Hande USLU, Mesude TOSUN, Arzu Serpil ARSLAN

Meme MRG’de Kitlesel Olmayan Kontrastlanma: Benign-Malign Patolojik Tanı ve Meme Kanserinde Moleküler Alt Grupların Dağılım ve Kontrastlanma Paternleri ile Karşılaştırılması

Amaç: Çalışmamızın amacı, benign ve malign tip kitlesel olmayan kontrastlanma (KOK) ile malign grupta farklı Ki-67 değerleri ve moleküler alt gruplar (Luminal A, Luminal B, Bazal-benzeri ve HER2 (+)) arasında lezyonların dağılımı (fokal, lineer, segmental, rejyonel, multiple alanlar, diffüz) ve internal kontrastlanma paternleri (İKP) (homojen, heterojen, kümeli, kümelenmiş halka) açısından farklılık olup olmadığını değerlendirmektir. Yöntemler: Ocak 2015-Mayıs 2018 tarihleri arasında rutin meme MRG uygulanan toplam 923 kadın retrospektif olarak incelendi. Çalışmaya 88 MR görüntüsü dahil edildi. Histopatolojik sonuçlarda 46 benign ve 35 malign lezyon vardı. Benign ve malign KOK tipleri arasındaki dağılım ve İKP'leri karşılaştırdık. Malign grupta farklı moleküler alt gruplar ve Ki-67 değerleri dağılım ve İKP’leri ile karşılaştırıldı. Bulgular: Kümelenmiş halka internal kontrastlanma paterni malignite ile anlamlı olarak ilişkiliyken, fokal dağılım ve homojen internal kontrastlanma paterni benignite ile ilişkiliydi. Binominal lojistik regresyon modeli, benign-malign durumdaki varyansın % 52.4'ünü açıklamış ve olguların % 77.3'ünü doğru sınıflandırmıştır. Model duyarlılığı %74.3, özgüllük %79.2, pozitif prediktif değer %70.2 ve negatif prediktif değer %82.3 idi. Farklı Ki-67 değerlerine sahip malign KOK’ların moleküler alt grupları arasında lezyonların dağılımı veya İKP’lerinde istatistiksel olarak anlamlı fark yoktu. Sonuç: 3 Tesla (T) MRG’de fokal dağılım ve homojen internal kontrastlanma paterninin benign KOK’ların anlamlı bir belirleyicisi olduğu bulundu. Kümelenmiş halka internal kontrastlanma paterni, KOK’larda malignite olasılığını tahmin edebilir.

Anahtar Kelimeler:

Meme MRG, kitlesel olmayan kontrastlanma, dağılım, internal kontrastlanma paterni, moleküler alt grup, Ki-67

Non-Mass Enhancement of Breast MRI: The Comparison of Benign and Malignant Pathological Diagnosis and Association of Internal Enhancement Pattern and Distribution with Breast Cancer Molecular Sub-Types

Objective: The aim of our study is to investigate the distribution of lesions (focal, linear, segmental, regional, multiple regions, diffuse) and internal enhancement patterns (IEP) (homogeneous, heterogeneous, clumped, clustered ring) between benign and malignant type of NME and to evaluate the difference between Ki-67 and molecular subtypes (Luminal A, Luminal B, Basal-like, and HER2(+)) in malignant group. Methods: A total of 923 women who underwent routine breast MRI between January 2015 and May 2018 were retrospectively reviewed. 88 MR images were included in the study. Histopathological results were 46 benign and 35 malignant lesions. We compared the distribution and IEPs between benign and malignant type of NME. In the malignant group, distribution and IEPs of different molecular subtypes and Ki-67 values were compared. Results: Clustered ring internal enhancement were significantly associated with malignancy, while focal distribution and homogeneous enhancement pattern were associated with benignancy. A binomial logistic regression model explained 52.4% of the variance in benign-malignant status and correctly classified 77.3% of cases. Model sensitivity was 74.3%, specificity was 79.2%, positive predictive value was 70.2% and negative predictive value was 82.3%. There were not statistically significant differences in either distribution type of lesions or IEPs between molecular subtypes of malignant NME with different Ki-67 values. Conclusion: 3-T MRI findings of focal distribution and homogeneous enhancement pattern were found to be a significant predictor of benign NME. Clustered ring enhancement can predict the probability of malignancy for non-mass like enhancement lesions.

Keywords:

Breast MRI, non-mass enhancement, clustered-ring enhancement, molecular sub-type, Ki-67,

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