动态增强MRI定性诊断乳腺导管上皮非典型增生

目的 观察动态增强MRI（DCE-MRI）定性诊断乳腺导管上皮非典型增生（ADH）的价值。方法 回顾性分析经穿刺活检或局部切除组织活检诊断的64例乳腺单发ADH患者，以手术病理结果为金标准，比较恶性与良性病变患者临床资料及乳腺X线、DCE-MRI征象，分析DCE-MRI预测乳腺恶性ADH的效能。结果 64例乳腺单发ADH中，28例为恶性（恶性组），36例非恶性（非恶性组），组间活检方式、病灶最大径、MRI示乳腺实质背景强化（BPE）、乳腺X线表现差异均有统计学意义（P均<0.1）；将上述因素纳入Logistic多因素回归分析，结果显示仅BPE为乳腺恶性ADH的独立影响因素[OR=7.550，95%CI（1.575，36.197），P=0.011]。DCE-MRI诊断BI-RADS 4A及以下者27例，其中3例为恶性；4A类以上（4B及4C）37例，25例为恶性，诊断敏感度89.29%（25/28），特异度66.67%（24/36），阳性预测值67.57%（25/37），阴性预测值88.89%（24/27）。结论 DCE-MRI可用于定性诊断乳腺ADH；其所示中重度BPE为术后病理恶性的正相关因素。

Dynamic contrast-enhanced MRI for qualitative diagnosis of breast ductal epithelial atypical hyperplasia

Objective To explore the value of dynamic contrast-enhanced MRI (DCE-MRI) for qualitative diagnosis of breast ductal epithelial atypical hyperplasia (ADH). Methods Data of 64 patients of breast single ADH initially diagnosed with puncture biopsy or local excision were retrospectively analyzed. Taken final pathological results after surgical excision as gold standards, the clinical data, breast X-ray and DCE-MRI findings were compared between the patients with malignant (malignant group) and non-malignant lesions (non-malignant group). The efficacy of DCE-MRI for predicting malignant breast ADH was analyzed. Results Among 64 ADH patients, malignant lesions were diagnosed in 28 (malignant group), while 36 lesions were not malignant (non-malignant group). Significant differences of biopsy mode, the maximum diameter of lesions, breast parenchymal background enhancement (BPE) and breast X-ray signs were detected between malignant group and non-malignant group (all P<0.1). Logistic multivariate regression analysis showed that only breast BPE was an independent factor for prediction postoperative pathologic malignant of ADH (OR=7.550,95%CI[1.575,36.197], P=0.011). DCE-MRI diagnosed 27 lesions as BI-RADS 4A or below, among which 3 were malignant; 37 BI-RADS 4A or above (4B and 4C), including 25 final malignant ones. The sensitivity, specificity, positive predictive value and negative predictive value of DCE-MRI for predicting final malignant breast ADH was 89.29%(25/28), 66.67%(24/36), 67.57%(25/37) and 88.89%(24/27), respectively. Conclusion DCE-MRI could be used to qualitatively diagnose breast ADH. Moderate to severe BPE shown with DCE-MRI could be considered as a risk factor for postoperative pathological malignancy of ADH.