Department of Radiology, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea.
Department of Pathology, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea.
Korean J Radiol. 2024 Nov;25(11):992-1002. doi: 10.3348/kjr.2023.1073.
The aim of this study was to investigate postoperative imaging findings of patients who underwent breast-conserving surgery for cancer and reconstruction with MegaDerm (sheet-type and pellet-type), analyzing false positives and recurrences, using multi-modality images.
This study included 201 women (age range: 28-81 years, mean age ± standard deviation: 53.2 ± 8.6 years) who underwent breast-conserving surgery and immediate reconstruction with MegaDerm. Post-surgery, each patient underwent at least one mammography (MG), ultrasonography (US), and MRI, totaling 713 MG, 1063 US, and 607 MRI examinations. Postoperative images were reviewed separately for the two types of MegaDerm, and suspicious imaging findings (false positives and recurrences) were analyzed, with a particular focus on the findings in direct contact with MegaDerm.
MegaDerm appeared as a circumscribed mass with homogeneous iso- or high density on MG, posterior shadowing on US, and no enhancement on MRI. Calcification was more common and increased in size in sheet-type MegaDerm, while pellet-type often exhibited irregular margins. Nine out of 17 false positives had suspicious findings in direct contact with MegaDerm, and six out of nine recurrences showed similar findings. Common suspicious findings included calcifications, asymmetries, and MegaDerm irregularities on MG; masses and MegaDerm irregularities on US; and enhancing masses and MegaDerm irregularities with enhancement on MRI. Notably, MegaDerm irregularity with calcification was observed on MG and US in only one recurrence case. In 44.4% (4/9) of false-positives in direct contact with MegaDerm, suspicious findings showed no change or resolution on follow-up.
Suspicious imaging findings in direct contact with MegaDerm may be associated with false positives or recurrences. Therefore, it is essential to recognize these characteristic findings and review the patient's history of MegaDerm insertion when in doubt.
本研究旨在通过多模态影像分析，探讨接受保乳手术及 Megaderm（片状和颗粒状）即刻重建的癌症患者的术后影像学表现，分析假阳性和复发的情况。
本研究纳入了 201 名女性（年龄 28-81 岁，平均年龄±标准差：53.2±8.6 岁），均接受保乳手术及 Megaderm 即刻重建。术后每位患者至少接受一次乳腺 X 线摄影术（MG）、超声（US）和磁共振成像（MRI）检查，共进行了 713 次 MG、1063 次 US 和 607 次 MRI 检查。分别对两种类型的 Megaderm 进行术后图像复查，并分析可疑的影像学表现（假阳性和复发），特别关注与 Megaderm 直接接触的表现。
MG 上 Megaderm 表现为边界清楚的肿块，密度均匀或稍高，US 上呈后影，MRI 上无强化。片状 Megaderm 更常见且钙化增大，颗粒状 Megaderm 常表现为不规则边界。17 例假阳性中有 9 例与 Megaderm 直接接触的可疑发现，其中 6 例复发患者也有类似表现。常见的可疑发现包括 MG 上的钙化、不对称和 Megaderm 不规则；US 上的肿块和 Megaderm 不规则；MRI 上的强化肿块和 Megaderm 不规则伴强化。值得注意的是，只有 1 例复发患者的 MG 和 US 上观察到 Megaderm 不规则伴钙化。在与 Megaderm 直接接触的 9 例假阳性中，44.4%（4/9）的可疑发现随访时无变化或消失。
与 Megaderm 直接接触的可疑影像学表现可能与假阳性或复发有关。因此，当有疑问时，识别这些特征性表现并回顾 Megaderm 植入史至关重要。
