背景:乳腺MRI的非肿块增强(NME)影响手术计划。
目的:评估阳性预测值(PPV),并在初始分期MRI上识别乳腺癌同侧NME的恶性鉴别符。
方法:回顾性。
方法:86名女性(中位年龄,48年;范围,26-75岁)与已知癌症同侧的101个NME病变(BI-RADS4和5),并证实了组织病理学。
■1.5T和3.0T动态对比增强脂肪抑制T1加权快速破坏梯度回波。
结果:三位对病理学不了解的放射科医生独立审查了MRI特征(分布,内部增强模式,和增强动力学)的NME,相对于索引癌症的位置(连续,不连续,和不同的象限),相关的乳房钙化,淋巴管浸润(LVI),腋窝淋巴结转移,和放射学-病理学相关性。临床因素,NME功能,分析癌症特征与NME恶性肿瘤的相关性。
方法:Fisher的精确,卡方,Wilcoxon秩和检验,采用混合效应多变量logistic回归。显著性阈值设定为P<0.05。
结果:总体NME恶性率为48.5%(49/101)。连续NME的恶性率(86.7%)明显高于非连续NME(25.0%)和不同象限的NME(10.7%),但对于非连续NME,与癌症的距离没有观察到显著差异,P=0.68。与钙化指数癌相邻的所有钙化NME病变均为恶性。与NME相比,当指数癌症为肿块时,NME更可能是恶性的(52.9%vs.21.4%),有乳房X线钙化(63.2%vs.39.7%),LVI(81.8%与44.4%),和腋窝淋巴结转移(70.8%vs.41.6%)。PPV最高的NME特征为节段分布(85.7%),成团增强(66.7%),和非持久性动力学(77.1%)。在多变量分析中,邻接NME,分段分布,和非持续性动力学与恶性肿瘤相关。
结论:分期MRI上同侧NME的恶性鉴别器包括连续定位以指示癌症,分段分布,和非持久性动力学。
方法:3技术效果:阶段2。
BACKGROUND: Nonmass enhancement (NME) on breast MRI impacts surgical planning.
OBJECTIVE: To evaluate positive predictive values (PPVs) and identify malignancy discriminators of NME ipsilateral to breast cancer on initial staging MRI.
METHODS: Retrospective.
METHODS: Eighty-six women (median age, 48 years; range, 26-75 years) with 101 NME lesions (BI-RADS 4 and 5) ipsilateral to known cancers and confirmed histopathology.
UNASSIGNED: 1.5 T and 3.0 T dynamic contrast-enhanced fat-suppressed T1-weighted fast spoiled gradient-echo.
RESULTS: Three radiologists blinded to pathology independently reviewed MRI features (distribution, internal enhancement pattern, and enhancement kinetics) of NME, locations relative to index cancers (contiguous, non-contiguous, and different quadrants), associated mammographic calcifications, lymphovascular invasion (LVI), axillary node metastasis, and radiology-pathology correlations. Clinical factors, NME features, and cancer characteristics were analyzed for associations with NME malignancy.
METHODS: Fisher\'s exact, Chi-square, Wilcoxon rank sum tests, and mixed-effect multivariable logistic regression were used. Significance threshold was set at P < 0.05.
RESULTS: Overall NME malignancy rate was 48.5% (49/101). Contiguous NME had a significantly higher malignancy rate (86.7%) than non-contiguous NME (25.0%) and NME in different quadrants (10.7%), but no significant difference was observed by distance from cancer for non-contiguous NME, P = 0.68. All calcified NME lesions contiguous to the calcified index cancer were malignant. NME was significantly more likely malignant when index cancers were masses compared to NME (52.9% vs. 21.4%), had mammographic calcifications (63.2% vs. 39.7%), LVI (81.8% vs. 44.4%), and axillary node metastasis (70.8% vs. 41.6%). NME features with highest PPVs were segmental distribution (85.7%), clumped enhancement (66.7%), and nonpersistent kinetics (77.1%). On multivariable analysis, contiguous NME, segmental distribution, and nonpersistent kinetics were associated with malignancy.
CONCLUSIONS: Malignancy discriminators of ipsilateral NME on staging MRI included contiguous location to index cancers, segmental distribution, and nonpersistent kinetics.
METHODS: 3 TECHNICAL EFFICACY: Stage 2.