乳腺MRI在预测导管内癌早期浸润中的价值

Potential of breast MRI in predicting the presence of early invasion in ductal carcinoma in situ

目的：比较单纯导管内癌（ DCIS）和DCIS早期浸润的形态学及动态强化特点，探讨乳腺MRI在预测早期浸润中的价值。方法对经手术病理证实、术前行乳腺MRI的82个单纯DCIS病灶（ N1组）和51个DCIS早期浸润病灶（N2组），结合美国放射学会乳腺影像报告与数据系统（ACR BI-RADS），描述病变的形态学特征和时间信号强度曲线，采用单变量和多变量Logistic回归进行回顾性分析。结果病灶大小和延迟期曲线具有预测早期浸润的潜力，≥1．9 cm的病变出现早期浸润的可能性明显高于＜1．9 cm 的病变（ OR＝2．285，95％CI：1．119～4．663）；延迟期曲线呈平台型及流出型的病变出现早期浸润的可能性分别为流入型病变的2．657倍（95％CI：1．089～6．482）及4．773倍（95％CI：1．880～12．118）。非肿块样强化是DCIS及DCIS早期浸润最主要的强化方式。两组间各形态学特点的差异无统计学意义（P均＞0．05）。结论乳腺MRI所显示的病灶大小及延迟期曲线具有预测DCIS早期浸润的潜力。

Objective To evaluate the potential of breast MRI in predicting the presence of invasion by comparing the morphologic and kinetic characteristics between pure ductal carcinoma in situ （ DCIS） and DCIS with early invasion. Methods Preoperative breast MRI of 82 pure DCIS lesions（ N1 group） and 51 DCIS lesions with early invasion （ N2 group） were reviewed retrospectively.The morphologic characteristics and time-intensity curve （ TIC） of all lesions were described in accordance with American College of Radiology Breast Imaging Repot and Data System （ ACR BI-RADS） .All cases were confirmed by surgery and pathology.Statistical analyses were performed through univariate and multivariate logistic regression approach.Results Lesion size and delayed TIC were associated with the presence of early invasion.Compared with lesion size ＆lt;1.9 cm, the probability of invasion was higher for lesion size≥1.9 cm （OR=2.285, 95%CI：1.110-4.663）.Compared with persistent TIC, the probability of invasion of washout TIC was 4.773 times （95%CI：1.880-12.118）and the probability of plateau TIC was 2.657 times （95%CI：1.089-6.482）.The majority of both pure DCIS and DCIS with early invasion were depicted as non-mass-like enhancement, and there was no significant difference in morphology between two types of lesions（P＆gt;0.05）.Conclusion Lesion size and delayed TIC on breast MRI have the potential in predicting the presence of early invasion in DCIS.