乳腺MRI对实性乳头状癌的诊断价值

The diagnostic value of MRI in solid papillary carcinoma

目的:分析乳腺实性乳头状癌(solid papillary carcinoma,SPC)的磁共振成像(magnetic resonance imaging,MRI)特征,探究MRI对于SPC的诊断价值。方法:回顾并收集2017年1月—2021年12月上海交通大学医学院附属新华医院经手术后病理学检查证实为SPC且行术前MRI检查的患者57例(共61个SPC病灶)。57例患者中,行术前乳腺X线摄影及超声检查者分别为45例(48个SPC)和52例(55个SPC)。根据术前乳腺影像报告和数据系统(Breast Imaging Reporting and Data System,BI-RADS)分类结果,以BI-RADS≥4A类为可疑恶性,计算乳腺X线摄影、超声及MRI对SPC的检出率及诊断准确度。病灶形态分为非肿块强化(non-mass enhancement,NME)与肿块两组,两组大小比较采用Mann-Whitney U检验,伴随导管扩张的差异采用χ^(2)检验。结果:乳腺X线摄影、超声及MRI对SPC的检出率为分别为64.6%(31/48)、83.6%(46/55)和100.0%(61/61),诊断准确度分别为52.1%(25/48)、65.5%(36/55)和98.4%(60/61)。在MRI上,SPC表现为NME较肿块更多见(67.2%vs32.8%)。NME较肿块病灶更大[2.5(1.6,4.0)cmvs1.4(1.0,1.8)cm,P<0.001],伴随导管扩张的阳性率更高[82.9%(34/41)vs 25.0%(5/20),P<0.001]。结论:乳腺MRI对于SPC的检出率及诊断准确度均高于乳腺X线摄影和超声检查。在MRI上,SPC表现为NME较肿块更多见,前者病灶更大,更常伴随导管扩张。

Objective:To investigate the magnetic resonance imaging(MRI)features of solid papillary carcinoma(SPC)and to explore the diagnostic value of MRI in SPC.Methods:This respective study collected 57 patients with 61 pathologically confirmed SPC between January 2017 and December 2021 Xinhua Hospital,Shanghai Jiao Tong University School of Medicine.All the patients had preoperative MRI examinations.Of the 57 patients,45 patients with 48 SPC and 52 patients with 55 SPC underwent preoperative mammography and ultrasound examination respectively.The detection rate and diagnostic accuracy of mammography,ultrasound,and MRI for SPC based on the preoperative Breast Imaging Reporting and Data System(BI-RADS)categories were calculated.A BI-RADS≥4A category was considered as the suspicion of malignancy.According to the morphology of the lesions,lesions was divided into non-mass enhancement(NME)and mass two groups.The difference in size and the rate of duct dilation were compared between the two groups,using the Mann-Whitney U test and theχ^(2) test,respectively.Results:The detection rate of mammography,ultrasound,and MRI for SPC was 64.6%(31/48),83.6%(46/55),and 100.0%(61/61),respectively.The accuracy of mammography,ultrasound,and MRI for SPC was 52.1%(25/48),65.5%(36/55),and 98.4%(60/61),respectively.On MRI,SPC was more commonly presented as a NME lesion than a mass lesion(67.2%vs 32.8%).The NME lesion had a larger size[2.5(1.6,4.0)cm vs 1.4(1.0,1.8)cm,P=0.001]and a more frequent rate of duct dilation[82.9%(34/41)vs 25.0%(5/20),P<0.001].Conclusion:Breast MRI showed a higher detection rate and accuracy than mammography and ultrasound.SPC was more commonly presented as an NME lesion than a mass lesion.The NME lesion had a larger size and a more frequent rate of duct dilation.