The hook sign for differential diagnosis of malignant from benign lesions in magnetic resonance mammography: Experience in a study of 1084 histologically verified cases
The hook sign for differential diagnosis of malignant from benign lesions in magnetic resonance mammography: Experience in a study of 1084 histologically verified cases
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DOI：
10.3109/02841850903463638
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发表时间：
2010-03-01
期刊：
影响因子：
1.3
通讯作者：
Kaiser, Werner A.
中科院分区：
文献类型：
--
作者：
Dietzel, Matthias;Baltzer, Pascal A. T.;Kaiser, Werner A.
目的：为了分析HS的诊断价值在一个大的集合1084 cases.Material和方法：这项研究是由当地伦理委员会批准，和1084个连续病变（没有操作的乳房MRM前12个月）与组织学验证后，MRM。根据标准研究方案分析HS，如果可以看到连接病变与胸肌的钩状针状树突，则将其评定为阳性。由有经验的观察员对检查进行评分（> 500次检查）。HS的患病率与组织学诊断、分级和大小相关（卡方检验）。结果：HS与恶性肿瘤显著相关（P < 0.001），特异性、阳性似然比（LR+）和诊断优势比（DOR）分别为96.8%、9.1和12.5。直径> 20 mm的恶性肿瘤中HS的发生率明显高于直径< 20 mm的恶性肿瘤（P < 0.001）。HS是浸润性癌的特征性表现，在浸润前腺瘤中少见（P < 0.001）。浸润性小叶癌和导管癌的HS患病率无差异。HS与浸润性癌的分级无相关性。结论：在1084个病灶中，钩状征是MRM鉴别良恶性病灶的特异性描述符，对恶性肿瘤的预测有较高的证据，尤其是在晚期病灶和浸润性癌中。
Purpose: To analyze the diagnostic value of HS in a large collection of 1084 cases.Material and Methods: This study was approved by the local ethics committee, and 1084 consecutive lesions (no manipulations of the breast up to 12 months before MRM) with histological verification after MRM were included. HS was analyzed according to standard study protocols and was rated positive if a hook-like spiculated dendrite connecting a lesion with the pectoral muscle could be visualized. Examinations were rated by experienced observers (> 500 examinations). Prevalence of HS was correlated with histological diagnosis, grading, and size (chi-square test). Diagnostic accuracy was assessed using sensitivity, specificity, positive likelihood ratio (LR+), and diagnostic odds ratio (DOR).Results: HS was significantly associated with malignancy (P < 0.001), providing high specificity, LR+, and DOR (96.8%, 9.1, and 12.5, respectively). Malignant lesions > 20 mm presented with HS significantly more often than those < 20 mm (P < 0.001). HS was characteristic of invasive cancers and rare in preinvasive malignomas (P < 0.001). Prevalence of HS did not differ between invasive lobular and ductal carcinomas (n.s.). There was no correlation between HS and the grading of invasive carcinomas.Conclusion: In 1084 lesions, the hook sign was a specific descriptor for differentiation of benign and malignant lesions in MRM, with high evidence for prediction of malignancy, particularly in the case of advanced lesions and invasive carcinomas.