乳腺MRI误诊病例的影像学分析

Imaging analysis of misdiagnosis cases of breast MRI

目的:分析乳腺MRI误诊病例的影像学表现,探讨MRI检查在乳腺病诊断及鉴别诊断中的价值。方法:回顾性分析术前行MRI检查并经手术或穿刺病理证实的371例病例中,误诊病例31例,分析误诊病例的MRI表现特点并按BI-RADS分类进行评估,总结影像学表现对诊断结果的影响。结果:371例乳腺病变(良性91例,恶性280例)中MRI诊断错误31例,诊断准确率为91.4%;其中11例恶性病变误诊为良性病变,包括浸润性导管癌5例,导管内癌4例,浸润性小叶癌1例,粘液腺癌1例;16例良性病变误诊为恶性病变,包括慢性炎症2例,纤维腺病或增生7例,纤维腺瘤5例,导管内乳头状瘤2例;4例良性病变误诊为其他良性病变,包括腺病2例,叶状肿瘤1例,导管内乳头状瘤1例。结论:术前MRI检查是鉴别良、恶性病变的有效手段,虽然MRI诊断乳腺癌的敏感性高,但特异性相对低,对于分化好的及直径<1cm的早期乳腺癌术前容易漏诊;形成不规则形肿块的纤维腺瘤、乳头状瘤及表现复杂多样的纤维腺病容易误诊为恶性。

Objective：To analyze the imaging findings of breast misdiagnosis cases,and to explore the value of MRI in the diagnosis and differential diagnosis of breast diseases.Methods：371 cases with MRI examination and confirmed by surgical operation or puncture pathology were retrospectively analyzed.31 cases were misdiagnosed.The MRI features of misdiagnosed cases were analyzed and evaluated according to BI-RADS classification.The influence of imaging findings on the diagnosis were summarized.Results：In 371 cases of breast lesions（benign in 91 cases and malignant in 280 cases）,there were 31 cases of MRI diagnostic error.The diagnostic accuracy was 91.4%.11 cases of malignant lesions were misdiagnosed as benign lesions,including invasive ductal carcinoma in 5 cases,intraductal carcinoma in 4 cases,invasive lobular carcinoma in 1 case,and mucinous adenocarcinoma in one case;16 cases of benign lesions were misdiagnosed as malignant lesions,including chronic inflammation in 2 cases,fibrous adenosis or hyperplasia in 7 cases,fibroadenoma in 5 cases,and intraductal papilloma in 2 cases;4 cases of benign lesions were misdiagnosed as other benign lesions,including adenosis in 2 cases,1 case of lobular tumor and intraductal papilloma in 1 case.Conclusion：Preoperative MRI examination is an effective means to identify benign and malignant lesions.Although MRI is sensitive to breast cancer,the specificity is relatively low.It is easy to be misdiagnosed for early breast cancer with good differentiation and less than 1 cm in diameter.Fibroadenoma and papilloma with irregular masses,and fibrous adenosis with complex and diverse performance,are easily misdiagnosed as malignant lesions.