Categorization of non-mass-like breast lesions detected by MRI
Categorization of non-mass-like breast lesions detected by MRI
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DOI：
10.1007/s12282-007-0028-6
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发表时间：
2008-07-01
期刊：
影响因子：
4
通讯作者：
Fukuma, Eisuke
中科院分区：
文献类型：
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作者：
Sakamoto, Naomi;Tozaki, Mitsuhiro;Fukuma, Eisuke
背景 乳腺 MR 成像已成为一种高度敏感的乳腺肿瘤成像方式。然而，不存在解释显示非肿块样增强的病变的标准化方法。本研究的目的是分析 MRI 检测到的非肿块样乳腺病变的特征，并建立标准化的解释方法，以便对这些病变进行分类。 方法 对 102 例连续 102 例 MRI 检测到的不可扪及的乳腺 X 线隐匿性非肿块样病变进行回顾性分析，这些病变经过超声引导真空辅助活检。 MR 成像是在 1.5-Tesla 系统上进行的。分布模式分为以下三类：单象限/孤立病变（线性）、单象限/成群病变（局灶性、区域性、节段性）和多象限病变（多区域、弥漫性）。在确定肿瘤分布后，评估增强病灶中导管模式的存在。除了 BI-RADS-MRI 描述符之外，还评估了异质增强病灶中是否存在聚集环增强。我们将非肿块样病变分为具有小（3a 类）、中度（3b 类）或显着（4 类）恶性肿瘤可能性的病变。 结果 癌症阳性预测值 (PPV) 最高的特征是簇状环增强 (67%) (P = 0.004)、分支导管模式 (38%) (P = 0.003) 和簇状结构（20%）。线性导管模式癌症的 PPV 为 11% (1/9)。所有表现出多象限分布、线性非特异性病变、具有均匀和点状内部结构的非分支模式以及无簇状环强化的异质性病变均被诊断为良性。 结论 MRI 检测到的非肿块样乳腺病灶显示簇状环强化、分支导管模式和簇状结构应进一步通过活检进行评估（4 类），而未表现出这些特征的病变则无需不必要的干预即可观察到（4 类）。 3a）。显示线性导管模式的病变可以根据需要仔细跟踪或通过活检进行评估（3b 类）。
Background Breast MR imaging has emerged as a highly sensitive modality for the imaging of breast tumors. However, a standardized method of interpretation of lesions showing non-mass-like enhancement does not exist. The purpose of this study was to analyze the features of non-mass-like breast lesions detected by MRI, and to establish a standardized method of interpretation to allow categorization of these lesions.Methods A retrospective review was performed for 102 consecutive nonpalpable mammographically occult, non-mass- like lesions detected by MRI that had undergone ultrasound-guided vacuum-assisted biopsy. MR imaging was performed on a 1.5-Tesla system. The distribution patterns were classified into three categories as follows: single quadrant/solitary lesion (linear), single quadrant/grouped lesion (focal, regional, segmental), and multiquadrant lesion (multiple regions, diffuse). The presence of a ductal pattern was assessed in the enhancing lesions after the tumor distribution had been decided. In addition to the BI-RADS-MRI descriptors, the presence of clustered ring enhancement was also assessed in heterogeneous enhancing lesions. We divided non-mass-like lesions into those with a small (category 3a), moderate (category 3b), or substantial (category 4) likelihood of malignancy.Results The features with the highest positive predictive value (PPV) for cancer were clustered ring enhancement (67%) (P = 0.004), a branching-ductal pattern (38%) (P = 0.003), and clumped architecture (20%). The PPV for cancer of a linear-ductal pattern was 11% (1/9). All lesions showing multiquadrant distribution, linear-nonspecific lesion, non-branching pattern with homogeneous and stippled internal architectures, and heterogeneous lesion without clustered ring enhancement were diagnosed as benign.Conclusion Non-mass-like breast lesions detected on MRI showing a clustered ring enhancement, a branching-ductal pattern, and clumped architecture should be evaluated further by biopsy (category 4), while lesions not showing these characteristics may be observed without unnecessary intervention (category 3a). Lesions showing a linear-ductal pattern may be followed carefully or evaluated by biopsy as needed (category 3b).