Role of contrast-enhanced breast magnetic resonance angiography in characterizing suspicious breast lesions and evaluating the relationship between prognostic factors

Öz

Aim: Breast cancer is the most commonly diagnosed cancer in women, and mammography and ultrasonography are the most frequently used diagnostic radiological methods. Although they are highly sensitive, their specificity is low. Angiography can be added as a standard breast magnetic resonance imaging (MRI) protocol to increase specificity. In this study, we aimed to investigate the effectiveness of breast vascularity by evaluating the presence of an adjacent vessel sign (AVS) and increased ipsilateral breast vascularity (IIBV) in characterizing breast masses. 

Methods: 135 patients with a mean age of 47 years with radiologically or clinically suspicious breast masses underwent breast MRI before biopsy. The contrast-enhanced three-dimensional MR angiograms of the breasts were investigated for the presence of AVS and IIBV to characterize suspicious breast masses, and their correlation with histopathological prognostic factors were evaluated. 

Results: Patients’ age, tumor size, and the presence of AVS and IIBV were significantly higher in malignant masses than in benign masses (P<0.001). The sensitivity, specificity, and accuracy of AVS and IIBV in predicting malignant masses from benign ones were 75%, 79.3%, 77% and 56.9%, 90.4% and 72.5%, respectively. In malignant masses, AVS and IIBV were both significantly associated with ER (P=0.005, P<0.001) and PR expression (P=0.003, P<0.001). We found no relationship between AVS, IIBV and C-ERBB2 expression (P=0.245 and P=0.085, respectively).

Conclusion: The presence of AVS and IIBV as determined from contrast-enhanced 3D MR angiograms may be reliable parameters for further characterizing suspicious breast masses, both of which seem to be related with ER and PR expression.

Anahtar Kelimeler

• Angiography,Breast,Magnetic resonance imaging

Şüpheli meme lezyonlarını karakterize etmede ve prognostik faktörler arasındaki ilişkiyi değerlendirmede kontrastlı meme manyetik rezonans anjiyografisinin rolü

Öz

Amaç: Meme kanseri, kadınlarda en sık tanı alan kanser olup, mamografi ve ultrasonografi en sık kullanılan radyolojik yöntemlerdir. Bu yöntemlerin duyarlılığı yüksek olmasına rağmen, özgüllükleri düşüktür. Anjiyografi, özgüllüğü artırmak için standart bir meme manyetik rezonans görüntüleme (MRG) protokolü olarak eklenebilir. Bu çalışmada amacımız, komşu damar işareti (KDİ) ve artmış ipsilateral meme vaskülaritesi (AİMV) içeren meme damarlanmasının, meme kitlelerini karakterize etmedeki etkinliğini araştırmak ve histopatolojik prognostik faktörlerle korelasyonunu ortaya koymaktır. 

Yöntemler: Mart 2017 - Ocak 2019 tarihleri arasında radyolojik veya klinik olarak şüpheli meme kitleleri olan 135 hastaya (yaş aralığı: 19-79 yıl, ort. Yaş: 47 yıl) biyopsi öncesi meme MRG yapıldı. Kontrastlı 3D meme MR anjiyografileri, KDİ ve AİMV varlığı açısından şüpheli meme kitlelerini karakterize etmek için incelendi. Bu bulgular histopatolojik prognostik faktörler ile korele edildi.

Bulgular: Hastaların yaşı, tümör boyutu, KDİ ve AİMV bulunsı malign kitlelerde benign kitlelere göre anlamlı derecede yüksekti (P<0,001). KDİ %75 duyarlılık, %79,3 özgüllük ve %77 doğrulukla, AİMV varlığı ise %56,9 duyarlılık, %90,4 özgüllük ve %72,5 doğrulukla benign kitleleri malign olanlardan ayırt etmiştir. Malign kitlelerde KDİ ve AİMV, ER (sırasıyla P=0,005, P<0,001) ve PR ekspresyonuyla (sırasıyla P<0,001, P=0,003) ilişkiliydi. Ancak çalışmamızda, KDİ, AİMV ile C-ERBB2 ekspresyonu arasında ilişki saptanmadı (P=0,245 ve P=0,085, sırasıyla).

Sonuç: Kontrastlı 3D MR anjiyogramlarından elde edilen KDİ ve AİMV varlığı, şüpheli meme kitlelerinin karakterize edilmesi için güvenilir bir yöntemdir ve ER ve PR ekspresyonu ile ilişkili görünmektedir.

Anahtar Kelimeler

• Anjiyografi,Meme,Manyetik rezonans görüntüleme

Kaynakça

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