Department of Diagnostic Radiology, University of Sherbrooke, Toronto, ON M4N 3M5, Canada.
Radiology Department, University of Toronto, La Sarre Hospital, La Sarre, QC J9Z 2Y9, Canada.
Tomography. 2022 Feb 2;8(1):329-340. doi: 10.3390/tomography8010027.
: To determine if MRI features and molecular subtype influence the detectability of breast cancers on MRI in high-risk patients. : Breast cancers in a high-risk population of 104 patients were diagnosed following MRI describing a BI-RADS 4-5 lesion. MRI characteristics at the time of diagnosis were compared with previous MRI, where a BI-RADS 1-2-3 lesion was described. : There were 77 false-negative MRIs. A total of 51 cancers were overlooked and 26 were misinterpreted. There was no association found between MRI characteristics, the receptor type and the frequency of missed cancers. The main factors for misinterpreted lesions were multiple breast lesions, prior biopsy/surgery and long-term stability. Lesions were mostly overlooked because of their small size and high background parenchymal enhancement. Among missed lesions, 50% of those with plateau kinetics on initial MRI changed for washout kinetics, and 65% of initially progressively enhancing lesions then showed plateau or washout kinetics. There were more basal-like tumours in BRCA1 carriers (50%) than in non-carriers (13%), = 0.0001, OR = 6.714, 95% CI = [2.058-21.910]. The proportion of missed cancers was lower in BRCA carriers (59%) versus non-carriers (79%), < 0.05, OR = 2.621, 95% CI = [1.02-6.74]. : MRI characteristics or molecular subtype do not influence breast cancer detectability. Lesions in a post-surgical breast should be assessed with caution. Long-term stability does not rule out malignancy and multimodality evaluation is of added value. Lowering the biopsy threshold for lesions with an interval change in kinetics for a type 2 or 3 curve should be considered. There was a higher rate of interval cancers in BRCA 1 patients attributed to lesions more aggressive in nature.
: 目的：确定 MRI 特征和分子亚型是否会影响高危患者的 MRI 对乳腺癌的检出率。 : 对 104 例高危患者的乳腺病变进行 MRI 检查，描述为 BI-RADS 4-5 级病变，这些患者的乳腺癌被诊断出来。将诊断时的 MRI 特征与之前描述为 BI-RADS 1-2-3 级病变的 MRI 特征进行比较。 : 有 77 例假阴性 MRI。共漏诊了 51 例癌症，26 例误诊。未发现 MRI 特征、受体类型与漏诊癌症之间存在关联。误诊病变的主要因素是多灶性病变、先前活检/手术和长期稳定性。病变主要由于其体积小和背景实质增强高而被忽略。在漏诊的病变中，50%初始 MRI 呈平台型动力学的病变转变为洗脱型动力学，65%初始呈渐进性增强的病变随后表现为平台型或洗脱型动力学。BRCA1 携带者（50%）中基底样肿瘤比非携带者（13%）多， = 0.0001，OR = 6.714，95% CI = [2.058-21.910]。BRCA 携带者（59%）中漏诊癌症的比例低于非携带者（79%）， < 0.05，OR = 2.621，95% CI = [1.02-6.74]。 : MRI 特征或分子亚型不会影响乳腺癌的检出率。术后乳房的病变应谨慎评估。长期稳定性不能排除恶性肿瘤，多模态评估具有附加价值。对于动力学类型为 2 或 3 型曲线的病变，如有间隔变化，应考虑降低活检阈值。BRCA1 患者的间隔期癌症发生率较高，这归因于病变的侵袭性更强。
