Abstract：
OBJECTIVE: To explore the diagnostic value of multimodal imaging techniques, including automatic breast volume scanner (ABVS), mammography (MG), and magnetic resonance (MRI) in breast sclerosing adenosis (SA) associated with malignant lesions.
METHODS: From January 2018 to October 2020, 76 patients (88 lesions) with pathologically confirmed as SA associated with malignant or benign lesions were retrospective analyzed. All patients completed ABVS examination, 58 patients (67 lesions) with MG and 50 patients (62 lesions) with MRI were also completed before biopsy or surgical excision, of which, six patients (eight lesions) diagnosed as Breast Imaging Reporting and Data System (BI-RADS) category 3 by all imaging examinations underwent surgical excision without biopsy, other 70 patients (80 lesions) with BI-RADS category 4 or above by any imaging examination completed biopsy, including 65 patients (75 lesions) were further surgical excised and the other five patients (five lesions) were just followed up. All lesions were retrospectively described and classified, and were divided into benign group and malignant group according to their pathological results. Image features of different examination methods between the two groups were compared and analyzed. A ROC curve was established using the sensitivity of BI-RADS categories to predict malignant lesions in different imaging techniques as the ordinate and 1-specificity as the abscissa.
RESULTS: 88 lesions including 26 purely SA and 45 SA associated with benign lesions were classified as benign group, and the remaining 17 SA associated with malignant lesions were classified as malignant group. On ABVS, 40 mass lesions, their heterogeneous echo, not circumscribed margin and coronal convergence signs were statistically significant for malignant lesions (p < .05), but the remain 48 nonmass lesions lack specific sonographic features. On MG, 12 showed negative results, 55 showed with microcalcification, mass, structural distortion, and asymmetric density shadow, of which 11 lesions had the above two signs at the same time, but only microcalcification had statistical difference between the two groups. 35 mass enhanced lesions and 27 nonmass enhanced lesions on MRI, but there were no significant difference between their pathological results. Time signal intensity curves showed no differences, but ADC value <1.10 × 10-3 mm2 /s is more significant in malignant lesions (p < .05). The area under the ROC curve (AUC) of BI-RADS classification of ABVS, MG, and MRI in the diagnosis of malignant lesions were 0.611, 0.474, and 0.751, respectively, and the AUC of the combined diagnosis of the three was 0.761.
CONCLUSIONS: Mass lesions with heterogeneous echo, not circumscribed margin and coronal convergence sign on ABVS, microcalcification on MG and the ADC value <1.10 × 10-3 mm2 /s on MRI are significant signs for SA associated with malignant lesions. The combined diagnosis of the three methods was the highest, and the following were MRI, ABVS, and MG. Therefore, be cognizant of significant characteristics in SA associated with malignancy showed in different imaging examinations can improve the preoperative evaluation of SA and better provide basis for subsequent clinical decision-making.
METHODS: From January 2018 to October 2020, 76 patients (88 lesions) with pathologically confirmed as SA associated with malignant or benign lesions were retrospective analyzed. All patients completed ABVS examination, 58 patients (67 lesions) with MG and 50 patients (62 lesions) with MRI were also completed before biopsy or surgical excision, of which, six patients (eight lesions) diagnosed as Breast Imaging Reporting and Data System (BI-RADS) category 3 by all imaging examinations underwent surgical excision without biopsy, other 70 patients (80 lesions) with BI-RADS category 4 or above by any imaging examination completed biopsy, including 65 patients (75 lesions) were further surgical excised and the other five patients (five lesions) were just followed up. All lesions were retrospectively described and classified, and were divided into benign group and malignant group according to their pathological results. Image features of different examination methods between the two groups were compared and analyzed. A ROC curve was established using the sensitivity of BI-RADS categories to predict malignant lesions in different imaging techniques as the ordinate and 1-specificity as the abscissa.
RESULTS: 88 lesions including 26 purely SA and 45 SA associated with benign lesions were classified as benign group, and the remaining 17 SA associated with malignant lesions were classified as malignant group. On ABVS, 40 mass lesions, their heterogeneous echo, not circumscribed margin and coronal convergence signs were statistically significant for malignant lesions (p < .05), but the remain 48 nonmass lesions lack specific sonographic features. On MG, 12 showed negative results, 55 showed with microcalcification, mass, structural distortion, and asymmetric density shadow, of which 11 lesions had the above two signs at the same time, but only microcalcification had statistical difference between the two groups. 35 mass enhanced lesions and 27 nonmass enhanced lesions on MRI, but there were no significant difference between their pathological results. Time signal intensity curves showed no differences, but ADC value <1.10 × 10-3 mm2 /s is more significant in malignant lesions (p < .05). The area under the ROC curve (AUC) of BI-RADS classification of ABVS, MG, and MRI in the diagnosis of malignant lesions were 0.611, 0.474, and 0.751, respectively, and the AUC of the combined diagnosis of the three was 0.761.
CONCLUSIONS: Mass lesions with heterogeneous echo, not circumscribed margin and coronal convergence sign on ABVS, microcalcification on MG and the ADC value <1.10 × 10-3 mm2 /s on MRI are significant signs for SA associated with malignant lesions. The combined diagnosis of the three methods was the highest, and the following were MRI, ABVS, and MG. Therefore, be cognizant of significant characteristics in SA associated with malignancy showed in different imaging examinations can improve the preoperative evaluation of SA and better provide basis for subsequent clinical decision-making.
摘要：
目的：探讨多模态成像技术的诊断价值，包括自动乳房容积扫描仪（ABVS），乳房X线照相术（MG），与恶性病变相关的乳腺硬化性腺病（SA）的磁共振（MRI）。
方法：回顾性分析2018年1月至2020年10月，经病理证实为SA的恶性或良性病变患者76例（88个病灶）。所有患者均完成ABVS检查，58例MG患者（67个病灶）和50例MRI患者（62个病灶）也在活检或手术切除前完成，其中，通过所有影像学检查诊断为乳腺影像报告和数据系统（BI-RADS）3类的6例患者（8个病灶）接受了手术切除，但没有进行活检，其他70例（80个病灶）BI-RADS4类或以上，通过任何影像学检查完成活检，包括65例患者(75个病灶)进一步手术切除,另外5例患者(5个病灶)刚刚随访.对所有病变进行回顾性描述和分类，根据病理结果分为良性组和恶性组。对比分析两组患者不同检查方式的图像特征。使用BI-RADS类别的灵敏度以预测不同成像技术中的恶性病变为纵坐标，1-特异性为横坐标，建立ROC曲线。
结果：88个病变，包括26个单纯SA和45个SA与良性病变相关，其余17例与恶性病变相关的SA被归类为恶性组。在ABVS上，40个肿块,它们的异质回声，非边界边缘和冠状收敛征对恶性病变有统计学意义（p<0.05），但剩下的48个非肿块性病变缺乏特定的超声特征。在MG上，12显示阴性结果，55显示微钙化，质量,结构畸变,和不对称的密度阴影，其中11个病变同时具有上述两种体征，但两组之间只有微钙化有统计学差异。MRI上有35个肿块增强病变和27个非肿块增强病变，但其病理结果无显著差异。时间信号强度曲线显示无差异，但ADC值<1.10×10-3mm2/s在恶性病变中更为显著(p<0.05)。ABVS的BI-RADS分类的ROC曲线下面积(AUC),MG,和MRI对恶性病变的诊断分别为0.611、0.474和0.751,三者联合诊断的AUC为0.761。
结论：肿块性病变具有异质性回声，ABVS上没有界限边缘和日冕收敛符号，MG上的微钙化和MRI上的ADC值<1.10×10-3mm2/s是与恶性病变相关的SA的重要标志。三种方法的联合诊断最高，以下是MRI，ABVS,MG。因此,认识到不同影像学检查显示的SA与恶性肿瘤的显著特征，可以提高SA的术前评估，更好地为后续临床决策提供依据。
方法：回顾性分析2018年1月至2020年10月，经病理证实为SA的恶性或良性病变患者76例（88个病灶）。所有患者均完成ABVS检查，58例MG患者（67个病灶）和50例MRI患者（62个病灶）也在活检或手术切除前完成，其中，通过所有影像学检查诊断为乳腺影像报告和数据系统（BI-RADS）3类的6例患者（8个病灶）接受了手术切除，但没有进行活检，其他70例（80个病灶）BI-RADS4类或以上，通过任何影像学检查完成活检，包括65例患者(75个病灶)进一步手术切除,另外5例患者(5个病灶)刚刚随访.对所有病变进行回顾性描述和分类，根据病理结果分为良性组和恶性组。对比分析两组患者不同检查方式的图像特征。使用BI-RADS类别的灵敏度以预测不同成像技术中的恶性病变为纵坐标，1-特异性为横坐标，建立ROC曲线。
结果：88个病变，包括26个单纯SA和45个SA与良性病变相关，其余17例与恶性病变相关的SA被归类为恶性组。在ABVS上，40个肿块,它们的异质回声，非边界边缘和冠状收敛征对恶性病变有统计学意义（p<0.05），但剩下的48个非肿块性病变缺乏特定的超声特征。在MG上，12显示阴性结果，55显示微钙化，质量,结构畸变,和不对称的密度阴影，其中11个病变同时具有上述两种体征，但两组之间只有微钙化有统计学差异。MRI上有35个肿块增强病变和27个非肿块增强病变，但其病理结果无显著差异。时间信号强度曲线显示无差异，但ADC值<1.10×10-3mm2/s在恶性病变中更为显著(p<0.05)。ABVS的BI-RADS分类的ROC曲线下面积(AUC),MG,和MRI对恶性病变的诊断分别为0.611、0.474和0.751,三者联合诊断的AUC为0.761。
结论：肿块性病变具有异质性回声，ABVS上没有界限边缘和日冕收敛符号，MG上的微钙化和MRI上的ADC值<1.10×10-3mm2/s是与恶性病变相关的SA的重要标志。三种方法的联合诊断最高，以下是MRI，ABVS,MG。因此,认识到不同影像学检查显示的SA与恶性肿瘤的显著特征，可以提高SA的术前评估，更好地为后续临床决策提供依据。
