乳腺癌磁共振成像误诊和漏诊病例的临床、影像和病理学特点

Data analysis of MRI misdiagnosis and missed diagnosis of breast lesions on clinical, radiologic and pathologic features

目的 探讨乳腺癌磁共振成像（MRI）漏诊和误诊病例的临床、影像和病理学改变可能的原因.方法 回顾总结术前行乳腺MRI、超声和X线检查患者121例临床资料,经穿刺或手术病理证实为乳腺良、恶性病变共241个,采用BL-RADS分类,分析其影像学表现,并进行最终评估.由外科、影像科和病理科医生共同分析MRI误诊和漏诊病例的可能原因、病理学基础.结果 241个乳腺病变中恶性120个、良性121个.MRI漏诊4个,分别为导管内乳头状瘤病2个、纤维腺瘤2个,均为良性.MRI误诊23个,其中高估16个,高估的病变包括慢性乳腺炎3个、硬化性腺病各3个,纤维腺瘤、结节腺病伴重度非典型增生、导管内乳头状瘤、乳腺腺病各2个,乳腺癌胸肌侵犯、乳腺癌腋窝淋巴结转移各1个;低估7个,包括浸润性导管癌2个、黏液癌1个、乳腺原位癌2个、盲管腺病伴重度非典型增生局灶恶变1个、炎性乳腺癌化疗后1个. MRI诊断乳腺癌的敏感度为95.83％（115/120）,特异度为72.73％（88/121）,诊断准确率为84.23％（203/241）.乳腺MRI发现病变与乳腺超声或X线形态或临床检查的符合率为75.10％（181/241）.结论 MRI误诊和漏诊常发生于乳腺病灶较小、形态学和血流动力学恶性表现不典型者,特别是导管内病变.应结合体检、乳腺X线和超声检查以提高诊断准确度、减少漏诊.

Objective To analyze the MRI data of misdiagnosed and missed diagnosed of breast lesions and their histopathological features.Methods Data from 241 breast lesions within 121 patients were recruited in this study.The data included MRI images,uhrasounds and X-ray images were retrospectively interpreted by two radiologist and each lesion was assessed according to the BI-RADS classification.The pathologic features of miss or error diagnosed lesions on MRI were analyzed.Results In 241 breast lesions （malignance 120,bcnign 121）,4 lcsions were miss diagnosed on MRI.Thcy were 2 intraductal papillomatosis and 2 fibroadenoma.All was benign.Twenty three lesions were misdiagnosed on MRI.Sixteen were overestimation,including 3 chronic inflammations,3 sclerosing adenosis,2 fibroadenoma,4 fibrocystic changes with or without atypical ductal hyperplasia （ADH）,2 intraductal papilloma,1 infiltration of pectoralis major muscle and 1 axillary lymphnode metastasis.Meanwhile,there were 7 lesions were underestimation.These lesions included 2 invasive ductal carcinomas,1 mucinous adenocarcinoma,2 DCIS and 1 blunt duct adenosis with ADH and focal cancerous,1 inflammatory breast cancer underwent chemotherapy.The sensitivity and specificity and accuracy of breast MRI were 95.83 % （115/120）,72.73 % （88/121）,84.23 % （203/241）,respectively.MRI findings had no difference with respect to mammogram or ultrasound was 75.10 % （181/241）.Conclusion MRI misdiagnosis and missed often occurs in smaller breast lesions,morphologic and hemodynamic malignant manifestation atypical,especially intraductal lesions.MRI diagnosis should be combined with physical examination,X-ray mammogram and ultrasound to improve diagnostic accuracy and reduce missed diagnosis.