Meme patolojilerinin değerlendirilmesinde görüntüleme yöntemlerinin karşılaştırılması

Year 2011, Volume: 17 Issue: 3, 114 - 120, 01.04.2011

Eda Parlak Mustafa Yıldırım Ayhan Özkur Çağatay Andıç Metin Bayram

Abstract

Evaluating the performance of magnetic resonance imaging (MRI) and comparison with mammography, ultrasound (US) and histopathology results in cases of women with suspicious breast lesions. Forty nine cases on which histopathology was performed included in the study. All cases were applied mammography and US, and then MRI. Biopsy or post-operational results have been generated. Among the 49 cases, 27 (55%) benign and 22 (45%) were malign lesions. Using mammography, of the 49 cases, 24 (49%) were deemed to be malign. True positive cases were 20 (41%). In ultrasound, 25 (51%) were malign, 24 (49%) were benign. True positive cases were 21 (43%). Lesions were detected in all of the 49 cases using MRI. All of the 22 (45%) malign cases were diagnosed as malign lesion. Sensitivities of mammography, US and MRI in detecting lesions were 83%, 95% and 100%, and specificities were 85%, 85% and 92% respectively. In MRI, all cases were applied dynamic contrast sequences, for the cases with lesions detected, time signal intensity (SI) curves were drawn. 23 cases were detected as Type 1 (47%), 2 cases were Type 2 (4%), 24 cases were Type 3 (49%) SI curve. According to SI curves sensitivity in detecting malignities was 95% and specificity was 81%. MRI has been found superior to mammography and US in detecting masses especially with its characteristics of higher spatial resolution, less binding of dynamic properties evaluation on user. There may be a decrease of unnecessary interventional operations in benignmalign detection of breast lesions using dynamic breast MRI.

Keywords

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A comparison of imaging methods in the evaluation of breast pathologies

Abstract

Şüpheli meme lezyonu olan olgular mamografi, ultrasonografi (US) ve manyetik rezonans görüntüleme (MRG) yöntemi ile değerlendirilerek, histopatolojik sonuçları ile karşılaştırılmıştır. Histopatolojik incelemesi yapılan yapılan 49 olgu çalışmaya alındı. Tüm olgulara öncelikle mamografi ve US, daha sonra MRG uygulandı. Biyopsi veya ameliyat sonrası histopatolojik sonuçlar elde edildi. Patolojik sonuçlara göre 49 olgunun 27 (%55) tanesi benign, 22 (%45) tanesi malign lezyondu. Mammografi ile 49 olgunun 42 (%85) tanesi saptanabildi. Mamografi ile 49 olgunun 24 (%49) tanesi malign olarak değerlendirildi, bunlar arasında gerçek pozitiflerin sayısı 20 (%41) idi. Ultrasonografi ile 49 olgudaki lezyonların tamamı saptandı. 25 (%51) olgu malign, 24 (%49) olgu benign olarak değerlendirildi. Gerçek pozitif olgu sayısı 21 (%43) idi. MRG ile 49 olgunun tamamında lezyon saptandı. 22 (%45) malign olgunun tamamına malign lezyon tanısı konuldu. Memenin kitlesel lezyonlarını saptamada mamografi, US ve MRG'nin sırasıyla sensitivitesi %83, %95 ve %100, spesifitesi ise %85, %85 ve %92 olarak bulundu. MRG'de tüm olgulara dinamik kontrastlı sekanslar uygulandı, kontrastlanma şekilleri ve hızları değerlendirildi, lezyon saptanan olgulara zaman sinyal intensite (SI) eğrileri çizdirildi. 23 olguda Tip 1 (%47), 2 olguda Tip 2 (%4), 24 olguda ise Tip 3 (%49) SI eğrisi olarak saptandı. Tip 1 eğrinin benign, Tip 2 ve 3 eğrinin olası maligniteleri gösterdiği kabul edildi. Bu verilere göre zaman/sinyal intensite eğrilerinin maligniteleri saptamada sensitivitesi %95, spesifisitesi %81 olarak saptandı. MRG özellikle uzaysal çözünürlüğün daha yüksek olması, dinamik özelliklerin değerlendirilmesinin kullanıcıya daha az bağımlı olması, özellikleri ile kitleleri saptamada mamografi ve US'ye oranla daha üstün olarak bulunmuştur. Meme MRG ile dinamik inceleme kullanılarak meme lezyonlarının benign-malign ayrımında gereksiz girişimsel işlemlerin sayısında azalma sağlayabileceğini düşünmekteyiz.

Keywords

Meme, manyetik rezonans görüntüleme, mamografi, ultrasonografi

References

• 1. Howard M, Agarwal G, Lytwyn A. Accuracy of self-reports of Pap and mammography screening compared to medical record: a meta-analysis. Cancer Causes Control 2009;20(1):1-13
• 2. McCavert M, O'Donnell ME, Aroori S, Badger SA, Sharif MA, Crothers JG, Spence RA. Ultrasound is a useful adjunct to mammography in the assessment of breast tumours in all patients. Int J Clin Pract 2009;63(11):1589-94
• 3. Seigneurin A, Exbrayat C, Labarère J, Delafosse P, Poncet F, Colonna M. Association of diagnostic work-up with subsequent attendance in a breast cancer screening program for falsepositive cases. Breast Cancer Res Treat 2010;127(1):221-8
• 4. Rankin SC. MRI of the breast. Br J Radiol 2000;73(872):806- 18
• 5. Buadu LD, Murakami J, Murayama S, Hashiguchi N, Sakai S, Masuda K, et al. Breast lesions: correlation of contrast medium enhancement patterns on MR images with histopathologic findings and tumor angiogenesis. Radiology 1996;200(3):639- 49
• 6. Rim A, Chellman-Jeffers M. Trends in breast cancer screening and diagnosis. Cleve Clin J Med 2008;75 Suppl 1:S2-9
• 7. Sala E, Warren R, McCann J, Duffy S, Luben R, Day N
• Mammographic parenchymal patterns and breast cancer natural history--a case-control study. Acta Oncol 2001;40(4):461-5
• 8. Kolb TM, Lichy J, Newhouse JH. Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations. Radiology 2002;225(1):165-75
• 9. Berg WA, Gutierrez L, NessAiver MS, Carter WB, Bhargavan M, Lewis RS, et al. Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology 2004;233(3):830-49
• 10. Taboada JL, Stephens TW, Krishnamurthy S, Brandt KR, Whitman GJ. The many faces of fat necrosis in the breast. AJR Am J Roentgenol 2009;192(3):815-25
• 11. Vassiou K, Kanavou T, Vlychou M, Poultsidi A, Athanasiou E, Arvanitis DL, Fezoulidis IV. Characterization of breast lesions with CE-MR multimodal morphological and kinetic analysis: comparison with conventional mammography and highresolution ultrasound. Eur J Radiol 2009;70(1):69-76
• 12. Houssami N, Ciatto S, Irwig L, Simpson JM, Macaskill P. The comparative sensitivity of mammography and ultrasound in women with breast symptoms: an age-specific analysis. Breast 2002;11(2):125-30
• 13. Orel SG, Schnall MD. MR imaging of the breast for the detection, diagnosis, and staging of breast cancer. Radiology 2001;220(1):13-30
• 14. Kacl GM, Liu P, Debatin JF, Garzoli E, Caduff RF, Krestin GP
• Detection of breast cancer with conventional mammography and contrast-enhanced MR imaging. Eur Radiol 1998;8(2):194- 200
• 15. Malur S, Wurdinger S, Moritz A, Michels W, Schneider A
• Comparison of written reports of mammography, sonography and magnetic resonance mammography for preoperative evaluation of breast lesions, with special emphasis on magnetic resonance mammography. Breast Cancer Res 2001;3(1):55-60
• 16. Dietzel M, Baltzer PA, Vag T, Gröschel T, Gajda M, Camara O, et al. Magnetic resonance mammography of invasive lobular versus ductal carcinoma: systematic comparison of 811 patients reveals high diagnostic accuracy irrespective of typing. J Comput Assist Tomogr 2010;34(4):587-95
• 17. Yeh ED, Slanetz PJ, Edmister WB, Talele A, Monticciolo D, Kopans DB. Invasive lobular carcinoma: spectrum of enhancement and morphology on magnetic resonance imaging
• Breast J 2003;9(1):13-8
• 18. Kuhl CK, Mielcareck P, Klaschik S, Leutner C, Wardelmann E, Gieseke J, et al. Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions? Radiology 1999;211(1):101-10
• 19. Schrading S, Kuhl CK. Mammographic, US, and MR imaging phenotypes of familial breast cancer. Radiology 2008;246(1):58-70
• 20. Tuncbilek N, Unlu E, Karakas HM, Cakir B, Ozyilmaz F
• Evaluation of tumor angiogenesis with contrast-enhanced dynamic magnetic resonance mammography. Breast J 2003;9(5):403-8.