Zhou Jiayin, Sun Shiyun, Lin Luyi, Jiang Tingting, Hu Xiaoxin, Gu Yajia, You Chao
Department of Radiology, Fudan University Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Gland Surg. 2022 Aug;11(8):1323-1332. doi: 10.21037/gs-22-155.
The upgrade of high-risk breast lesions (HRLs) is closely related to subsequent treatment, but the current predictors for upgrade are limited to intratumoral features of single imaging mode.
We retrospectively reviewed 230 HRLs detected by mammography, ultrasound, and magnetic resonance imaging (MRI) before biopsy at the Fudan University Cancer Hospital from January 2017 to March 2018. The clinical features, imaging data according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon, and tumor upgrade situation were received. Based on the different risks of upgrade reported, the lesions were classified into high-risk I [HR-I, with atypical hyperplasia (AH)] and high-risk II (HR-II, without AH). We analyzed the association between clinicopathological and imaging factors and upgrade. We used the receiver operating characteristic (ROC) curve to compare the efficacy of three imaging modes for predicting upgrade.
We included 230 HRLs in 230 women in the study, and the overall upgrade rate was 20.4% (47/230). The upgrade rate was higher in HR-I compared to HR-II (38.5% 4.1%, P<0.01). In patients with AH, estrogen receptor-positive (ER+) patients accounted for 81.0% (64/79). For all HRLs and HR-I, in clinical characteristics, age, maximum size of lesion, and menopausal status were significantly associated with upgrade (P<0.05). In imaging factors, MRI background parenchymal enhancement (BPE), signs of MRI and ultrasound were significantly correlated with upgrade (P<0.05). Patients with negative MRI or ultrasound manifestations had lower upgrade rates (P<0.01). For HR-II, only BPE showed a significant difference between groups (P=0.001). Multifactorial analysis of all HRLs showed that age and BPE were independent predictors of upgrade (P<0.01). The areas under the ROC cure (AUCs) for predicting upgrade in mammography, ultrasound, and MRI were 0.606, 0.590, and 0.913, respectively, indicating that MRI diagnosis was significantly better than mammography and ultrasound (P<0.001).
HRLs with AH had a higher rate of upgrade and increased ER expression. Among three imaging modes, MRI was more effective than ultrasound and mammography in diagnosing the upgrade of HRLs. Older age and moderate to marked BPE can indicate malignant upgrade. MRI can provide a certain value for the diagnosis and follow-up of HRLs.
高危乳腺病变（HRLs）的升级与后续治疗密切相关，但目前升级的预测指标仅限于单一成像模式的瘤内特征。
我们回顾性分析了2017年1月至2018年3月在复旦大学附属肿瘤医院活检前通过乳腺X线摄影、超声和磁共振成像（MRI）检测出的230例HRLs。收集临床特征、根据乳腺影像报告和数据系统（BI-RADS）词典的影像数据以及肿瘤升级情况。根据报告的不同升级风险，将病变分为高危I型[HR-I，伴有非典型增生（AH）]和高危II型（HR-II，无AH）。我们分析了临床病理和影像因素与升级之间的关联。我们使用受试者操作特征（ROC）曲线比较三种成像模式预测升级的效能。
本研究纳入了230名女性的230例HRLs，总体升级率为20.4%（47/230）。HR-I型的升级率高于HR-II型（38.5%对4.1%，P<0.01）。在有AH的患者中，雌激素受体阳性（ER+）患者占81.0%（64/79）。对于所有HRLs和HR-I型，在临床特征方面，年龄、病变最大尺寸和绝经状态与升级显著相关（P<0.05）。在影像因素方面，MRI背景实质强化（BPE）、MRI和超声的征象与升级显著相关（P<0.05）。MRI或超声表现为阴性的患者升级率较低（P<0.01）。对于HR-II型，仅BPE在组间显示出显著差异（P=0.001）。对所有HRLs的多因素分析表明，年龄和BPE是升级的独立预测因素（P<0.01）。乳腺X线摄影、超声和MRI预测升级的ROC曲线下面积（AUCs）分别为0.606、0.590和0.913，表明MRI诊断明显优于乳腺X线摄影和超声（P<0.001）。
伴有AH的HRLs升级率较高且ER表达增加。在三种成像模式中，MRI在诊断HRLs升级方面比超声和乳腺X线摄影更有效。年龄较大以及中度至显著的BPE可提示恶性升级。MRI可为HRLs的诊断和随访提供一定价值。
