-54. doi: 10.2214/AJR.21.27161. Epub 2022 Feb 2.
Digital breast tomosynthesis (DBT) has led to increased detection and biopsy of architectural distortion, which may yield malignancy, radial scar, or other benign pathologies. Management of nonmalignant architectural distortion on DBT remains controversial. The purpose of this study was to determine upgrade rates of architectural distortion on DBT from nonmalignant pathology at biopsy to malignancy at surgery. This retrospective study included cases of mammographically detected architectural distortion from July 1, 2016, to June 30, 2019, that were nonmalignant at image-guided needle biopsy and underwent surgical excision. Mammographic examinations included digital 2D mammography and DBT. Imaging data were extracted from radiology reports. Upgrade rates were summarized using descriptive statistics. Features of upgraded and nonupgraded cases were compared using Pearson chi-square test and Wilcoxon signed rank test. The study included 129 cases of architectural distortion with nonmalignant pathology at biopsy that underwent excision in 125 women (mean age, 54 years; range, 23-90 years). At biopsy, 92 (71.3%) were radial scars and 37 (28.7%) were other nonmalignant pathologies. Of 66 radial scars without atypia at biopsy, one (1.5%) was upgraded to ductal carcinoma in situ (DCIS) at surgery and none to invasive cancer. Of 24 benign pathologies without atypia at biopsy, one was considered discordant. Of the 23 remaining concordant cases, one (4.3%) was upgraded to DCIS at surgery and none to invasive cancer. The overall upgrade rate to cancer of architectural distortion with concordant nonmalignant pathology at biopsy was 10.2% (13/128). The upgrade rate to cancer of architectural distortion without atypia was 2.2% (2/89) and with atypia was 28.2% (11/39). Explored features (age, personal or family breast cancer history, presentation by screening vs diagnostic mammography, breast density, associated mammographic findings, presence and size of ultrasound correlate, biopsy modality) showed no signifi-cant associations with upgrade risk ( > .05). Architectural distortion on DBT with concordant nonmalignant pathology at biopsy has an overall upgrade rate to malignancy at surgery of 10.2%. Architectural distortion without atypia has a low upgrade rate of 2.2%. Imaging surveillance can be considered for architectural distortion on DBT yielding radial scar without atypia or other concordant benign pathologies without atypia at biopsy.
数字乳腺断层摄影术（DBT）提高了对结构扭曲的检测和活检率，这些结构扭曲可能为恶性肿瘤、放射状瘢痕或其他良性病变。DBT 上非恶性结构扭曲的处理仍存在争议。本研究的目的是确定从 DBT 上非恶性病理活检到手术恶性肿瘤的结构扭曲升级率。本回顾性研究纳入了 2016 年 7 月 1 日至 2019 年 6 月 30 日期间经乳腺 X 线摄影发现的结构扭曲病例，这些病例在图像引导下经皮穿刺活检结果为非恶性，并接受了手术切除。乳腺 X 线检查包括数字 2D 乳腺 X 线摄影和 DBT。从放射学报告中提取影像学数据。使用描述性统计总结升级率。使用 Pearson 卡方检验和 Wilcoxon 符号秩检验比较升级和非升级病例的特征。该研究纳入了 129 例结构扭曲患者，这些患者在 125 名女性中接受了手术切除（平均年龄 54 岁；范围，23-90 岁）。在活检时，92 例（71.3%）为放射状瘢痕，37 例（28.7%）为其他非恶性病变。在 66 例无非典型性的放射状瘢痕中，有 1 例（1.5%）在手术中升级为导管原位癌（DCIS），无浸润性癌。在 24 例无非典型性的良性病变中，有 1 例被认为不一致。在其余 23 例一致的病例中，有 1 例（4.3%）在手术中升级为 DCIS，无浸润性癌。具有一致性的非恶性病理活检的结构扭曲的癌症总体升级率为 10.2%（13/128）。无非典型性的结构扭曲的癌症升级率为 2.2%（2/89），有非典型性的为 28.2%（11/39）。研究中探讨的特征（年龄、个人或家族乳腺癌病史、筛查与诊断性乳腺 X 线摄影的表现、乳腺密度、相关的乳腺影像学表现、超声表现的存在和大小、活检方式）与升级风险无显著相关性（>.05）。DBT 上具有一致性的非恶性病理活检的结构扭曲总体手术恶性肿瘤升级率为 10.2%。无非典型性的结构扭曲的升级率较低，为 2.2%。对于 DBT 上的结构扭曲，放射状瘢痕无非典型性或其他一致性良性病变无非典型性活检，可考虑影像学监测。
