MRI在BI-RADS4类乳腺疾病中的应用价值

目的探讨MR成像在乳腺x线摄影BI-RADS 4类乳腺病变中的应用价值。方法 107例乳腺x线摄影评估为BI-RADS 4类的乳腺疾病入选本研究,分为MRI和活检两组,与病理或临床随访结果相比较,并以Fisher精确检验比较两组管理方案间的差异。结果 48例MRI组中,31例乳腺病变BI-RADS评级维持4类或评级上升(≥4类),手术病理示乳腺癌29例,良性2例;17例病变评级下降(≤3类),其中3例选择手术治疗,病理结果为乳腺纤维腺瘤1例和乳腺腺病伴钙盐沉积2例,余14例随访1年以上病灶未见明显变化,MRI准确率为95.83%。59例活检组中,真阳性18例,假阴性7例,真阴性34例,准确性为88.14%,MRI组和活检组两者对乳腺癌诊断差异无统计学意义(x~2=2.036;P=0.154)。结论乳腺MR成像对X线摄影评估为BI-RADS 4类的病变具有细分和参考价值,可提高早期乳腺癌的检出率,减少不必要的手术及活检,并对良性病变提供更多的影像学支持。

Value of MRI in breast lesions of BI-RADS 4 category

Objective To investigate the added value of MRI in evaluating breast lesions of BI-RADS category 4.Methods 107 patients with BI-RADS category 4 assessment on mammography were randomly divided to undergo breast MRI（48）or biopsy（59）. The pathology or clinical follow-up between these women were compared using the Fisher exact probability test.Results The BI-RADS category was≥4 in 31/48 lesions on MRI with 29 pathologically confirmed malignancy and 2 benign.In the 17/48 lesions with BIRADS category≤3 on MRI,3 were removed surgically with pathological diagnosis of fibroadenoma in 1 and adenosis in 2.The remaining 14 lesions were stable in the 1-year follow up.The accuracy of MRI was 95.83%.Of 59 lesions that were biopsied,18 were malignant,7 were false negative and 34 were true negative.The MRI accuracy of 95.83%was not significantly（χ2=2.036;P=0.154） higher than that of biopsy alone（88.14%）.Conclusion Breast MRI can increase the detection rate of early breast cancer and reduce unnecessary biopsy and surgery.It can also increase the diagnostic confidence of benign lesions.