基于对比增强 MRI 和 US 相关性的乳腺 X 线摄影结构扭曲的处理。

Management of Mammographic Architectural Distortion Based on Contrast-enhanced MRI and US Correlation.

机构信息

Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA, USA.

Mass General Brigham - Salem Hospital, Department of Radiology, Salem, MA, USA.

出版信息

J Breast Imaging. 2023 Jul 28;5(4):425-435. doi: 10.1093/jbi/wbad032.

DOI:10.1093/jbi/wbad032

PMID:38416901

Abstract

OBJECTIVE

The objective was to evaluate outcomes of mammographic architectural distortion (AD) with and without MRI and US correlates.

METHODS

A retrospective review of unexplained mammographic AD with subsequent MRI from January 1, 2007 to September 30, 2017 was performed using a reader-based study design. Mammographic, MRI, and US features and outcomes were documented. Truth was based on biopsy results or minimum two-year imaging follow-up. Measures of diagnostic accuracy were calculated.

RESULTS

Fifty-six cases of AD were included: 29 (51.8%) detected on 2D mammogram and 27 (48.2%) detected on digital breast tomosynthesis. Of 35.7% (20/56) with MRI correlate, 40.0% (8/20) were enhancing masses, 55.0% (11/20) were non-mass enhancement (NME), and 5.0% (1/20) were nonenhancing AD. Of eight enhancing masses, 75.0% (6/8) were invasive cancers, and 25.0% (2/8) were high-risk lesions. Of 11 NME, 18.2% (2/11) were ductal carcinoma in situ, 36.4% (4/11) were high-risk lesions, and 45.4% (5/11) were benign. Of 64.3% (36/56) without MRI correlate, 94.4% (34/36) were benign by pathology or follow-up, one (2.8%, 1/36) was a 4-mm focus of invasive cancer with US correlate, and one (1/36, 2.8%) was a high-risk lesion. Of cases without MRI and US correlates, one (3.0%, 1/33) was a high-risk lesion and 97.0% (32/33) were benign. The negative predictive value of mammographic AD without MRI correlate was 97.2% (35/36) and without both MRI and US correlates was 100.0% (33/33).

CONCLUSION

Mammographic AD without MRI or US correlate was not cancer in our small cohort and follow-up could be considered, reducing interventions.

摘要

目的

评估伴有和不伴有 MRI 和 US 相关性的乳腺形态结构扭曲（AD）的结果。

方法

使用基于读者的研究设计，对 2007 年 1 月 1 日至 2017 年 9 月 30 日期间原因不明的乳腺 AD 进行回顾性研究，记录乳腺、MRI 和 US 的特征和结果。以活检结果或至少两年的影像学随访为金标准。计算诊断准确性的衡量标准。

结果

共纳入 56 例 AD 患者：29 例（51.8%）在 2D 乳腺 X 线摄影中检出，27 例（48.2%）在数字乳腺断层合成摄影中检出。在 35.7%（20/56）有 MRI 相关性的患者中，40.0%（8/20）为增强肿块，55.0%（11/20）为非肿块增强（NME），5.0%（1/20）为非增强性 AD。在 8 个增强肿块中，75.0%（6/8）为浸润性癌，25.0%（2/8）为高危病变。在 11 个 NME 中，18.2%（2/11）为导管原位癌，36.4%（4/11）为高危病变，45.4%（5/11）为良性。在 56 例无 MRI 相关性的患者中，94.4%（34/36）的病理或随访结果为良性，1 例（2.8%，1/36）为 US 相关性的 4mm 浸润性癌灶，1 例（1/36，2.8%）为高危病变。在无 MRI 和 US 相关性的病例中，1 例（3.0%，1/33）为高危病变，97.0%（32/33）为良性。无 MRI 相关性的乳腺 AD 的阴性预测值为 97.2%（35/36），无 MRI 和 US 相关性的阴性预测值为 100.0%（33/33）。