Comparative Study of Dynamic Contrast-Enhanced Breast MRI, Ultrasound, and X-ray Mammography in Differential Diagnosis of Benign and Malignant Breast Lesions_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 YUANHong-mei ^1,2 ,  YUJian-qun ¹ , CHUZhi-gang ¹ , PENGLi-qing ¹

1. Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;
2. Department of Ultrasonography, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China;

Corresponding author：

YUJian-qun, Email: cjr.yujianqun@vip.163.com

Keywords：

Breast tumor; Magnetic resonance imaging; Ultrasound; X-ray; Differential diagnosis

DOI：

10.7507/1007-9424.20150066

Video：

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Objective To assess the values of MRI, ultrasound (US), and X-ray in the differential diagnosis of benign and malignant breast lesions. Methods The image data of 50 breast lesions confirmed with histopathology were analyzed retrospectively and the values of MRI, US and X-ray mammography in the differential diagnosis of benign and malignant breast lesions based on the breast imaging reporting and data system (BI-RADS) were assessed. The diagnostic efficiency of MRI, US, and X-ray in 50 benign and malignant breast lesions were compared using receiver operating characteristics (ROC) curves. The areas of ROC curves of MRI, US, and X-ray were calculated with Z test using SPSS 16.0. Results There were 44 patients with 50 breast lesions, 26 malignant lesions, 24 benign lesions. Based on the BI-RADS, according to X-ray imaging features, 26 malignant breast lesions were classified as 5 lesions of category 5, 7 lesions of category 4, 6 lesions of category 3, 3 lesions of category 2, 1 lesion of category 1, 4 lesions of category zero. Twenty-four benign breast lesions were classified as 1 lesion of category 4, 3 lesions of category 3, 4 lesions of category 2, 13 lesions of category 1, 3 lesions of category zero. According to the characteristics of US findings, 26 malignant breast lesions were classified as 17 lesions of category 5, 4 lesions of category 4, 1 lesion of category 3, 1 lesion of category 2, 3 lesions of category 1. Twenty-four benign breast lesions were classified as 1 lesion of category 5, 2 lesions of category 4, 4 lesions of category 3, 14 lesions of category 2, 2 lesions of category 1, 1 lesion of category 0. According to MRI imaging findings, 26 malignant breast lesions were classified as 6 lesions of category 5, 18 lesions of category 4, 1 lesion of category 3, 1 lesion of category 1. Twenty-four benign breast lesions were classified as 20 lesions of category 1, 3 lesions of category 2, 1 lesion of category 3. The area under the ROC curve of the MRI, US, and X-ray was 0.977, 0.835, and 0.764, respectively. The differences of MRI with US (Z=2.05, P < 0.05) and MRI with X-ray mammography (Z=2.81, P < 0.05) were statistically significant. While the difference of US with X-ray mammography (Z=0.73, P > 0.05) was't statistically significant. Conclusions Dynamic contrast-enhanced MRI is an accurate examination in the differential diagnosis of benign and malignant breast lesions. The differential diagnostic efficiency of MRI is significantly better than those with US and X-ray.

Citation： YUANHong-mei, YUJian-qun, CHUZhi-gang, PENGLi-qing. Comparative Study of Dynamic Contrast-Enhanced Breast MRI, Ultrasound, and X-ray Mammography in Differential Diagnosis of Benign and Malignant Breast Lesions. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(2): 246-250. doi: 10.7507/1007-9424.20150066 Copy

1.	American College of Radiology. Breast imaging reporting and data system (BI-RADS). 4th edition. Reston (VA) 7 American College of Radiology, 2003.
2.	顾雅佳, 肖勤.乳腺X线报告规范化——BI-RADS介绍.中国医学计算机成像杂志, 2007, 13(5): 322-326.
3.	Mendelson EB, Baum JK, Berg WA, et al. Breast imaging reporting and data system: ultrasound. Reston: American College of Radiology, 2003: 1-81.
4.	Heinig J, Witteler R, Schmitz R, et al. Accuracy of classification of breast ultrasound findings based on criteria used for BI-RADS. Ultrasound Obstet Gynecol, 2008, 32(4): 573-578.
5.	Erguvan-Dogan B, Gj W, Kushwaha AC, et al. BI-RADS-MRI: a primer. AJR Am J Roentgenol, 2006, 187(2): W152-W160.
6.	汤光宇, 肖湘生, 刘勇, 等. MR影像报告数据系统鉴别良恶性乳腺肿块的价值初探.临床放射学杂志, 2007, 26(12): 1306-1308.
7.	Kuhl CK, Mielcareck P, Klaschik S, et al. Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions. Radiology, 1999, 211(1): 101-110.
8.	邵志敏, 余科达.乳腺外科的发展趋势.中国普外基础与临床杂志, 2007, 14(3): 252-254.
9.	Macura KJ, Ouwerkerk R, Jacobs MA, et al. Patterns of enhancement on breast MR images: interpretation and imaging pitfalls. Radiographics, 2006, 26(6): 1719-1734.
10.	El Khouli RH, Macura KJ, Jacobs MA, et al. Dynamic contrast-enhanced MRI of the breast: quantitative method for kinetic curve type assessment. AJR Am J Roentgenol, 2009, 193(4): W295-W300.
11.	Stavros AT, Thickman D, Rapp CL, et al. Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology, 1995, 196(1): 123-134.
12.	Rotten D, Levaillant J, Contancis E, et al. Three-dimensional imaging of solid breast tumours with ultrasound:preliminary data. Ultrasound Obslet Gynecol, 2003, 1(6): 384-390.
13.	Leconte I, Feger C, Galant C, et al. Mammography and subsequent whole-breast sonography of nonpalpable breast cancers: the importance of radiologic breast density. AJR Am J Roentgenol, 2003, 180(6): 1675-1679.
14.	Hollingsworth AB, Taylor LD, Rhodes DC. Establishing a histologic basis for false-negative mammograms. Am J Surg, 1993, 166(6): 643-648.
15.	张立娜, 黎庶, 郑新宇, 等.乳腺X线及超声影像诊断乳腺癌的优势及不足.中国医科大学学报, 2010, 39(6): 485-486.
16.	赵立志.超声在乳腺肿块鉴别诊断中的应用.现代中西医结合杂志, 2009, 18(7): 803, 838.
17.	Raza S, Goldkamp AL, Chikarmane SA, et al. US of breast masses categorized as BI-RADS 3, 4, and 5: pictorial review of factors influ-encing clinical management. Radiographics, 2010, 30(5): 1199-1213.
18.	马步云, 彭玉兰, 罗燕, 等.超声诊断乳腺癌的漏诊和误诊分析.华西医学, 2007, 22(1): 16-17.
19.	Stanzani D, Chala LF, Barros N, et al. Can doppler or contrast-enh-anced ultrasound analysis add diagnostically important information about the nature of breast lesions. Clinics (Sao Paulo), 2014, 69(2): 87-92.
20.	袁红梅, 刘健, 高砚春, 等.超声引导下Mammotome微创旋切术在乳腺良性病变中的应用.川北医学院学报, 2011, 26(6): 493-496.
21.	张丽芝, 曾涵江, 黄子星, 等.乳腺浸润性导管癌的MRI诊断价值.中国普外基础与临床杂志, 2012, 19(9): 1008-1011.
22.	Yang Q, Li LH, Zhang J, et al. Computer-aided diagnosis of breast DCE-MRI images using bilateral asymmetry of contrast enhancement between two breasts. J Digit Imaging, 2014, 27(1): 152-160.
23.	Schnall MD, Rosten S, Englander S, et al. A combined architectural and kinetic interpretation model for breast MR images. Acad Radiol, 2001, 8(7): 591-597.
24.	黄娟, 余建群.乳腺肿块型浸润性导管癌MRI动态增强扫描征象与WHO病理分级的关系.中国普外基础与临床杂志, 2014, 21(5): 636-640.
25.	Biglia N, Bounous VE, Martincich L, et al. Role of MRI (magnetic resonance imaging) versus conventional imaging for breast cancer presurgical staging in young women or with dense breast. Eur J Surg Oncol, 2011, 37(3): 199-204.

1. American College of Radiology. Breast imaging reporting and data system (BI-RADS). 4th edition. Reston (VA) 7 American College of Radiology, 2003.
2. 顾雅佳, 肖勤.乳腺X线报告规范化——BI-RADS介绍.中国医学计算机成像杂志, 2007, 13(5): 322-326.
3. Mendelson EB, Baum JK, Berg WA, et al. Breast imaging reporting and data system: ultrasound. Reston: American College of Radiology, 2003: 1-81.
4. Heinig J, Witteler R, Schmitz R, et al. Accuracy of classification of breast ultrasound findings based on criteria used for BI-RADS. Ultrasound Obstet Gynecol, 2008, 32(4): 573-578.
5. Erguvan-Dogan B, Gj W, Kushwaha AC, et al. BI-RADS-MRI: a primer. AJR Am J Roentgenol, 2006, 187(2): W152-W160.
6. 汤光宇, 肖湘生, 刘勇, 等. MR影像报告数据系统鉴别良恶性乳腺肿块的价值初探.临床放射学杂志, 2007, 26(12): 1306-1308.
7. Kuhl CK, Mielcareck P, Klaschik S, et al. Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions. Radiology, 1999, 211(1): 101-110.
8. 邵志敏, 余科达.乳腺外科的发展趋势.中国普外基础与临床杂志, 2007, 14(3): 252-254.
9. Macura KJ, Ouwerkerk R, Jacobs MA, et al. Patterns of enhancement on breast MR images: interpretation and imaging pitfalls. Radiographics, 2006, 26(6): 1719-1734.
10. El Khouli RH, Macura KJ, Jacobs MA, et al. Dynamic contrast-enhanced MRI of the breast: quantitative method for kinetic curve type assessment. AJR Am J Roentgenol, 2009, 193(4): W295-W300.
11. Stavros AT, Thickman D, Rapp CL, et al. Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology, 1995, 196(1): 123-134.
12. Rotten D, Levaillant J, Contancis E, et al. Three-dimensional imaging of solid breast tumours with ultrasound:preliminary data. Ultrasound Obslet Gynecol, 2003, 1(6): 384-390.
13. Leconte I, Feger C, Galant C, et al. Mammography and subsequent whole-breast sonography of nonpalpable breast cancers: the importance of radiologic breast density. AJR Am J Roentgenol, 2003, 180(6): 1675-1679.
14. Hollingsworth AB, Taylor LD, Rhodes DC. Establishing a histologic basis for false-negative mammograms. Am J Surg, 1993, 166(6): 643-648.
15. 张立娜, 黎庶, 郑新宇, 等.乳腺X线及超声影像诊断乳腺癌的优势及不足.中国医科大学学报, 2010, 39(6): 485-486.
16. 赵立志.超声在乳腺肿块鉴别诊断中的应用.现代中西医结合杂志, 2009, 18(7): 803, 838.
17. Raza S, Goldkamp AL, Chikarmane SA, et al. US of breast masses categorized as BI-RADS 3, 4, and 5: pictorial review of factors influ-encing clinical management. Radiographics, 2010, 30(5): 1199-1213.
18. 马步云, 彭玉兰, 罗燕, 等.超声诊断乳腺癌的漏诊和误诊分析.华西医学, 2007, 22(1): 16-17.
19. Stanzani D, Chala LF, Barros N, et al. Can doppler or contrast-enh-anced ultrasound analysis add diagnostically important information about the nature of breast lesions. Clinics (Sao Paulo), 2014, 69(2): 87-92.
20. 袁红梅, 刘健, 高砚春, 等.超声引导下Mammotome微创旋切术在乳腺良性病变中的应用.川北医学院学报, 2011, 26(6): 493-496.
21. 张丽芝, 曾涵江, 黄子星, 等.乳腺浸润性导管癌的MRI诊断价值.中国普外基础与临床杂志, 2012, 19(9): 1008-1011.
22. Yang Q, Li LH, Zhang J, et al. Computer-aided diagnosis of breast DCE-MRI images using bilateral asymmetry of contrast enhancement between two breasts. J Digit Imaging, 2014, 27(1): 152-160.
23. Schnall MD, Rosten S, Englander S, et al. A combined architectural and kinetic interpretation model for breast MR images. Acad Radiol, 2001, 8(7): 591-597.
24. 黄娟, 余建群.乳腺肿块型浸润性导管癌MRI动态增强扫描征象与WHO病理分级的关系.中国普外基础与临床杂志, 2014, 21(5): 636-640.
25. Biglia N, Bounous VE, Martincich L, et al. Role of MRI (magnetic resonance imaging) versus conventional imaging for breast cancer presurgical staging in young women or with dense breast. Eur J Surg Oncol, 2011, 37(3): 199-204.

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Comparative Study of Dynamic Contrast-Enhanced Breast MRI, Ultrasound, and X-ray Mammography in Differential Diagnosis of Benign and Malignant Breast Lesions

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