MRI导丝定位术对仅MRI显示的乳腺病变的诊断价值
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摘要
目的:初步探索MRI导丝定位术对仅MRI显示的乳腺微小病变的诊断价值。方法:使用Toshiba 1.5T VISART超导MRI仪,八通道相控阵乳腺专用线圈,专用导丝及定位系统,对16例患者19处仅MRI显示、BI-RADS分类为4类及以上的乳腺微小隐匿病灶进行导丝定位术。根据MRI检查可疑病灶的部位,结合专用软件进行测量计算,选择外侧位、内侧位,精准定位进针,观察操作方式及定位准确性,准确划定手术区域位置及范围,定位结束后送病人行外科手术切除,结合手术病理结果进行对比分析。结果:16例患者19个病灶均一次定位成功,病理切片证实病变完全成功切除,成功率为100%。术前MRI综合诊断BI-RADS分类4A类5处,4B类6处,4C类6处,5类2处;病理包括:导管内多发乳头状瘤3处(其中1例伴不典型增生),中度不典型增生2处,重度不典型增生5处,导管内癌4例,导管内癌伴微浸润1例,浸润性乳腺癌1例,大汗腺化生伴导管上皮增生1例,硬化性腺病伴筛状增生1例,微小纤维腺瘤1例,术前MRI诊断结论与术后病理结果对照,诊断符合率为84. 21%(16/19)。结论:对X线、超声无法检出,临床触及阴性,仅MRI显示的乳腺微小隐匿性病灶,应用MRI进行初步定性诊断,对BI-RADS分类4A类及以上的病灶进行MRI导丝定位术,是一种早期、安全、准确可靠的方法,弥补了X线、超声诊断的不足及假阴性的发生,提高了早期乳腺癌、导管内癌及不典型增生的精准诊治水平,是对乳腺X线和超声引导乳腺导丝定位术的重要补充。
Objective:To explore the application value of MRI localization biopsy in the diagnosis of nonpalpable breast lesions shown by MRI only.Methods:We performed MR localization biopsy in the 16 cases with 19 small hidden breast lesions showed by MRI only.All of the breast lesions were categorized as 4 to 5 on BI-RADS.The materials to be used are as follows:Toshiba MRI(1.5 T VISART superconducting),special coil for 8-channel phased-array mammary gland,special guide wire and positioning system.According to the location of suspicious lesions detected by MRI,and combined with special software for measurement,we can get the needle in exactly.Observing the operation mode and positioning accuracy,accurately delineating the position and scope of the surgical area,then sending the patient for surgical resection,finally,the pathological results of the operation are compared with MRI findings.Results:The location and surgical excision were succeeded on the 16 patients(100%). Preoperative MRI comprehensive diagnosis of BI-RADS classification included 5 of 4 A,6 of 4 B,6 of 4 C,and 2 of 5.The pathologic findings were as followed:Multiple intraductal papilloma in 3 rest lesions(one case was accompanied by atypical hyperplasia),moderate atypical hyperplasia in 2 rest lesions,severe dysplasia in 5 rest lesions,intraductal carcinoma in 4 cases,intraductal carcinoma with microinvasion in 1 case,invasive breast cancer in 1 case,large sweat gland metaplasia with ductal epithelial hyperplasia in 1 case,sclerosing adenopathy with cribriform hyperplasia in 1 rest lesion,microscopic fibrous adenoma in 1 case.Compared the preoperative MRI diagnosis with the postoperative pathological results,we calculated a diagnostic coincidence rate of 84.21%(16/19).Conclusion:Breast small hidden diseases showed by only MRI showed and categorized as 4 to 5 on BI-RADS,MRI guided breast lesion localization and biopsy provides an accurate and safe method for detecting the breast lesions.This technology can make up for the deficiency of X-ray and ultrasound diagnosis,reduce the false negative rate of diagnosis,and improve the precision diagnosis and treatment level of early breast cancer,intraductal cancer and dysplasia.It is an important supplement for mammography and ultrasound-guided mammography.
Objective:To explore the application value of MRI localization biopsy in the diagnosis of nonpalpable breast lesions shown by MRI only.Methods:We performed MR localization biopsy in the 16 cases with 19 small hidden breast lesions showed by MRI only.All of the breast lesions were categorized as 4 to 5 on BI-RADS.The materials to be used are as follows:Toshiba MRI(1.5 T VISART superconducting),special coil for 8-channel phased-array mammary gland,special guide wire and positioning system.According to the location of suspicious lesions detected by MRI,and combined with special software for measurement,we can get the needle in exactly.Observing the operation mode and positioning accuracy,accurately delineating the position and scope of the surgical area,then sending the patient for surgical resection,finally,the pathological results of the operation are compared with MRI findings.Results:The location and surgical excision were succeeded on the 16 patients(100%). Preoperative MRI comprehensive diagnosis of BI-RADS classification included 5 of 4 A,6 of 4 B,6 of 4 C,and 2 of 5.The pathologic findings were as followed:Multiple intraductal papilloma in 3 rest lesions(one case was accompanied by atypical hyperplasia),moderate atypical hyperplasia in 2 rest lesions,severe dysplasia in 5 rest lesions,intraductal carcinoma in 4 cases,intraductal carcinoma with microinvasion in 1 case,invasive breast cancer in 1 case,large sweat gland metaplasia with ductal epithelial hyperplasia in 1 case,sclerosing adenopathy with cribriform hyperplasia in 1 rest lesion,microscopic fibrous adenoma in 1 case.Compared the preoperative MRI diagnosis with the postoperative pathological results,we calculated a diagnostic coincidence rate of 84.21%(16/19).Conclusion:Breast small hidden diseases showed by only MRI showed and categorized as 4 to 5 on BI-RADS,MRI guided breast lesion localization and biopsy provides an accurate and safe method for detecting the breast lesions.This technology can make up for the deficiency of X-ray and ultrasound diagnosis,reduce the false negative rate of diagnosis,and improve the precision diagnosis and treatment level of early breast cancer,intraductal cancer and dysplasia.It is an important supplement for mammography and ultrasound-guided mammography.
引文
[1] Fujiuchi N,Saeki T,Takeuchi H,et al.A false positive for metastatic lymph nodes in the axillary region of a breast cancer patient following mastectomy[J].Chemical Abstracts,2011,18(2):141.
[2] Radiology AC.Breast imaging reporting and data system atlas (BI-RADS atlas)[J].Reston,VA:American College of Radiology,2013.
[3] Morris EA.Diagnostic breast MR imaging:Current status and future directions[J].Magn Reson Imaging Clin N Am,2010,18:57-74.
[4] Oxner CR,Vora L,Yim J,et al.Magnetic resonance imaging-guided breast biopsy in lesions not visualized by mammogram or ultrasound[J].Am Surg,2012,78:1087-1090.
[5] Mc Grath AL,Price ER,Eby PR,et al.MRI-guided breast interventions[J].J Magn Reson Imaging,2017,46(3):631-645.
[6] Mann RM,Kuhl CK,Kinkel K,et al.Breast MRI:Guidelines from the european society of breast imaging[J].Eur Radiol,2008,18(7):1307-1318.
[7] Lu Lunbo,Zhang Chengzhong,Zhuo Yaoyao,et al.Application of MRI-guided vacuum-assisted breast biopsy:Initial clinical experience[J].Chin J Med Imaging Technol,2017,33(5):657-661.[鲁伦博,张承中,卓瑶瑶,等.MRI导引下真空辅助乳腺病灶旋切活检技术的临床应用[J].中国医学影像技术,2017,33(5):657-661.]
[8] Lu Bolun,Kong Dexing,Xie Le,et al.MRI-guided localization of breast lesions and biopsy[J/CD].Chinese Journal Breast Disease (Electronic Edition),2018,12(12):110-112.[鲁伦博,孔德兴,谢叻.等.磁共振成像引导下乳腺病灶定位与活组织检查[J/CD].中华乳腺病杂志(电子版),2018,12(12):110-112.]
[9] Wang HY,Zhao YN,Wu JZ,et al.MRI-guided wire localization open biopsy is safe and effective for suspicious cancer on breast MRI[J].Asian Pacific Journal of Cancer Prevention,2015,16(5):1715-8.
[10] Anika L,McGrath MD,Elissa R,et al.MRI-guided breast interventions[J].2017,46(3):631-645.
[11] Gu Yajia,Xu Linghui,Zhang Shengjian,et al.MRI-guided breast lesion localization and lesion analysis[J].Chinese Journal of Radiology,2013,47(8):685-689.[顾雅佳,许玲辉,张盛箭,等.MR导引的乳腺病变定位方法及其病变特征分析[J].中华放射学杂志,2013,47(8):685-689.]
[12] Mariscotti G,Houssami N,Durando M,et al.Digital breasttomosynthesis (DBT)to characterize MRI-Detected additional lesions unidentified at targeted ultrasound in newly diagnosed breast cancer patients[J].Eur Radiol,2015,25(9):2673-2681.
[13] Murase K.Efficient method for calculating kinetic parameters using T1-weighted dynamic contrast-enhanced magnetic resonance imaging[J].Magn Reson Med,2004,51:858-862.
[14] Bickel H,Pinker-Domenig K,Bogner W,et al.Quantitative apparent diffusion coefficient as a noninvasive imaging biomarker for the differentiation of invasive breast cancer and ductal carcinoma in situ[J].Invest Radiol,2015,50(2):95-100.
[15] Ying Zhu,Shu Pingzhan,Pei Fangliu,et al.Solitary intraductal papillomas of the breast:MRI features and differentiation from small invasive ductal carcinomas[J].AJR,2012,199(4):936-942.
[16] Aljarrah A,Malik KA,Jamil H,et al.Diagnostic dilemmas in intraductal papillomas of the breast-experience at sultan qaboos university hospital in the sultanate of oman[J].Pak J Med Sci,2015,31(2):431-434.
[17] Wang WY,Wang X,Gao JD,et al.Analysis of the clinicopathological characteristics and prognosis in 674 cases of breast intraductal papillary tumor[J].Chin J Oncol,2017,39(6):429-433.[王文彦,王昕,高纪东,等.674例乳腺导管内乳头状肿瘤的临床病理特征及预后分析[J].中华肿瘤杂志,2017,39(6):429-433.]
[18] Berg WA,Gutierrez L,NessAiver MS,et al.Diagnostic accuracy of mammography,clinical examination,US,and MR imaging in preoperative assessment of breast cancer[J].Radiology 2004,233:830-849.
[19] Kuhl CK,Scehrading S,Bieling HB,et al.MRI for diagnosis of pure ductal carcinoma in situ:Aprospective observational study[J].Lancet,2007,370:485-492.
[20] Elada R,Chong J,Lulkarni S,et al.Papillary lesions of the breast:MRI,ultrasoundan mammographic appearances[J].Am J Roentgenol,2012,198(2):264-271.
[21] Xu Linghui,Peng Weijun,Gu Yajia,et al.The MRI features of breast ductal carcinoma[J].Chin J Radiol,2011,45(2):159-163.[许玲辉,彭卫军,顾雅佳,等.乳腺导管原位癌的MRI表现[J].中华放射学杂志,2011,45(2):159-163.]
[22] You Chao,Gu Yajia,Peng Weijun,et al.MRI in the differential diagnosis of breast ductal cancer in situ[J].China Oncology,2014,24(6):463-468.[尤超,顾雅佳,彭卫军,等.MRI鉴别乳腺导管原位癌与其他导管内病变的价值[J].中国癌症杂志,2014,24(6):463-468.]
[23] Liu Yufeng,Xu Maosheng,Liu Xuejing,et al.Comparative study of MR diffusionweighted imaging and dynamic contrast enhanced magnetic resonance imaging in assessment on breast ductal carcinoma in situ and invasive ductal carcinoma[J].Journal of Medical Imaging,2014,24(6):954-958.
[24] Page DL,Rogers LW.Combined histologic and cytologic criteria for the diagnosis of mammary atypical ductal hyperplasia[J].Hum Pathol,1992,23:1095-1097.
[25] Tsuchiya K,Mori N,Schacht DW,et al.Value of breast MRI for patients with a biopsy showing atypical ductal hyperplasia (ADH)[J].Journal of Magnetic Resonance Imaging,2017,46(6):1738-1747.
[26] Menes TS,Rosenberg R,Balch S,et al.Upgrade of high-risk breast lesions detected on mammography in the breast cancer surveillance consortium[J].Am J Surg,2014,207:24-31.
[2] Radiology AC.Breast imaging reporting and data system atlas (BI-RADS atlas)[J].Reston,VA:American College of Radiology,2013.
[3] Morris EA.Diagnostic breast MR imaging:Current status and future directions[J].Magn Reson Imaging Clin N Am,2010,18:57-74.
[4] Oxner CR,Vora L,Yim J,et al.Magnetic resonance imaging-guided breast biopsy in lesions not visualized by mammogram or ultrasound[J].Am Surg,2012,78:1087-1090.
[5] Mc Grath AL,Price ER,Eby PR,et al.MRI-guided breast interventions[J].J Magn Reson Imaging,2017,46(3):631-645.
[6] Mann RM,Kuhl CK,Kinkel K,et al.Breast MRI:Guidelines from the european society of breast imaging[J].Eur Radiol,2008,18(7):1307-1318.
[7] Lu Lunbo,Zhang Chengzhong,Zhuo Yaoyao,et al.Application of MRI-guided vacuum-assisted breast biopsy:Initial clinical experience[J].Chin J Med Imaging Technol,2017,33(5):657-661.[鲁伦博,张承中,卓瑶瑶,等.MRI导引下真空辅助乳腺病灶旋切活检技术的临床应用[J].中国医学影像技术,2017,33(5):657-661.]
[8] Lu Bolun,Kong Dexing,Xie Le,et al.MRI-guided localization of breast lesions and biopsy[J/CD].Chinese Journal Breast Disease (Electronic Edition),2018,12(12):110-112.[鲁伦博,孔德兴,谢叻.等.磁共振成像引导下乳腺病灶定位与活组织检查[J/CD].中华乳腺病杂志(电子版),2018,12(12):110-112.]
[9] Wang HY,Zhao YN,Wu JZ,et al.MRI-guided wire localization open biopsy is safe and effective for suspicious cancer on breast MRI[J].Asian Pacific Journal of Cancer Prevention,2015,16(5):1715-8.
[10] Anika L,McGrath MD,Elissa R,et al.MRI-guided breast interventions[J].2017,46(3):631-645.
[11] Gu Yajia,Xu Linghui,Zhang Shengjian,et al.MRI-guided breast lesion localization and lesion analysis[J].Chinese Journal of Radiology,2013,47(8):685-689.[顾雅佳,许玲辉,张盛箭,等.MR导引的乳腺病变定位方法及其病变特征分析[J].中华放射学杂志,2013,47(8):685-689.]
[12] Mariscotti G,Houssami N,Durando M,et al.Digital breasttomosynthesis (DBT)to characterize MRI-Detected additional lesions unidentified at targeted ultrasound in newly diagnosed breast cancer patients[J].Eur Radiol,2015,25(9):2673-2681.
[13] Murase K.Efficient method for calculating kinetic parameters using T1-weighted dynamic contrast-enhanced magnetic resonance imaging[J].Magn Reson Med,2004,51:858-862.
[14] Bickel H,Pinker-Domenig K,Bogner W,et al.Quantitative apparent diffusion coefficient as a noninvasive imaging biomarker for the differentiation of invasive breast cancer and ductal carcinoma in situ[J].Invest Radiol,2015,50(2):95-100.
[15] Ying Zhu,Shu Pingzhan,Pei Fangliu,et al.Solitary intraductal papillomas of the breast:MRI features and differentiation from small invasive ductal carcinomas[J].AJR,2012,199(4):936-942.
[16] Aljarrah A,Malik KA,Jamil H,et al.Diagnostic dilemmas in intraductal papillomas of the breast-experience at sultan qaboos university hospital in the sultanate of oman[J].Pak J Med Sci,2015,31(2):431-434.
[17] Wang WY,Wang X,Gao JD,et al.Analysis of the clinicopathological characteristics and prognosis in 674 cases of breast intraductal papillary tumor[J].Chin J Oncol,2017,39(6):429-433.[王文彦,王昕,高纪东,等.674例乳腺导管内乳头状肿瘤的临床病理特征及预后分析[J].中华肿瘤杂志,2017,39(6):429-433.]
[18] Berg WA,Gutierrez L,NessAiver MS,et al.Diagnostic accuracy of mammography,clinical examination,US,and MR imaging in preoperative assessment of breast cancer[J].Radiology 2004,233:830-849.
[19] Kuhl CK,Scehrading S,Bieling HB,et al.MRI for diagnosis of pure ductal carcinoma in situ:Aprospective observational study[J].Lancet,2007,370:485-492.
[20] Elada R,Chong J,Lulkarni S,et al.Papillary lesions of the breast:MRI,ultrasoundan mammographic appearances[J].Am J Roentgenol,2012,198(2):264-271.
[21] Xu Linghui,Peng Weijun,Gu Yajia,et al.The MRI features of breast ductal carcinoma[J].Chin J Radiol,2011,45(2):159-163.[许玲辉,彭卫军,顾雅佳,等.乳腺导管原位癌的MRI表现[J].中华放射学杂志,2011,45(2):159-163.]
[22] You Chao,Gu Yajia,Peng Weijun,et al.MRI in the differential diagnosis of breast ductal cancer in situ[J].China Oncology,2014,24(6):463-468.[尤超,顾雅佳,彭卫军,等.MRI鉴别乳腺导管原位癌与其他导管内病变的价值[J].中国癌症杂志,2014,24(6):463-468.]
[23] Liu Yufeng,Xu Maosheng,Liu Xuejing,et al.Comparative study of MR diffusionweighted imaging and dynamic contrast enhanced magnetic resonance imaging in assessment on breast ductal carcinoma in situ and invasive ductal carcinoma[J].Journal of Medical Imaging,2014,24(6):954-958.
[24] Page DL,Rogers LW.Combined histologic and cytologic criteria for the diagnosis of mammary atypical ductal hyperplasia[J].Hum Pathol,1992,23:1095-1097.
[25] Tsuchiya K,Mori N,Schacht DW,et al.Value of breast MRI for patients with a biopsy showing atypical ductal hyperplasia (ADH)[J].Journal of Magnetic Resonance Imaging,2017,46(6):1738-1747.
[26] Menes TS,Rosenberg R,Balch S,et al.Upgrade of high-risk breast lesions detected on mammography in the breast cancer surveillance consortium[J].Am J Surg,2014,207:24-31.