Is Elevated Choline on Magnetic Resonance Spectroscopy a Reliable Marker of Breast Lesion Malignancy?
Is Elevated Choline on Magnetic Resonance Spectroscopy a Reliable Marker of Breast Lesion Malignancy?
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DOI：
10.3389/fonc.2021.610354
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发表时间：
2021
影响因子：
4.7
通讯作者：
Boban J
中科院分区：
文献类型：
--
作者：
Prvulovic Bunovic N;Sveljo O;Kozic D;Boban J
现代乳腺磁共振成像（MRI）代表了一种强大的癌症检测诊断模式，具有出色的灵敏度和高特异性。磁共振波谱（MRS）正在探索作为一个额外的工具，提高乳腺癌检测的特异性，使用多参数MRI。本研究的目的是探讨1H-MRS鉴别乳腺良恶性病变的可能性，使用升高的胆碱（Cho）峰作为成像生物标志物。本前瞻性研究共纳入60例患者：30例恶性乳腺病变（平均年龄55.2岁;平均病变大小35 mm）和30例良性乳腺病变（平均年龄44.8岁;平均病变大小20 mm），这些患者在3年内在1.5 T扫描仪上接受了多参数MRI和多体素3D 1H-MRS。3例良性乳腺病变患者被排除在研究之外。所有病变均经组织学证实。在1H-MRS上鉴别的峰为脂质峰（0.9、2.3、2.8和5.2 ppm）、胆碱峰（3.2 ppm）和水峰（4.7 ppm）。使用ROC曲线定义灵敏度和特异性以及阳性和阴性预测值。进行了测试间可靠性的Cohen Kappa检验[测试1H-MRS与组织学发现之间的一致性，以及1H-MRS与MR乳腺X线摄影（MRM）之间的一致性]。24/30例乳腺恶性病变和20/27例乳腺良性病变的胆碱峰值升高。1H-MRS的敏感性为0.8，特异性为0.741，阳性预测值为0.774，阴性预测值为0.769。ROC下面积为0.77（CI 0.640-0.871）。1H-MRS与组织学结果之间的检验间可靠性为0.543（中度一致），1H-MRS与MRM之间的检验间可靠性为0.573（中度一致）。假阴性结果最常见于浸润性小叶癌，而假阳性结果最常见于腺样纤维腺瘤。虽然胆碱峰升高在乳腺癌检测中具有良好的敏感性和特异性，但两者均显著低于多参数MRM。包含位于肿瘤边缘的光谱以及脂质峰的分析可以帮助灵敏度和特异性。在特定类型的乳腺病变（小叶癌和腺样纤维腺瘤）中，假阳性和假阴性的比率很高，这提示对这些病变的解释要谨慎。
Contemporary magnetic resonance imaging (MRI) of the breast represents a powerful diagnostic modality for cancer detection, with excellent sensitivity and high specificity. Magnetic resonance spectroscopy (MRS) is being explored as an additional tool for improving specificity in breast cancer detection, using multiparametric MRI. The aim of this study was to examine the possibility of 1H-MRS to discriminate malignant from benign breast lesions, using elevated choline (Cho) peak as an imaging biomarker. A total of 60 patients were included in this prospective study: 30 with malignant (average age, 55.2 years; average lesion size, 35 mm) and 30 with benign breast lesions (average age, 44.8 years; average lesion size, 20 mm), who underwent multiparametric MRI with multivoxel 3D 1H-MRS on a 1.5-T scanner in a 3-year period. Three patients with benign breast lesions were excluded from the study. All lesions were histologically verified. Peaks identified on 1H-MRS were lipid (0.9, 2.3, 2.8, and 5.2 ppm), choline (3.2 ppm), and water peaks (4.7 ppm). Sensitivity and specificity, as well as positive and negative predictive values, were defined using ROC curves. Cohen’s Kappa test of inter-test reliability was performed [testing the agreement between 1H-MRS and histologic finding, and 1H-MRS and MR mammography (MRM)]. Choline peak was elevated in 24/30 malignant lesions and in 20/27 benign breast lesions. The sensitivity of 1H-MRS was 0.8, specificity was 0.741, positive predictive value was 0.774, and negative predictive value was 0.769. Area under ROC was 0.77 (CI 0.640–0.871). Inter-test reliability between 1H-MRS and histologic finding was 0.543 (moderate agreement) and that between 1H-MRS and MRM was 0.573 (moderate agreement). False-negative findings were most frequently observed in invasive lobular cancers, while false-positive findings were most frequently observed in adenoid fibroadenomas. Although elevation of the choline peak has a good sensitivity and specificity in breast cancer detection, both are significantly lower than those of multiparametric MRM. Inclusion of spectra located on tumor margins as well as analysis of lipid peaks could aid both sensitivity and specificity. An important ratio of false-positive and false-negative findings in specific types of breast lesions (lobular cancer and adenoid fibroadenoma) suggests interpreting these lesions with a caveat.
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影响因子：
--
作者：
Baek HM
通讯作者：
Baek HM
影响因子：
4.7
作者：
Sardanelli F;Carbonaro LA;Montemezzi S;Cavedon C;Trimboli RM
通讯作者：
Trimboli RM
影响因子：
5.5
作者：
Bartella, Lia;Huang, Wei
通讯作者：
Huang, Wei
DOI：
10.1016/j.ejmp.2016.09.008
发表时间：
2016-12-01
影响因子：
3.4
作者：
Cavedon, Carlo;Meliado, Gabriele;Montemezzi, Stefania
通讯作者：
Montemezzi, Stefania
DOI：
10.1007/978-1-4939-9690-2_12
发表时间：
2019-01-01
期刊：
NMR-BASED METABOLOMICS: METHODS AND PROTOCOLS
影响因子：
--
作者：
Sharma, Uma;Jagannathan, Naranamangalam R.
通讯作者：
Jagannathan, Naranamangalam R.