PURPOSE The goal of this study is to evaluate the frequency and imaging features of lobular neoplasia (LN) diagnosed on MRI-guided biopsy, determine the upgrade rate to malignancy, and assess for any features that may be associated with an upgrade on surgical excision. MATERIALS AND METHODS Research ethical board approved the review of consecutive patients with MRI-detected LN between January 2009 and December 2018 with differentiation between pure LN and LN with associated other high-risk lesions. The final outcome was determined by final pathology results from surgical excision or 24 months of follow-up. Appropriate statistical tests were used. RESULTS Out of 1250 MRI-guided biopsies performed, 76 lesions (6%) fulfilled the inclusion criteria and formed the study cohort. Of the 76 lesions, 54 (71%) were pure LN while the rest had coexistent high-risk lesion. Non-mass enhancement (NME) was the most common lesion type (62, 82%). Fifty-nine lesions (78%) were surgically excised, the other 17 had benign follow-up. Overall, 8 lesions (11%) were upgraded to malignancy on final pathology. Malignant outcome was associated with larger lesion size (5.5 versus 1.9 cm, P < 0.001) and a clumped NME pattern (75% versus 24%, P = 0.006). Lesion size and clumped NME remained significantly associated with upgrade on sub-analysis of the pure LN group. CONCLUSION Larger lesion size and clumped NME are imaging findings associated with upgrade of LN diagnosed by MRI-guided biopsy. This may influence patient management in this clinical setting. Additional larger studies are needed to consolidate our results and to potentially detect additional factors associated with upgrade.

中文翻译：

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传统影像学隐匿性小叶瘤形成并通过 MRI 引导活检诊断：我们可以估计手术病理的升级吗？

目的 本研究的目的是评估在 MRI 引导活检中诊断出的小叶瘤形成 (LN) 的频率和影像学特征，确定恶性的升级率，并评估可能与手术切除升级相关的任何特征。材料和方法 研究伦理委员会批准了对 2009 年 1 月至 2018 年 12 月期间 MRI 检测到的 LN 的连续患者的审查，以区分纯 LN 和伴有其他高风险病变的 LN。最终结果由手术切除或 24 个月随访的最终病理结果决定。使用了适当的统计检验。结果 在进行的 1250 次 MRI 引导活检中，76 处病变 (6%) 符合纳入标准并形成研究队列。在 76 个病灶中，54 (71%) 例为纯 LN，其余为共存高危病变。非肿块增强 (NME) 是最常见的病变类型 (62, 82%)。59 个病灶 (78%) 被手术切除，另外 17 个有良性随访。总体而言，8 个病变 (11%) 在最终病理上升级为恶性肿瘤。恶性结果与较大的病灶大小（5.5 对 1.9 厘米，P < 0.001）和聚集的 NME 模式（75% 对 24%，P = 0.006）相关。病变大小和聚集的 NME 仍然与纯 LN 组的亚分析升级显着相关。结论 较大的病灶大小和聚集的 NME 是与 MRI 引导活检诊断的 LN 升级相关的影像学表现。这可能会影响这种临床环境中的患者管理。