Dual enerji kontrastlı mamografi: Teknik, endikasyonlar ve manyetik rezonans görüntüleme/mamografi ile kıyaslama
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Tarih
2019
Yazarlar
Dergi Başlığı
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Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
AMAÇ Histopatolojik tanıyı referans kabul ederek meme kanseri açısından kuşkulu bulgulara sahip 40 hastanın dual enerji kontrastlı mamografi (CEDM), kontrastlı manyetik rezonans görüntüleme (MRG) ve dijital mamografi (MG) görüntülerini değerlendirip bu üç görüntüleme yönteminin tanısal performansını kıyaslamak. GEREÇ VE YÖNTEM Klinik, ultrasonografik veya mamografik değerlendirmede malignite açısından kuşkulu bulguları olan 40 hastaya ait Mart-Ağustos 2018 tarihleri arasındaki görüntüler retrospektif olarak incelendi. Tüm hastalar yeni tanılı olup toplamda 62 lezyon kaydedildi. CEDM, MRG ve MG'nin sensitivite, spesifite, pozitif prediktif değer (PPV), negatif prediktif değer (NPV) ve doğruluk değerleri hesaplanıp kıyaslandı. İstatistik çalışmasında malign ve malignite açısından yüksek riskli prekürsör lezyonlar pozitif kabul edilirken benign lezyonlar negatif olarak kabul edildi. Histopatolojik tanı ise referans kabul edildi. Lezyonların en geniş boyutu ölçülüp kaydedildi ve Spearman's Rho testi ile sonuçların korelasyonu değerlendirildi. Çalışmamızın etik kurul onayı ve işlem öncesi tüm hastalardan alınmış aydınlatılmış yazılı onam formu mevcuttur. BULGULAR Toplam 40 hastaya ait 62 malignite açısından kuşkulu lezyon saptandı. 62 malignite kuşkulu lezyondan 55 tanesi(88.7%) MRG , 48 tanesi(77.4%) CEDM ve 42 tanesi(67.7%) MG ile saptanabilmiştir. Toplam 62 lezyonun 41 tanesi malign(66.1%) , 21 tanesi benign(33.9%) histopatoloji sonucuna sahiptir. 41 malign lezyondan 24 tanesi(58.5%) İnvaziv duktal karsinom tanısı almıştır. 21 adet benign lezyondan 10 tanesinde(47.6%) fibrokistik değişiklikler saptanmıştır. CEDM ve MRG sensitivite değerleri %100 olarak hesaplandı. MG'nin sensitivitesi ise %80 olarak hesaplandı ve CEDM ile MRG, MG'den istatitiksel olarak anlamlı üstünlüğe sahiptir. Spesifite değerleri sırasıyla CEDM %66, MRG %33, MG %57 olarak hesaplandı. CEDM'nin spesifite değeri daha yüksek ancak tanı yöntemleri arasında istatistiksel olarak anlamlı farklılık gözlenmedi. CEDM tetkikinin pozitif prediktif değeri %85 olup MRG(%74) ve MG(78.6%)'den üstün bulundu ancak istatistiksel olarak anlamlı farklılık gözlenmedi. Doğruluk (accuracy) oranları sırasıyla CEDM %88, MRG %77, MG%72 olarak hesaplandı ve yine CEDM üstün olmakla birlikte diğer iki test ile arasında anlamlı farklılık gözlenmedi. Negatif prediktif değer CEDM ve MRG için %100 olup MG'den (%60) istatistiksel olarak üstündür. Yalancı pozitiflik oranı en yüksek tetkik 66%(14 lezyon) ile MRG olup MG'de bu oran 42%(9 lezyon) CEDM'de ise 33%(7 lezyon) olarak hesaplandı. Yalancı negatiflik oranı en yüksek tanı yöntemi 24% ile MG olup 8 malign lezyonu saptayamamıştır. SONUÇ CEDM tetkiki MRG ile benzer şekilde lezyon morfolojik özellikleri ve perfüzyon karakteristikleri hakkında bilgi veren güncel bir tanı yöntemidir. CEDM tetkiki MRG ile kıyaslandığında benzer sensitivite oranlarına ve daha yüksek PPV'ye sahiptir. Maliyet ve hız konusunda MRG'ye belirgin üstünlükleri olup daha uygun maliyete sahiptir. CEDM rutin tanısal görüntülemeye entegre edilmesi ve MRG'nin kontraendike olduğu durumlarda kullanılabilir. Yüksek riskli olgularda yıllık MRG+MG kombinasyonunun yerine alternatif bir tarama yöntemi olarak kullanılması tartışılabilir.
OBJECTIVE The purpose of this study was to compare diagnostic performance of contrast enhanced digital mammography (CEDM), contrast enhanced magnetic resonance imaging (MRI) and digital mammography (MG) according to histopathological findings in 40 women with suspicion of breast cancer. MATERIALS AND METHODS Images from 40 patients with suspicious findings in clinic, ultrasonographic or mammographic images between March and August of 2018 is evaluated retrospectively. All of the patients were newly diagnosed and 62 lesions were detected in total. Sensitivity, specificity, positive predictive value (PPV), negative predictive value(NPV) and accuracy of CESM, MRI, MG was investigated and compared. Malign and high risk precursor lesions were accepted as positive result and benign lesions were accepted as negative result in statistical analysis. Histopathological results were accepted as the gold standart. Maximum dimesions of 62 lesions measured and correlations of this results evaluated with Spearman’s Rho test. Approval from ethics commitee and written informed consent from every patients were taken before the study. RESULTS 62 lesions with malignity suspicion were detected in 40 women. Among the 62 lesions, 55 lesions(88.7%) can be detected with MRI , 48 lesions(77.4%) can be detected with CESM and 42 lesions(67.7%) can be detected by MG. In histopathological analysis, 41 of 62 lesions(66.1%) were malign, 21 lesions(33.9%) were benign. 24 of 41 malign lesions(58.5%) were diagnosed as invasive ductal carcinoma. 10 of 21 benign lesions(47.6%) were diagnosed as fibrocystic changes. CEDM and MRI had a sensitivity of 100%. MG had a sensitivity of 80% and sensitivity was significantly better with CESM and MRI than with MG. CEDM had a specificity of %66 , MRI had a specificity of %33 and MG had a specificity of %57. Specificity of CEDM was higher than orther modlities but this difference was not statistically significant. PPV was %85 with CEDM , %74 with MRI and 78.6% for MG. The PPV of CEDM was higher than others but there was not significant difference statistically. The accuracy was %88 with CEDM, %77 with MRI and %72 with MG. The accuracy of CEDM was higher than other modalities but there was not significant difference statistically. The NPV of CEDM and MRI was 100% and higher than the 60% NPV of MG. MRI had the highest false positivity rate with 66%(14 lesions) false positivity rate of MG was 42%(9 lesions) and of CEDM 33%(7 lesions). MG had the highest false negativity rate (%24) by missing 8 malign lesions. CONCLUSION CEDM is a current modality giving information about morphology and perfusion characteristics of the breast lesions like MRI. CEDM has similiar sensitivity, better PPV and lower false positivity comparing to MRI. Also, CEDM has an advantage in cost and shorter examination relative to MRI. Integration of CEDM to diagnostic breast imaging and usage in patients with contraindications to MRI can be possible. CEDM may be valuable as an alternative screening test for yearly MRI and MG combination in high risk patients.
OBJECTIVE The purpose of this study was to compare diagnostic performance of contrast enhanced digital mammography (CEDM), contrast enhanced magnetic resonance imaging (MRI) and digital mammography (MG) according to histopathological findings in 40 women with suspicion of breast cancer. MATERIALS AND METHODS Images from 40 patients with suspicious findings in clinic, ultrasonographic or mammographic images between March and August of 2018 is evaluated retrospectively. All of the patients were newly diagnosed and 62 lesions were detected in total. Sensitivity, specificity, positive predictive value (PPV), negative predictive value(NPV) and accuracy of CESM, MRI, MG was investigated and compared. Malign and high risk precursor lesions were accepted as positive result and benign lesions were accepted as negative result in statistical analysis. Histopathological results were accepted as the gold standart. Maximum dimesions of 62 lesions measured and correlations of this results evaluated with Spearman’s Rho test. Approval from ethics commitee and written informed consent from every patients were taken before the study. RESULTS 62 lesions with malignity suspicion were detected in 40 women. Among the 62 lesions, 55 lesions(88.7%) can be detected with MRI , 48 lesions(77.4%) can be detected with CESM and 42 lesions(67.7%) can be detected by MG. In histopathological analysis, 41 of 62 lesions(66.1%) were malign, 21 lesions(33.9%) were benign. 24 of 41 malign lesions(58.5%) were diagnosed as invasive ductal carcinoma. 10 of 21 benign lesions(47.6%) were diagnosed as fibrocystic changes. CEDM and MRI had a sensitivity of 100%. MG had a sensitivity of 80% and sensitivity was significantly better with CESM and MRI than with MG. CEDM had a specificity of %66 , MRI had a specificity of %33 and MG had a specificity of %57. Specificity of CEDM was higher than orther modlities but this difference was not statistically significant. PPV was %85 with CEDM , %74 with MRI and 78.6% for MG. The PPV of CEDM was higher than others but there was not significant difference statistically. The accuracy was %88 with CEDM, %77 with MRI and %72 with MG. The accuracy of CEDM was higher than other modalities but there was not significant difference statistically. The NPV of CEDM and MRI was 100% and higher than the 60% NPV of MG. MRI had the highest false positivity rate with 66%(14 lesions) false positivity rate of MG was 42%(9 lesions) and of CEDM 33%(7 lesions). MG had the highest false negativity rate (%24) by missing 8 malign lesions. CONCLUSION CEDM is a current modality giving information about morphology and perfusion characteristics of the breast lesions like MRI. CEDM has similiar sensitivity, better PPV and lower false positivity comparing to MRI. Also, CEDM has an advantage in cost and shorter examination relative to MRI. Integration of CEDM to diagnostic breast imaging and usage in patients with contraindications to MRI can be possible. CEDM may be valuable as an alternative screening test for yearly MRI and MG combination in high risk patients.
Açıklama
Anahtar Kelimeler
Meme Kanseri, Manyetik Rezonans Görüntüleme (MRG), Dual Enerji Kontrastlı Mamografi (CEDM-CESM), Kontrast Madde, Mamografi (MG), Breast Cancer, Magnetic Resonance Imaging (MRI), Dual Energy Contrast Enhanced Mammography (CEDM-CESM), Contrast Media, Mammography (MG)
