乳腺MRI检查中检出乳腺外病变的价值

Value of breast MRI in detecting extramammary lesions

目的探讨乳腺MRI检查中发现乳腺外病变的检出率、发生部位及性质。方法选取721例乳腺磁共振检查的患者,其中初诊乳腺癌患者163例,乳腺癌治疗后随访患者322例,无乳腺癌病史(如常规体检、乳腺良性病变或其它病变原因进行乳腺MRI检查)患者236例,观察乳腺MRI是否存在乳腺外的其它部位病变及其发生率、分布类型。结果721例乳腺MRI检查患者中,发现乳腺外病变196例(27.18%,196/721),恶性病变124例(17.20%,124/721),良性病变72例(9.99%,72/721)。最常见的乳腺外病变是淋巴结115例(15.95%,115/721),其次是肝脏65例(9.01%,65/721)、胸部63例(8.74%,63/721)、骨质病变21例(2.91%,21/721)及其它(包括皮肤、胆囊、脾脏等)5例(0.69%,5/721)。163例初诊乳腺癌患者中发现乳腺外恶性病变61例(37.42%,61/163),322例乳腺癌治疗后随访中发现乳腺外恶性病变60例(18.63%,60/322),236例无乳腺癌病史患者发现乳腺外恶性病变3例(1.27%,3/236)。结论在进行乳腺MRI检查时不仅要注意乳腺本身是否存在病变,还要注意扫描范围内乳腺以外的其它区域,特别是对于初诊乳腺癌或乳腺癌治疗后随访的患者。

Objective To evaluate the occurrence rate, the location, and positive predictive value of incidental discovery of extramammary lesions on magnetic resonance imaging(MRI) of the breast. Methods In this retrospective analysis, 721 patients with breast MRI, including 163 patients newly diagnosed with primary breast cancer, 322 patients with post-treatment breast cancer history, 236 patients without breast cancer(routine screening workup, pathologically or aspiration confirmed benign lesions, or other reasons for breast MRI) were enrolled to investigate incidental findings outside the breast on MRI and their incidence and distribution types. Results Among 721 cases of breast MRI, 196 cases(27.18%, 196/721) were found with extramammary lesions, including 124 cases(17.20%, 124/721) with malignant lesions and 72 cases(9.99%, 72/721) with benign lesions. The most common extramammary lesions were located in lymph nodes(15.95%, 115/721), followed by liver(9.01%, 65/721), chest(8.74%, 63/721), bone(2.91%, 21/721), and other locations including skin, gallbladder and spleen, etc.(0.69%, 5/721). 61 cases of 163 patients(37.42%, 61/163) with newly diagnosed breast cancer were found with extramammary malignant lesions, while 60 cases of 322 patients(18.63%, 60/322) with post-treatment breast cancer were found to have extramammary malignant lesions, and 3 cases of 326 patients(1.27%, 3/236) without history of breast cancer were found to have extramammary malignant lesions. Conclusion Except for primary lesion, extramammary locations should be carefully examined on breast MRI, especially for those patients with history of breast cancer or newly diagnosed breast cancer.