de Faria Castro Fleury Eduardo, Castro Caio, do Amaral Mario Sergio Campos, Roveda Junior Décio
Department of Radiology, Faculdade de Ciências Médicas da Santa Casa de Sâo Paulo, São Paulo, Brazil.
Department of Radiology, Femme-Laboratório da Mulher, São Paulo, Brazil.
Breast Cancer (Auckl). 2022 May 16;16:11782234221095897. doi: 10.1177/11782234221095897. eCollection 2022.
According to the Breast Imaging and Reporting Data System (BI-RADS), one of the main limitations of MRI is diagnosing the non-mass enhancement (NME). The NME lesion is challenging since it is unique to the MRI lexicon. This study aims to report our experience with NME lesions diagnosed by MRI referred for MRI-guided biopsies and discuss the management and follow-up of these lesions.
We retrospectively evaluated all MRI-guide breast biopsies. We included all patients referred for NME breast MRI-guided biopsy in screening settings. All patients had a negative second-look mammography or ultrasonography. We correlated the distribution and internal enhancement pattern (IEP) of the NME lesions with histology. Invasive ductal carcinomas (IDC) of no special type and ductal carcinoma in situ (DCIS) were considered malignant lesions.
From January-2018 to July-2021, we included 96 women with a total of 96 lesions in the study. There were 90 benign and 6 malignant lesions with DCIS prevalence (5/6 cancers). The most frequent benign lesion type was fibrocystic changes. There were no NME lesions with diffuse or multiple area distribution features referred to MRI-guided biopsy. The positive-predictive values (PPV) were respectively 0.0%, 2.5%, 9.0%, and 11.0% for linear, focal, regional, and segmental distribution describers, and 0.0, 3.0%, 7.9%, and 50% for homogenous, heterogeneous, clumped, and clustered-ring enhancement patterns.
We observe the high potential risk for malignancy in the clustered-ring enhancement followed by the clumped pattern. Segmental distribution presented the highest predictive-positive values.
根据乳腺影像报告和数据系统（BI-RADS），MRI的主要局限性之一是对非肿块强化（NME）进行诊断。NME病变具有挑战性，因为它在MRI术语中是独特的。本研究旨在报告我们对经MRI诊断为NME病变并接受MRI引导活检的经验，并讨论这些病变的管理和随访情况。
我们回顾性评估了所有MRI引导下的乳腺活检。纳入了所有在筛查中因NME乳腺MRI引导活检而转诊的患者。所有患者的二次乳腺X线摄影或超声检查均为阴性。我们将NME病变的分布和内部强化模式（IEP）与组织学进行了关联。非特殊类型的浸润性导管癌（IDC）和原位导管癌（DCIS）被视为恶性病变。
从2018年1月至2021年7月，我们在研究中纳入了96名女性，共96个病变。有90个良性病变和6个恶性病变，DCIS患病率为（5/6例癌症）。最常见的良性病变类型是纤维囊性改变。没有NME病变具有弥漫或多区域分布特征而被转诊进行MRI引导活检。对于线性、局灶性、区域性和节段性分布描述符，阳性预测值（PPV）分别为0.0%、2.5%、9.0%和11.0%，对于均匀、不均匀、团块状和簇状环状强化模式，PPV分别为0.0%、3.0%、7.9%和50%。
我们观察到簇状环状强化模式后是团块状模式，其恶性风险很高。节段性分布呈现出最高的预测阳性值。
