MRI对超声阴性、乳腺X线摄影中乳腺影像报告和数据系统4类单纯钙化病变的诊断价值

Diagnostic value of MRI in breast imaging reporting and data system 4 mammography-detected ultrasound-negative pure calcification lesions

目的探讨乳腺MRI对超声阴性、乳腺X线摄影中乳腺影像报告和数据系统(BI-RADS)4类单纯钙化病变的诊断价值。方法回顾性分析2013年12月至2019年12月在上海交通大学医学院附属新华医院乳腺X线摄影检查诊断为BI-RADS 4类单纯钙化、超声检查未见明显异常,并最终取得病理结果的51例(52个钙化病灶)患者的资料。52个钙化病灶中良性40个、恶性12个。分析良恶性病灶的乳腺X线摄影表现(乳腺腺体构成及钙化的形态学、分布特点)及MR表现(强化类型等),并与组织病理学结果进行对照,计算MR的诊断效能。结果良恶性钙化病灶的乳腺X线摄影上钙化形态和MR上强化类型差异有统计学意义(P<0.05)。乳腺MRI上恶性钙化灶均表现为肿块或非肿块强化(12/12),而良性钙化灶多表现为无强化或点状强化(27/40)。乳腺MRI诊断超声阴性、乳腺X线摄影中BI-RADS 4类单纯钙化病变的灵敏度、特异度、阳性预测值、阴性预测值,分别为66.7%(8/12)、75.0%(30/40)、44.4%(8/18)、88.2%(30/34);诊断4A类钙化的灵敏度、特异度、阳性预测值、阴性预测值分别为66.7%(2/3)、74.2%(23/31)、20.0%(2/10)、95.8%(23/24),诊断4B类钙化的灵敏度、特异度、阳性预测值、阴性预测值分别为66.7%(4/6)、85.7%(6/7)、80.0%(4/5)、75.0%(6/8)。结论MRI对超声阴性、乳腺X线摄影BI-RADS 4类单纯钙化具有较高的鉴别诊断价值,尤其是对4A类钙化的阴性预测值较高;MRI表现为无强化或点状强化的病灶建议随访代替活检。

Objective To explore the diagnostic value of breast MRI in breast imaging reporting and data system(BI-RADS)4 mammography-detected ultrasound-negative(MG+/US-)pure calcification lesions.Methods The data of 51 patients(52 calcification lesions)who were diagnosed with BI-RADS 4 pure calcification by mammography,had no significant abnormality on ultrasonography,and finally obtained pathological results at Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from December 2013 to December 2019 were retrospectively analyzed.Of the 52 calcification lesions,40 were benign and 12 were malignant.The mammographic findings(breast composition,calcification morphology,and distribution)and MR findings(enhancement pattern),of benign and malignant lesions were analyzed and compared with the histopathological results.The diagnostic performance of MRI was calculated.Results There was a significant difference between benign and malignant calcification lesions in calcification morphology on mammography and enhancement pattern on MRI(P<0.05).On breast MRI,malignant calcifications lesions showed mass or non-mass enhancement(12/12),while benign calcified lesions mostly showed no enhancement or punctate enhancement(27/40).The sensitivity,specificity,positive predictive value,and negative predictive value of breast MRI in the diagnosis of BI-RADS 4 MG+/US-pure calcification lesions were 66.7%(8/12),75.0%(30/40),44.4%(8/18)and 88.2%(30/34),respectively;The sensitivity,specificity,positive predictive value and negative predictive value for BI-RADS 4A calcifications were 66.7%(2/3),74.2%(23/31),20.0%(2/10)and 95.8%(23/24),respectively.The sensitivity,specificity,positive predictive value and negative predictive value for BI-RADS 4B calcifications were 66.7%(4/6),85.7%(6/7),80.0%(4/5)and 75.0%(6/8),respectively.Conclusions MRI has a high differential diagnostic value for mammographic BI-RADS 4 pure calcifications with ultrasound-negative,especially for BI-RADS 4A calcifications.Follow-up instead of biopsy is recommended for lesions with no enhancement or punctate enhancement on MRI.