Performance of DWI as a Rapid Unenhanced Technique for Detecting Mammographically Occult Breast Cancer in Elevated-Risk Women With Dense Breasts.
Performance of DWI as a Rapid Unenhanced Technique for Detecting Mammographically Occult Breast Cancer in Elevated-Risk Women With Dense Breasts.
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DOI：
10.2214/ajr.15.15873
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发表时间：
2016-07
期刊：
影响因子：
--
通讯作者：
Partridge SC
中科院分区：
文献类型：
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作者：
McDonald ES;Hammersley JA;Chou SH;Rahbar H;Scheel JR;Lee CI;Liu CL;Lehman CD;Partridge SC
本研究的目的是评估DWI在高风险致密型乳腺妇女中检测乳腺X线检查隐匿性乳腺癌的性能。我们回顾性分析了2007年1月至2013年5月在我们机构接受筛查乳腺MRI的所有女性。我们创建了一个病例对照队列，由48名乳腺摄影致密乳腺受试者组成：24名在MRI上检测到乳腺摄影隐匿性癌症，24名MRI结果阴性的健康女性，这些女性与乳腺癌患者的年龄，乳腺密度和MRI方案相匹配。在DWI上评估所有恶性肿瘤的对比噪声比（CNR）、表观扩散系数（ADC）和显著性评分（范围，1-5）。使用Wilcoxon符号秩检验比较病变和正常组织;使用Mann-Whitney U检验评价与临床特征的关联。三名经验丰富的乳腺成像师对病历和对比增强MRI结果不知情，他们独立评估了48名妇女的非增强MRI扫描是否存在癌症。乳腺X线隐匿性癌乳腺致密女性中的乳腺癌（浸润性癌，n = 16;导管原位癌，n = 8）在DWI上通常表现出比正常实质更高的信号强度（癌症的中位CNR，1.4;癌症的中位显著性评分，4）和更低的ADC（中位数，分别为1.31和1.79 × 10−3 mm 2/s）（p < 0.0001）。显著性评分、CNR和ADC与患者年龄、绝经状态、病变大小、形态学类型或组织学无关（p > 0.05）。使用未增强MRI的平均阅片者表现为45%的灵敏度，91%的特异性，62%的阳性预测值和83%的阴性预测值。在乳腺致密的高危女性中，DWI可以显示除了乳腺X线摄影检测到的癌症外的其他癌症，假阳性率较低;这些结果表明DWI可能具有作为快速补充筛查工具的潜力。
The objective of our study was to evaluate the performance of DWI to detect mammographically occult breast cancer in elevated-risk women with dense breasts. We retrospectively reviewed all women who underwent screening breast MRI at our institution from January 2007 through May 2013. We created a case-control cohort composed of 48 subjects with mammographically dense breasts: 24 with mammographically occult cancer detected on MRI and 24 healthy women with negative MRI findings who were matched to the subjects with breast cancer patients for age, breast density, and MRI protocol. The contrast-to-noise ratio (CNR), apparent diffusion coefficient (ADC), and conspicuity score (range, 1–5) were assessed on DWI for all malignancies. Lesions and normal tissue were compared using the Wilcoxon signed rank test; associations with clinical characteristics were evaluated using the Mann-Whitney U test. Three experienced breast imagers who were blinded to medical records and contrast-enhanced MRI findings independently evaluated the unenhanced MRI scans of the 48 women for the presence of cancer. Mammographically occult breast cancers (invasive carcinoma, n = 16; ductal carcinoma in situ, n = 8) in women with dense breasts typically exhibited higher signal intensity on DWI than normal parenchyma (median CNR of cancers, 1.4; median conspicuity score of cancers, 4) and a lower ADC (median, 1.31 vs 1.79 × 10−3 mm2/s, respectively) (p < 0.0001). The conspicuity score, CNR, and ADC were not associated with patient age, menopausal status, lesion size, morphologic type, or histology (p > 0.05). Average reader performance using unenhanced MRI was 45% sensitivity, 91% specificity, 62% positive predictive value, and 83% negative predictive value. In elevated-risk women with dense breasts, DWI can reveal cancers in addition to those detected on mammography alone with a low false-positive rate; these results suggest that DWI may have potential as a rapid supplemental screening tool.