切换至 "中华医学电子期刊资源库"

中华乳腺病杂志(电子版) ›› 2020, Vol. 14 ›› Issue (06) : 337 -341. doi: 10.3877/cma.j.issn.1674-0807.2020.06.003

所属专题: 文献

论著

增强磁共振成像对乳腺微钙化灶的管理价值
冯金燕1, 万航宇1, 罗静1,(), 杨枫1   
  1. 1. 610000 成都,四川省妇幼保健院乳腺甲状腺科
  • 收稿日期:2020-03-19 出版日期:2020-12-01
  • 通信作者: 罗静

Dynamic contrast enhanced magnetic resonance imaging in management of microcalcifications of breast lesions

Jinyan Feng1, Hangyu Wan1, Jing Luo1,(), Feng Yang1   

  1. 1. Department of Breast and Thyroid Surgery, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu 610000, China
  • Received:2020-03-19 Published:2020-12-01
  • Corresponding author: Jing Luo
引用本文:

冯金燕, 万航宇, 罗静, 杨枫. 增强磁共振成像对乳腺微钙化灶的管理价值[J]. 中华乳腺病杂志(电子版), 2020, 14(06): 337-341.

Jinyan Feng, Hangyu Wan, Jing Luo, Feng Yang. Dynamic contrast enhanced magnetic resonance imaging in management of microcalcifications of breast lesions[J]. Chinese Journal of Breast Disease(Electronic Edition), 2020, 14(06): 337-341.

目的

评估乳腺增强MRI对乳腺X线检查为BI-RADS 4类微钙化灶的管理价值。

方法

回顾性分析2017年2月至2019年6月在四川省妇幼保健院行乳腺X线检查引导下金属导丝定位活组织检查的87例BI-RADS 4类乳腺微钙化灶患者资料,评价此部分患者在术前接受增强MRI检查的临床意义。增强MRI与病理诊断对乳腺癌检出率的差异比较采用McNemar检验,增强MRI与乳腺X线检查对乳腺癌检出敏感度的差异比较采用Fisher确切概率法,增强MRI与乳腺X线检查对乳腺癌检出特异度、阳性预测值、阴性预测值的差异比较采用χ2检验。

结果

87例患者中病理组织学检查结果为良性者71例,DCIS 6例,浸润性导管癌(IDC)10例。BI-RADS为4A、4B和4C的患者,病理组织学检查为恶性的比例分别为2.4%(1/42),24.3%(9/37)和6/8。乳腺增强MRI对乳腺X线检查为BI-RADS 4类的微钙化灶判断的敏感度、特异度、阳性预测值、阴性预测值和诊断正确率分别为14/16、74.7%(53/71)、43.8%(14/32)、96.4%(53/55)和77.0%(67/87)。增强MRI的诊断特异度高于乳腺X线检查[74.7%(53/71)比57.8%(41/71),χ2=4.532,P=0.033],74.7%(53/71)的良性病灶可通过增强MRI检查避免活组织检查,但有2/16的恶性病灶被增强MRI误判为阴性。

结论

乳腺增强MRI有助于降低乳腺X线检查为BI-RADS 4类微钙化灶的活组织检查比例,可有效避免乳腺恶性肿瘤的漏诊,有利于临床医师根据患者具体情况对BI-RADS 4类微钙化灶进行合理的诊疗。

Objective

To evaluate the role of dynamic contrast enhanced magnetic resonance imaging ( DCE-MRI) in clinical management of breast lesions with BI-RADS 4 microcalcifications at mammography.

Methods

We retrospectively analyzed the clinical data of 87 patients who underwent wire-guided biopsy and showed BI-RADS 4 microcalcifications at mammography in the Sichuan Provincial Maternity and Child Health Care Hospital from February 2017 to January 2019. The necessity of preoperative DCE-MRI of those patients was evaluated. The McNemar test was used to compare the detection rates of breast cancer between MRI and pathology. The Fisher exact test was used to compare the sensitivity and the χ2 test was used to compare the specificity, positive and negative predictive values between mammography and MRI in the diagnosis of breast cancer.

Results

Histopathologic results confirmed 71 cases of benign microcalcifications, 6 DCIS and 10 invasive ductal carcinomas (IDC). Malignancy rates were 2.4% (1/42), 24.3% (9/37) and 6/8 in the BI-RADS 4A, 4B and 4C patients, respectively. The sensitivity, specificity, positive, negative predictive values and diagnostic accuracy of DCE-MRI in the diagnosis of BI-RADS 4 microcalcifications were (14/16), 74.7% (53/71), 43.8% (14/32), 96.4% (53/55) and 77.0%(67/87), respectively. The specificity of DCE-MRI was significantly higher than that of mammography [74.7%(53/71)vs 57.8%(41/71), χ2=4.532, P=0.033]. Totally 53 out of 71 benign cases (74.7%) could avoid unnecessary biopsies based on the findings of DCE-MRI, but two out of 16 malignant cases (12.5%) was diagnosed negative by DCE-MRI.

Conclusion

DCE-MRI can avoid unnecessary biopsies of BI-RADS 4 microcalcifications at mammopraphy, reduce missed-diagnosis of malignant tumors and help to make rational clinical decisions in patients with BI-RADS 4 microcalcifications.

表1 乳腺X线检查为BI-RADS 4类患者中乳腺癌的检出情况(例)
表2 87例乳腺微钙化灶患者的乳腺X线检查结果和术后病理诊断结果(例)
图1 1例漏诊的导管原位癌患者的影像学检查结果 a图为乳腺X线检查,左乳外上象限可见细点、粗糙不均质钙化,BI-RADS 4B类;b图为乳腺MRI平扫图像,钙化灶对应位置未见占位性病灶;c图为乳腺增强MRI图像,增强后该处病灶呈现环形强化
表3 乳腺增强MRI不同BI-RADS分类乳腺癌的检出情况(例)
表4 87例乳腺微钙化灶患者的乳腺增强MRI结果和术后病理诊断结果(例)
[1]
Oeffinger KC, Fontham ET, Etzioni R,et al. Breast cancer screening for women at average risk: 2015 guideline update from the american cancer society [J]. JAMA,2015,314(15): 1599-1614.
[2]
Rominger M, Wisgickl C, Timmesfeld N. Breast microcalcifications as type descriptors to stratify risk of malignancy: A systematic review and meta-analysis of 10665 cases with special focus on round/punctate microcalcifications [J]. Rofo,2012,184(12): 1144-1152.
[3]
Fowler EE, Sellers TA, Lu B,et al. Breast imaging reporting and data system (BI-RADS) breast composition descriptors: Automated measurement development for full field digital mammography [J]. Med Phys,2013,40(11): 113 502.
[4]
中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2019年版)[J]. 中国癌症杂志,2019,29(8): 609-680.
[5]
Hrkac Pustahija A, Ivanac G, Brkljacic B. US and MRI in the evaluation of mammographic BI-RADS 4 and 5 microcalcifications [J]. Diagn Interv Radiol,2018,24(4): 187-194.
[6]
Sanders MA, Roland LS, Sahoo S. Clinical implications of subcategorizing BI-RADS 4 breast lesions associated with microcalcification: A radiology-pathology correlation study [J]. Breast J,2010,16(1): 28-31.
[7]
徐晓军,颜蕴文,张敬杰. 高频彩色超声结合钼靶X线摄片精确定位切除乳腺隐匿性钙化灶[J/CD]. 中华乳腺病杂志(电子版),2012,6(5): 88-92.
[8]
郑荣寿,孙可欣,张思维,等. 2015年中国恶性肿瘤流行情况分析[J].中华肿瘤杂志,2019,41(1): 19-28.
[9]
Sarosiek T. Systemic treatment of early breast cancer - current state of knowledge after the conference St Gallen 2017 [J]. Pol Merkur Lekarski,2017,43(257): 232-236.
[10]
DeSantis CE, Fedewa SA, Goding Sauer A,et al. Breast cancer statistics, 2015: Convergence of incidence rates between black and white women [J]. CA Cancer J Clin,2016,66(1): 31-42.
[11]
Barreau B, de Mascarel I, Feuga C,et al. Mammography of ductal carcinoma in situ of the breast: Review of 909 cases with radiographic-pathologic correlations [J]. Eur J Radiol,2005,54(1): 55-61.
[12]
黄育北. 中国女性乳腺癌筛查指南[J]. 中国肿瘤临床,2019,46(9): 429-431.
[13]
Raza S, Vallejo M, Chikarmane SA,et al. Pure ductal carcinoma in situ: A range of mri features [J]. AJR Am J Roentgenol,2008,191(3): 689-699.
[14]
Eun NL, Son EJ, Gweon HM,et al. The value of breast mri for BI-RADS category 4B mammographic microcalcification: Based on the 5(th) edition of bi-rads [J]. Clin Radiol,2018,73(8): 750-755.
[15]
Kuhl CK, Schrading S, Bieling HB,et al. MRI for diagnosis of pure ductal carcinoma in situ: A prospective observational study [J]. Lancet,2007,370(9586): 485-492.
[16]
Hartmann LC, Sellers TA, Frost MH,et al. Benign breast disease and the risk of breast cancer [J]. N Engl J Med,2005,353(3): 229-237.
[17]
Wang Y, Gao Y, Battsend M,et al. Development of a risk assessment tool for projecting individualized probabilities of developing breast cancer for chinese women [J]. Tumour Biol,2014,35(11): 10 861-10 869.
[18]
Ahmadiyeh N, Stoleru MA, Raza S,et al. Management of intraductal papillomas of the breast: An analysis of 129 cases and their outcome [J]. Ann Surg Oncol,2009,16(8): 2264-2269.
[19]
Hodorowicz-Zaniewska D, Szpor J, Basta P. Intraductal papilloma of the breast - management [J]. Ginekol Pol,2019,90(2): 100-103.
[20]
Vachon CM, Pankratz VS, Scott CG,et al. The contributions of breast density and common genetic variation to breast cancer risk [J]. J Natl Cancer Inst,2015,107(5): dju397.
[21]
Worsham MJ, Raju U, Lu M,et al. Multiplicity of benign breast lesions is a risk factor for progression to breast cancer [J]. Clin Cancer Res,2007,13(18 Pt 1): 5474-5479.
[22]
Rosen EL, Smith-Foley SA, DeMartini WB,et al. BI-RADS MRI enhancement characteristics of ductal carcinoma in situ [J]. Breast J,2007,13(6): 545-550.
[23]
van Seijen M, Lips EH, Thompson AM,et al. Ductal carcinoma in situ: to treat or not to treat, that is the question [J]. Br J Cancer,2019,121(4): 285-292.
[1] 丁建民, 秦正义, 张翔, 周燕, 周洪雨, 王彦冬, 经翔. 超声造影与普美显磁共振成像对具有高危因素的≤3 cm肝结节进行LI-RADS分类诊断的前瞻性研究[J]. 中华医学超声杂志(电子版), 2023, 20(09): 930-938.
[2] 张莲莲, 惠品晶, 丁亚芳. 颈部血管超声在粥样硬化斑块易损性评估中的应用价值[J]. 中华医学超声杂志(电子版), 2023, 20(08): 816-821.
[3] 王洁, 丁泊文, 尹健. 糖尿病性乳腺病52例临床分析[J]. 中华乳腺病杂志(电子版), 2023, 17(05): 285-289.
[4] 刘冰茹, 刘皓希, 陈莹, 赖世伟, 陈蓉. 疑似乳腺癌的韧带样纤维瘤病一例[J]. 中华乳腺病杂志(电子版), 2023, 17(05): 314-317.
[5] 叶艳娜, 叶瑞婷, 陈艳玲, 彭雯, 刘乐, 肖文秋, 黄辉, 李明深, 钟慕仪, 叶娴. 基于影像学表现和临床病理特征预测良性与交界性乳腺叶状肿瘤复发的列线图模型[J]. 中华乳腺病杂志(电子版), 2023, 17(04): 229-237.
[6] 方心俞, 黄昌瑜, 胡洪新, 林溢铭, 陈旸, 张楠心, 张文明. 膝关节软骨下不全骨折的治疗选择与疗效分析[J]. 中华关节外科杂志(电子版), 2023, 17(04): 583-587.
[7] 董晓燕, 赵琪, 唐军, 张莉, 杨晓燕, 李姣. 奥密克戎变异株感染所致新型冠状病毒感染疾病新生儿的临床特征分析[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 595-603.
[8] 韩宇, 张武, 李安琪, 陈文颖, 谢斯栋. MRI肝脏影像报告和数据系统对非肝硬化乙肝患者肝细胞癌的诊断价值[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 669-673.
[9] 雷漫诗, 邓锶锶, 汪昕蓉, 黄锦彬, 向青, 熊安妮, 孟占鳌. 人工智能辅助压缩感知技术在上腹部T2WI压脂序列中的应用[J]. 中华肝脏外科手术学电子杂志, 2023, 12(05): 551-556.
[10] 钟广俊, 刘春华, 朱万森, 徐晓雷, 王兆军. MRI联合不同扫描序列在胃癌术前分期诊断及化疗效果和预后的评估[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 378-382.
[11] 吴钰娴, 冯亚园, 霍雷, 贾宁阳, 张娟. 原发性肝脏淋巴瘤的影像学诊断价值研究[J]. 中华消化病与影像杂志(电子版), 2023, 13(05): 349-353.
[12] 冯海涛, 徐涛, 刘文阳, 孙晨, 曹尚超. 三维动脉自旋标记联合动态对比增强MRI对脑胶质瘤术后复发及放射性脑坏死诊断的研究[J]. 中华消化病与影像杂志(电子版), 2023, 13(04): 262-265.
[13] 王志文, 郑雪梅, 张庆坤, 王海江. 自发性低颅压综合征75例临床分析[J]. 中华临床医师杂志(电子版), 2023, 17(04): 398-401.
[14] 岳永飞, 朱利平, 王晓艳. 磁共振成像技术在预测胎盘植入性疾病患者剖宫产术中出血量的研究[J]. 中华产科急救电子杂志, 2023, 12(03): 167-172.
[15] 赵暾, 徐霁华, 何有娣, 鲁明. 误诊为脑梗死且险些溶栓的急性自发微量脑出血一例[J]. 中华脑血管病杂志(电子版), 2023, 17(04): 369-372.
阅读次数
全文


摘要