Şehnaz TEZCAN, Ülkü BEKAR, Funda ULU ÖZTÜRK

Meme kanseri tahmininde kısaltılmış meme MRG ve diffüzyon ağırlıklı MRG'nin beraber kullanımının tanısal değeri

Amaç: Bu çalışmanın amacı meme kanserini benign meme hastalıklarından ayırma da kullanılan kısaltılmış protocol (AP) manyetik rezonanas görünütleme (MRG), AP ile difüzyon ağırlıklı görüntülemenin (DWI) kombine kullanımı ve tam dinamik protokolün (FDP) tanısal performansını karşılaştırmaktır. Gereç ve Yöntem: Toplam çalışma populasyonu Ocak 2016 ile Aralık 2021 tarihleri arasında mamografi veya ultrasonografide şüpheli bulguların değerlendirilmesi amacıyla meme MRG (1,5 Tesla) çekilen 68 hastadan oluşmaktadır. Tüm lezyonlar 2 radyolog tarafından AP, AP+DWI ve FDP ile değerlendirildi. Okuyucu duyarlılığı, özgüllüğü ve doğruluğu “Ki kare” testi ile analiz edildi. Her iki okuyucunun Meme Görüntüleme Raporlama ve Veri Sistemi (BI-RADS)’ne göre oluşturduğu kategoriler arasındaki gözlemciler arası uyum (IOA), “Kappa istatistiği” kullanılarak değerlendirildi. Bulgular: 72 lezyonu olan 68 hasta (31 maligniteli ve 41 benign patolojili) analiz edildi. Okuyucu 1 için AP ve AP+DWI için duyarlılık/özgüllük oranları sırasıyla %67.7/%90.2 ve %80.6/%87.8 iken okuyucu 2 için bu oranlar sırasıyla %67.7/%92.6 ve %70.9/%90.2’idi. FDP için duyarlılık/özgüllük oranları, okuyucu 1 için %83.7/%85.3 iken okuyucu 2 için %80.6/90.2’idi. BI-RADS kategori değerlendirmesindeki IOA, iki okuyucu arasında tüm modellerde neredeyse mükemmel uyum kategorisindeydi (kappa değeri AP, AP+DWI ve FDP'de sırasıyla 0.907, 0.825 ve 0.858’idi). Sonuç: FDP, tümör biyolojisinin karakterizasyonunda AP ve AP+DWI'den daha iyi tanısal etkinlik göstermektedir. AP'ye DWI’nin eklenmesi, malignitenin öngörülmesinde MRG'nin tanısal performansını arttırmaktadır.

Anahtar Kelimeler:

diffüzyon ağırlıklı görüntüleme, kısaltılmış meme MRG, meme kanseri

Diagnostic value of combined use of abbreviated breast MRI and diffusion-weighted MRI in the prediction of breast cancer

Purpose: The aim of this study was to compare the diagnostic performances of abbreviated protocol (AP) magnetic resonance imaging (MRI), AP combined with diffusion-weighted imaging (DWI), and full dynamic protocol (FDP) in the differentiation of breast cancers from benign breast diseases. Materials and Methods: The total study population consisted of 68 patients who underwent breast MRI (1.5 Tesla) between January 2016 and December 2021 for the evaluation of suspicious findings on mammography or ultrasonography. All lesions were evaluated by 2 radiologists using AP, AP+DWI, and FDP. The reader sensitivity, specificity, and accuracy were analyzed using the “Chi-squared” test. The inter-observer agreement (IOA) between the Breast Imaging Reporting and Data System (BI-RADS) category assessments of the two readers was evaluated by using the “Kappa statistics”. Results: Sixty-eight patients with 72 lesions (31 malignant and 41 benign) were analyzed. The sensitivity/specificity for AP and AP+DWI for reader 1 was 67.7/90.2% and 80.6/87.8%, respectively, and for reader 2 was 67.7/92.6% and 70.9/90.2%, respectively. The sensitivity/specificity for FDP for reader 1 was 83.7/85.3% and for reader 2 was 80.6/90.2%. The IOA in the BI-RADS category assessment was almost perfect in all models between two readers (the kappa value was 0.907, 0.825, and 0.858 in AP, AP+DWI, and FDP, respectively). Conclusion: FDP showed greater diagnostic efficiency in the characterization of tumor biology as compared to AP and AP +DWI. Combining AP with DWI improved the diagnostic performance of MRI for the determination of malignancy.

Keywords:

Diffusion-Weighted Imaging, Abbreviated Protocol, Breast Cancer,

PDF

___

References: 1. Kuhl CK, Schrading S, Strobel K, Schild HH, Hilgers RD, Bieling HB. Abbreviated breast magnetic resonance imaging (MRI): first postcontrast subtracted images and maximum-intensity projection-a novel approach to breast cancer screening with MRI. J Clin Oncol. 2014 Aug 1;32(22):2304-10.
2. Oldrini G, Derraz I, Salleron J, Marchal F, Henrot P. Impact of an abbreviated protocol for breast MRI in diagnostic accuracy. Diagn Interv Radiol. 2018 Jan-Feb;24(1):12-16.
3. Baxter GC, Selamoglu A, Mackay JW, Bond S, Gray E, Gilbert FJ. A meta-analysis comparing the diagnostic performance of abbreviated MRI and a full diagnostic protocol in breast cancer. Clin Radiol. 2021 Feb;76(2):154.e23-154.e32.
4. Park KW, Han SB, Han BK, Ko ES, Choi JS, Rhee SJ, Ko EY. MRI surveillance for women with a personal history of breast cancer: comparison between abbreviated and full diagnostic protocol. Br J Radiol. 2020 Feb 1;93(1106):20190733.
5. Yamada T, Kanemaki Y, Okamoto S, Nakajima Y. Comparison of detectability of breast cancer by abbreviated breast MRI based on diffusion-weighted images and postcontrast MRI. Jpn J Radiol. 2018 May;36(5):331-339.
6. Ikizceli T, Gulsen G. The Diagnostic Accuracy of Abbreviated Breast Magnetic Resonance Imaging (Abbreviated Breast MRI). Dicle Med J (2021) 48 (3) : 468-477.
7. Park EK, Cho KR, Seo BK, Woo OH, Cho SB, Bae JW. Additional Value of Diffusion-Weighted Imaging to Evaluate Prognostic Factors of Breast Cancer: Correlation with the Apparent Diffusion Coefficient. Iran J Radiol. 2016; 13:e33133.
8. Zhang L, Tang M, Min Z, Lu J, Lei X, Zhang X. Accuracy of combined dynamic contrast-enhanced magnetic resonance imaging and diffusion-weighted imaging for breast cancer detection: a meta-analysis. Acta Radiol. 2016 Jun;57(6):651-60.
9. Zhu CR, Chen KY, Li P, Xia ZY, Wang B. Accuracy of multiparametric MRI in distinguishing the breast malignant lesions from benign lesions: a meta-analysis. Acta Radiol. 2021 Oct;62(10):1290-1297.
10. Bickelhaupt S, Laun FB, Tesdorff J, Lederer W, Daniel H, Stiever A, et al. Fast and noninvasive characterization of suspicious lesions detected at breast cancer X-ray screening: capability of difusion-weighted MR imaging with MIPs. Radiology. 2016;278:689–97.
11. Shin HJ, Chae EY, Choi WJ, Ha SM, Park JY, Shin KC, Cha JH, Kim HH. Diagnostic Performance of Fused Diffusion-Weighted Imaging Using Unenhanced or Postcontrast T1-Weighted MR Imaging in Patients With Breast Cancer. Medicine (Baltimore). 2016 Apr;95(17):e3502.
12. Kul S, Metin Y, Kul M, Metin N, Eyuboglu I, Ozdemir O. Assessment of breast mass morphology with diffusion-weighted MRI: Beyond apparent diffusion coefficient. J Magn Reson Imaging. 2018 Dec;48(6):1668-1677.
13. Shao Z, Liu P, Zhang S, Lu H. Abbreviated protocol combining quantitative diffusion-weighted imaging: a new strategy increasing diagnostic accuracy for breast magnetic resonance imaging? Gland Surg. 2021 Sep;10(9):2705-2714.
14. Chen SQ, Huang M, Shen YY, Liu CL, Xu CX. Abbreviated MRI Protocols for Detecting Breast Cancer in Women with Dense Breasts. Korean J Radiol. 2017 May-Jun;18(3):470-475.
15. Pham R, Marshall H, Plecha D. Abbreviated Protocol Breast MRI. AJR Am J Roentgenol. 2020 Sep;215(3):765-769.
16. Wang J, Greuter MJW, Vermeulen KM, Brokken FB, Dorrius MD, Lu W, de Bock GH. Cost-effectiveness of abbreviated-protocol MRI screening for women with mammographically dense breasts in a national breast cancer screening program. Breast. 2022 Feb;61:58-65.
17. Monticciolo DL, Newell MS, Moy L, Niell B, Monsees B, Sickles EA. Breast Cancer Screening in Women at Higher-Than-Average Risk: Recommendations From the ACR. J Am Coll Radiol. 2018 Mar;15(3 Pt A):408-414.
18. Grimm LJ, Soo MS, Yoon S, Kim C, Ghate SV, Johnson KS. Abbreviated screening protocol for breast MRI: a feasibility study. Acad Radiol. 2015;22:1157–62.
19. Harvey SC, Di Carlo PA, Lee B, Obadina E, Sippo D, Mullen L. An abbreviated protocol for high-risk screening breast MRI saves time and resources. J Am Coll Radiol. 2016;13:R74–80.
20. Moschetta M, Telegrafo M, Rella L, Stabile Ianora AA, Angelelli G. Abbreviated combined MR protocol: a new faster strategy for characterizing breast lesions. Clin Breast Cancer. 2016;16:207–11.
21. Heacock L, Melsaether AN, Heller SL, Gao Y, Pysarenko KM, Babb JS, et al. Evaluation of a known breast cancer using an abbreviated breast MRI protocol: correlation of imaging characteristics and pathology with lesion detection and conspicuity. Eur J Radiol. 2016;85:815–23
22. Machida Y, Shimauchi A, Kanemaki Y, Igarashi T, Harada M, Fukuma E. Feasibility and potential limitations of abbreviated breast MRI: an observer study using an enriched cohort. Breast Cancer. 2017;24:411–9
23. Aydın H, Güner B, Esen Bostancı I, Coşkun Bilge A, Bulut ZM, Arıbaş B, Doğan L, Gülçelik MA. Acta Oncol Tur. 2021; 54(2): 128-140.