Metin BAYRAM, Ayhan ÖZKUR, Çağatay ANDIÇ, Mustafa YILDIRIM, Eda PARLAK

A comparison of imaging methods in the evaluation of breast pathologies

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.

Meme patolojilerinin değerlendirilmesinde görüntüleme yöntemlerinin karşılaştırılması

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.

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