Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Eur J Radiol. 2024 Jun;175:111440. doi: 10.1016/j.ejrad.2024.111440. Epub 2024 Mar 22.
To compare the performance of mammography, high-resolution DW-MRI, DCE-MRI, and their combinations in detecting clinically occult breast cancer in women with dense breasts.
544 breasts from 281 consecutive asymptomatic women with dense breasts were retrospectively identified. They underwent breast MRI for preoperative evaluation of breast cancers (n = 214) or as supplemental screening (n = 67) including DCE-MRI and DW-MRI (b values, 0 and 1000 sec/mm; in-plane resolution, 1.1 × 1.1 mm and 1.3 × 1.3 mm; section thickness, 3 mm), in addition to mammography. Three readers independently reviewed each examination on a per-breast basis. Histopathology and at least two year of imaging follow-up served as the gold standard. The sensitivities and specificities of different imaging modalities were compared using McNemar test.
230 of 544 breasts (42 %) had malignant lesions. The sensitivity of DW-MRI was higher than that of mammography (77.0 % vs 57.9 %; adjusted p < 0.001), but lower than that of DCE-MRI (84.8 %; adjusted p = 0.014). The specificity of DW-MRI was comparable to those of mammography (98.1 % vs 99.1 %; adjusted p > 0.999) and DCE-MRI (97.1 %; adjusted p > 0.999). DW-MRI plus mammography had a comparable sensitivity and specificity to those of DCE-MRI plus mammography (88.6 % vs 90.9 % and 97.1 % vs 96.2 %; adjusted p > 0.999 for both).
High-resolution DW-MRI had a sensitivity higher than mammography and lower than DCE-MRI. Nevertheless, DW-MRI plus mammography showed a comparable sensitivity and specificity to DCE-MRI plus mammography for detecting clinically occult cancers in women with dense breasts.
比较乳腺钼靶、高分辨率弥散加权 MRI（DW-MRI）、动态对比增强 MRI（DCE-MRI）及其组合在检测致密乳腺中临床隐匿性乳腺癌的性能。
回顾性分析 281 例连续无症状致密乳腺女性的 544 个乳腺，这些女性均接受乳腺 MRI 检查，用于术前评估乳腺癌（n=214）或作为补充筛查（n=67），包括 DCE-MRI 和 DW-MRI（b 值分别为 0 和 1000 sec/mm；成像分辨率分别为 1.1×1.1mm 和 1.3×1.3mm；层厚 3mm），此外还进行了乳腺钼靶检查。三位读者分别在每个乳腺基础上独立进行检查。以组织病理学和至少 2 年的影像学随访作为金标准。采用 McNemar 检验比较不同影像学方法的敏感性和特异性。
544 个乳腺中有 230 个（42%）有恶性病变。DW-MRI 的敏感性高于乳腺钼靶（77.0% vs 57.9%；调整后 p<0.001），但低于 DCE-MRI（84.8%；调整后 p=0.014）。DW-MRI 的特异性与乳腺钼靶（98.1% vs 99.1%；调整后 p>0.999）和 DCE-MRI（97.1%；调整后 p>0.999）相当。DW-MRI 加乳腺钼靶的敏感性和特异性与 DCE-MRI 加乳腺钼靶相当（88.6% vs 90.9%和 97.1% vs 96.2%；调整后 p>0.999）。
高分辨率 DW-MRI 的敏感性高于乳腺钼靶，低于 DCE-MRI。然而，DW-MRI 加乳腺钼靶在检测致密乳腺中临床隐匿性乳腺癌方面与 DCE-MRI 加乳腺钼靶具有相当的敏感性和特异性。
