术前MRI对初诊乳腺癌患者对侧乳腺可疑病变的评估价值  

The diagnostic value of preoperative MRI for contralateral suspicious lesions in patients with newly diagnosed breast cancer

作　　者：霍敏 胡益祺 胡奇兰 刘少欣 詹晨奥 艾涛 HUO Min;HU Yi-qi;HU Qi-lan(Department of Radiology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院放射科,湖北武汉430030 [2]长江大学附属仙桃市第一人民医院放射影像科,湖北仙桃433000

出　　处：《放射学实践》2024年第12期1614-1622,共9页Radiologic Practice

基　　金：湖北省卫生健康委2023-2024年度科研面上项目(WJ2023M163);仙桃市2023年指导性科技研究与开发计划项目(XT-2023-005)。

摘　　要：目的:评估乳腺MRI对初诊乳腺癌患者对侧乳腺可疑病灶的诊断效能。方法:回顾性分析2017年1月-2023年5月在本院初诊为乳腺癌且对侧存在可疑病变的137例患者的临床、病理及影像学资料。所有患者行乳腺MRI(T 2WI、DWI、DCE-MRI序列)、超声及乳腺X线摄影(CC位及MLO位)。由2位具有5年以上乳腺MRI诊断经验的放射科医师独立评估每例患者对侧乳腺可疑病变的MRI征象并进行BI-RADS分类。以病理结果作为金标准,比较乳腺MRI、超声、乳腺X线摄影(MG)检查对对侧乳腺癌的检出效能。同时,比较初诊乳腺癌(第一癌)和对侧乳腺癌(第二癌)的临床、病理及乳腺MRI特征的异同。结果:经病理证实,对侧病变为乳腺癌者33例,为良性病灶者104例。多模态MRI对初诊乳腺癌患者对侧可疑病灶的诊断具有高敏感度(94%)、较高的特异度(72%)和符合率(77%),AUC(0.83)高于乳腺US(AUC=0.60)和MG(AUC=0.57)。双侧和单侧乳腺癌患者的年龄分别为(48.5±8.8)和(46.0±8.5)岁。双侧乳腺癌均以浸润性导管癌(IDC)居多(第一癌占48.5%,第二癌占36.4%),第二癌病灶的直径显著小于第一癌(P=0.033),孕激素受体(PR)阳性(P=0.040)、Ki-67低表达(P=0.017)及同侧腋窝淋巴结转移(P=0.011)的占比均高于第一癌且差异均具有统计学意义。第二癌的MRI表现中,非肿块型病灶较多(57.6%);肿块型病灶多表现为不规则形(78.6%)、边界不光整(78.6%)和不均匀强化(64.3%),非肿块型病灶则以区域性分布(47.4%)、强化不均匀(42.1%)和集簇状强化(42.1%)为特征,这些特征的出现率与第一癌之间的差异均无统计学意义(P>0.05)。第二癌与第一癌的时间-信号强度曲线(TIC)类型的差异具有统计学意义(P=0.017)。结论:术前MRI对初诊乳腺癌患者对侧乳腺癌的检出具有较高的敏感性和准确性,AUC高于乳腺US及MG。双侧乳腺癌患者的双侧病灶在T分期、N分期、PR表达状态、Ki-67水平及同侧腋窝淋Objective:To assess the diagnostic performance of breast magnetic resonance imaging(MRI)in detecting contralateral suspicious lesions in patients with newly diagnosed breast cancer.Methods:A retrospective analysis was conducted on 137 patients with newly diagnosed breast cancer and contralateral suspicious lesions at our hospital from January 2017 to May 2023.Their clinical,pa-thological,and imaging data were reviewed.All patients underwent breast MRI(including T 2WI,DWI and DCE-MRI sequences),ultrasound(US)and mammography(CC position and MLO position)examinations.Two radiologists with over 5 years of breast MRI diagnostic experience independently evaluated MRI images of contralateral suspicious lesions in patients with newly diagnosed breast cancer and classified them using the BI-RADS system.Taken the biopsy or postoperative pathology results as the gold standard,the detecting efficacy of MRI,US,and mammography(MG)for contralateral breast cancer was compared.Additionally,clinical,pathological,and breast MRI features were compared between the initially diagnosed breast cancer(first cancer)and contralateral breast cancer(second can-cer).Results:Pathologically confirmed contralateral breast cancer was identified in 33 patients,while 104 patients had benign lesions.Multi-modal MRI showed high sensitivity(94%),substantial specificity(72%)and accuracy(77%)for detecting contralateral lesions in breast cancer patients,with higher AUC value(0.83)than that of breast US(AUC=0.60)and MG(AUC=0.57).The average age of patients with bilateral breast cancer was(48.5±8.8)years,while unilateral breast cancer patients ave-raged 46.0±8.5 years.In bilateral breast cancer,invasive ductal carcinoma(IDC)predominated(first cancer 48.5%,second cancer 36.4%).The breast cancer lesions of the secondary cancer were significantly smaller than those of the primary cancer(P=0.033),and features such as PR positivity(P=0.040),low Ki-67 expression(P=0.017),and ipsilateral axillary lymph node metastasis(P=0.011)were statistically significant comp

关 键 词：乳腺疾病 双侧乳腺癌 磁共振 临床病理特征 乳腺X线摄影 

分 类 号：R445.2[医药卫生—影像医学与核医学] R737.9[医药卫生—诊断学]