磁共振动态增强在乳腺癌切除活检后残留病灶评估中的应用价值  

Application Value of Dynamic Contrast Enhanced MRI in Evaluating Residual Lesions After Breast Cancer Excision Biopsy

作　　者：文洁 何翠菊 孙佳乐 刘周 关剑 王猛 向露 WEN Jie;HE Cui-ju;SUN Jia-le;LIU Zhou;GUAN Jian;WANG Meng;XIANG Lu(Department of Radiology,Nation Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital&Shenzhen Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Shenzhen,518116,Guangdong Province,China;Department of Radiology,Cancer Hospital of China Medical University/Liaoning Cancer Hospital&Institute,Shenyang,110042,Liaoning Province,China;Department of Breast surgery,Nation Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital&Shenzhen Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Shenzhen,518116,Guangdong Province,China;Department of Pathology,Nation Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital&Shenzhen Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Shenzhen,518116,Guangdong Province,China)

机构地区：[1]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院深圳医院放射诊断科,广东深圳518116 [2]中国医科大学肿瘤医院/辽宁省肿瘤医院放射诊断科,辽宁沈阳110042 [3]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院深圳医院乳腺外科,广东深圳518116 [4]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院深圳医院病理科,广东深圳518116

出　　处：《中国CT和MRI杂志》2023年第6期86-88,共3页Chinese Journal of CT and MRI

基　　金：国家科技部“重大慢性非传染性疾病防控研究”重点专项项目课题资助(2017YFC1309100);中国医学科学院肿瘤医院深圳医院院内科研课题资助(E010321005)。

摘　　要：目的探讨乳腺磁共振动态增强在乳腺癌首次切除活检后,再次切除前评估残留病变中的应用价值。方法回顾性分析2019年11月至2022年1月38例切除活检后乳腺癌患者,来我院再次手术前行乳腺MRI检查的影像资料。根据再次手术后病理分为有残留组及无残留组,比较两组临床和病理资料、MRI影像特征及BI-RADS分类的差异。结果再次手术后病理证实15例乳腺癌有残留,23例患者无残留。两组间腋窝淋巴结转移状态、对侧乳腺是否异常、病理结果、免疫组化结果、手术方式均无显著统计学差异(P>0.05)。残腔边缘结节性强化、叶段样、导管样非肿块强化或距离残腔≥5mm结节状强化,提示乳腺癌残留。残留组TIC曲线更多表现为Ⅱ型或Ⅲ型,BI-RADS分类多表现为4及5类。MRI BI-RADS分类对乳腺癌残留诊断的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为80.00%、86.96%、80.00%、86.96%、80.00%。结论乳腺动态增强MRI有利于乳腺癌切除术后残留病灶的评估。Objective To explore the value of breast dynamic contrast enhanced MRI(DCE-MRI)in the evaluation of residual lesions before reoperation.Methods According to the pathology after reoperation,enrolled patients were assigned into residual group and non-residual group.The differences in clinical and pathological characteristics,MRI findings and BI-RADS classification between the two groups were compared.Results After operation again,pathology confirmed that 15 cases had residual breast cancer and 23 patients had no residual.There was no significant difference in axillary lymph node metastasis,contralateral breast abnormality,pathological results,immunohistochemical results and surgical methods between the two groups(P>0.05).Nodular enhancement at the periphery of the residual cavity,segmental,ductal non-mass-like enhancement or distance from the residual cavity to nodular enhancement,suggesting the presence of residual breast cancer.In the residual group,typeⅡor typeⅢTIC(time-intensity curve),and type 4 and 5 categories in the BI-RADS classification were dominant..MRI BI-RADS classification is highly sensitive,specific and accurate in the diagnosis of breast cancer.Conclusions DCE-MRI could assist the evaluation of residual lesions after breast cancer resection.

关 键 词：乳腺癌 磁共振 残留病灶 乳腺数据和报告系统 

分 类 号：R445.2[医药卫生—影像医学与核医学]