Purpose

To evaluate the diagnostic performance of dynamic contrast-enhanced (DCE)–MRI in predicting malignancy after percutaneous biopsy diagnosis of atypical ductal hyperplasia (ADH).

Methods and materials

In this retrospective study, 68 lesions (66 women) with percutaneous biopsy diagnosis of ADH and pre-operative breast DCE-MRI performed between January 2016 and December 2017 were included. Two radiologists reviewed in consensus mammography, ultrasound, and MR images. The final diagnosis after surgical excision was used as standard of reference. Clinical and imaging features were compared in patients with and without upgrade to malignancy after surgery. The diagnostic performance of DCE-MRI in predicting malignant upgrade was evaluated.

Results

A 9-gauge vacuum-assisted biopsy was performed in 40 (58.8%) cases and a 14-gauge core needle biopsy in 28 (41.2%) cases. Upgrade to malignancy was observed in 17/68 (25%) lesions, including 4/17 (23.5%) cases of invasive cancer and 13/17 (76.5%) cases of ductal carcinoma in situ (DCIS). In 16/17 (94.1%) malignant and 20/51 (39.2%) benign lesions, a suspicious enhancement could be recognized in DCE-MRI. The malignant lesion without suspicious enhancement was a low-grade DCIS (4 mm size). Sensitivity, specificity, positive predictive value, and negative predictive value of DCE-MRI on predicting malignancy were respectively 94.1%, 60.7%, 44.4%, and 96.8%. No other clinical or imaging features were significantly different in patients with and without upgrade to malignancy.

Conclusion

After a percutaneous biopsy diagnosis of ADH, malignancy can be ruled out in most of the cases, if no suspicious enhancement is present in the biopsy area at DCE-MRI. Breast DCE-MRI may be used to avoid surgery in more than half of the patients with final benign diagnosis.

Key Points

• Breast DCE-MRI can safely rule out malignancy if no suspicious enhancement is present in the biopsy area after a percutaneous biopsy diagnosis of ADH.

• All cases of upgrade to high-grade DCIS and invasive cancers can be identified at breast DCE-MRI after a percutaneous biopsy diagnosis of ADH.

• Breast DCE-MRI may be used to avoid surgery in more than half of the patients with final benign diagnosis.

中文翻译：

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非典型导管增生：乳房DCE-MRI可用于减少不必要的开放性手术切除。

目的

评估动态对比增强（DCE）-MRI在非典型导管增生（ADH）的经皮活检诊断后预测恶性肿瘤的诊断性能。

方法和材料

在这项回顾性研究中，纳入了2016年1月至2017年12月进行的经皮活检诊断为ADH的术前乳房DCE-MRI的68个病灶（66名女性）。两位放射科医生对钼靶，超声和MR图像进行了共识。手术切除后的最终诊断用作参考标准。比较了有无恶性手术后患者的临床和影像学特征。评价了DCE-MRI在预测恶性肿瘤升级中的诊断性能。

结果

在40例（58.8％）的病例中进行了9号真空辅助活检，在28例（41.2％）的病例中进行了14号芯针活检。在17/68（25％）病变中观察到恶性程度升级，包括4/17（23.5％）浸润性癌和13/17（76.5％）导管原位癌（DCIS）。在16/17（94.1％）恶性和20/51（39.2％）良性病变中，在DCE-MRI中可以识别出可疑的增强。没有可疑增强的恶性病变是低度DCIS（4 mm大小）。DCE-MRI对恶性肿瘤的敏感性，特异性，阳性预测值和阴性预测值分别为94.1％，60.7％，44.4％和96.8％。在没有或没有升级为恶性肿瘤的患者中，其他临床或影像学特征均无显着差异。

结论

如果经DCE-MRI在活检区域内未发现可疑增强，则在大多数情况下，经皮活检诊断为ADH后，可以排除恶性肿瘤。最终良性诊断的一半以上患者可使用乳房DCE-MRI避免手术。

关键点

•如果经皮穿刺活检诊断为ADH后，活检区域中没有可疑的增强，则乳房DCE-MRI可以安全地排除恶性肿瘤。

•经ADH经皮活检诊断后，可在乳腺DCE-MRI上确定所有升级为高级DCIS和浸润性癌症的病例。

•在最终良性诊断的一半以上患者中，可使用乳房DCE-MRI避免手术。