探究数字乳腺体层合成(digital breast tomosynthesis,DBT)假阴性乳腺癌临床、影像学和病理学特征,以避免漏诊。
方法:
回顾并收集2018年7月2020年10月于上海交通大学医学院附属新华医院经病理学检查证实为乳腺癌、术前行诊断性DBT检查且判定为乳腺影像报告和数据系统(Breast Imaging Reporting and Data System,BI-RADS)1、2或3类的患者的资料,由2名经验丰富的乳腺影像专科医师进行回顾性阅片,分析其临床、影像学和病理学特征。
结果:
378例患者中31例患者共32个病灶DBT诊断为假阴性(8.2%),中位大小0.8(1.0)cm、不超过1 cm的病灶22个占68.8%。其中2个病灶未摄入,6个病灶分类错误,24个病灶在DBT不可见;术前超声阳性率56.25%(18/32),术前磁共振成像(magnetic resonance imaging,MRI)阳性率100.00%(32/32)。病理学类型包括乳腺导管原位癌(ductal carcinoma in situ of the breast,DCIS)14个(43.75%),乳头状癌8个(25.00%)和浸润癌10个(31.25%)。
and pathological features of breast cancer with false negative digital breast tomosynthesis (DBT) and to avoid missed cancer.
Methods:
The database was retrospectively reviewed to collect pathologically confirmed breast cancer from July 2018 to October 2020 in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine
which underwent preopera
tive diagnostic DBT with a Breast Imaging Reporting and Data System (BI-RADS) 1
2
or 3 diagnoses. Two experienced breast imaging specialists reviewed DBT images of these cases. Clinical
imaging and pathological features were collected.
Results:
A total of 31 cases with 32 cancer lesions of 378 cases were included in this study. Median size of these lesions was 0.8(1.0) cm
22 lesions no larger than 1 cm accounting for 68.8%. 2 lesions were not covered in the field of view
6 lesions were incorrectly classified
and 24 lesions were not visible on DBT images. The positive rate of preoperative ultrasound and magnetic resonance imaging (MRI) was 56.25% (18/32) and 100.00% (32/32)
respectively. Pathological types of these lesions include ductal carcinoma in situ of the breast (DCIS) 14 lesions (43.75%)
papillary carcinoma 8 lesions (25.00%)
and invasive carcinoma 10 lesions (31.25%).
Conclusion:
DBT false-negative breast cancer is not uncommon. Most of these lesions are small
and occurred in relatively dense breasts
which can be DCIS or invasive cancer. Supplemental ultrasonography and MRI may help reduce missed diagnosis in DBT false-negative cases.