超声造影预测不典型导管增生的恶性升级。

Contrast-enhanced ultrasound to predict malignant upgrading of atypical ductal hyperplasia.

机构信息

Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.

Department of Ultrasound, Chinese PLA 63820 Hospital, Mianyang, Sichuan, China.

出版信息

Breast Cancer Res. 2024 Feb 12;26(1):27. doi: 10.1186/s13058-024-01772-2.

DOI:10.1186/s13058-024-01772-2

PMID:38347651

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10863177/

Abstract

BACKGROUND

A malignancy might be found at surgery in cases of atypical ductal hyperplasia (ADH) diagnosed via US-guided core needle biopsy (CNB). The objective of this study was to investigate the diagnostic performance of contrast-enhanced ultrasound (CEUS) in predicting ADH diagnosed by US-guided CNB that was upgraded to malignancy after surgery.

METHODS

In this retrospective study, 110 CNB-diagnosed ADH lesions in 109 consecutive women who underwent US, CEUS, and surgery between June 2018 and June 2023 were included. CEUS was incorporated into US BI-RADS and yielded a CEUS-adjusted BI-RADS. The diagnostic performance of US BI-RADS and CEUS-adjusted BI-RADS for ADH were analyzed and compared.

RESULTS

The mean age of the 109 women was 49.7 years ± 11.6 (SD). The upgrade rate of ADH at CNB was 48.2% (53 of 110). The sensitivity, specificity, positive predictive value, and negative predictive value of CEUS for identification of malignant upgrading were 96.2%, 66.7%,72.9%, and 95.0%, respectively, based on BI-RADS category 4B threshold. The two false-negative cases were low-grade ductal carcinoma in situ. Compared with the US, CEUS-adjusted BI-RADS had better specificity for lesions smaller than 2 cm (76.7% vs. 96.7%, P = 0.031). After CEUS, 16 (10 malignant and 6 nonmalignant) of the 45 original US BI-RADS category 4A lesions were up-classified to BI-RADS 4B, and 3 (1 malignant and 2 nonmalignant) of the 41 original US BI-RADS category 4B lesions were down-classified to BI-RADS 4A.

CONCLUSIONS

CEUS is helpful in predicting malignant upgrading of ADH, especially for lesions smaller than 2 cm and those classified as BI-RADS 4A and 4B on ultrasound.

摘要

背景

在经超声引导下核心针活检（CNB）诊断为非典型导管增生（ADH）的病例中，手术时可能会发现恶性肿瘤。本研究旨在探讨对比增强超声（CEUS）在预测经超声引导 CNB 诊断为 ADH 且术后升级为恶性肿瘤的诊断性能。

方法

在这项回顾性研究中，纳入了 2018 年 6 月至 2023 年 6 月期间接受超声、CEUS 和手术的 109 例连续女性患者的 110 个经 CNB 诊断的 ADH 病变。CEUS 被纳入到 US BI-RADS 中，并产生了 CEUS 调整后的 BI-RADS。分析并比较了 US BI-RADS 和 CEUS 调整后的 BI-RADS 对 ADH 的诊断性能。

结果

109 例女性的平均年龄为 49.7±11.6（标准差）岁。ADH 在 CNB 中的升级率为 48.2%（53/110）。CEUS 对识别恶性升级的敏感性、特异性、阳性预测值和阴性预测值分别为 96.2%、66.7%、72.9%和 95.0%，基于 BI-RADS 类别 4B 阈值。两个假阴性病例均为低级别导管原位癌。与超声相比，CEUS 调整后的 BI-RADS 对小于 2cm 的病变具有更好的特异性（76.7%比 96.7%，P=0.031）。CEUS 后，45 个原始 US BI-RADS 类别 4A 病变中有 16 个（10 个恶性和 6 个非恶性）被升级为 BI-RADS 4B，41 个原始 US BI-RADS 类别 4B 病变中有 3 个（1 个恶性和 2 个非恶性）被降级为 BI-RADS 4A。