Vrijednost ciljanog ultrazvučnog pregleda u dijagnostici lezija uočenih na magnetskoj rezonanciji dojke na postkontrastnim suptrakcijskim sekvencama [The value of second look US examination in diagnosis of MRI detected breast lesions on dynamic postcontrast sequences]

Huzjan Korunić, Renata (2011) Vrijednost ciljanog ultrazvučnog pregleda u dijagnostici lezija uočenih na magnetskoj rezonanciji dojke na postkontrastnim suptrakcijskim sekvencama [The value of second look US examination in diagnosis of MRI detected breast lesions on dynamic postcontrast sequences]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Aim of the study: to evaluate the sensitivity of targeted »second look» US examination and to analyze the spectrum of final PHD findings. ----- Patients and methods: 242 patients with 282 MR lesions were included. MR findings were described as focuses, masses and «non-mass» lesions. For detailed characterization and final scoring BIRADS lexicon was used. US lesions were characterized as masses or «non-mass» lesions and also attributed BIRADS score. ----- Results: 237/282 MR lesions had US correlate. More MR masses had positive US findings (93%) compared to MR «non-mass» lesions (83%). MR lesions correlated well with their US correlates regarding the type and the size of the lesion. In 50% of lesions with US correlate malignancy was proven, 48,7% were proven benign and in 1,3% LCIS was found. Malignant lesions were MR masses in 62,7% and malignancy correlated with irregular borders and «wash in wash out» kinetic curve. The US features that correlated with malignancy were hypoechoic internal structure and irregular borders. IDC were more commonly presented as MR masses and were smaller in size than DCIS. Malignant lesions were in 34,9% MR «non-mass» lesions. Features that correlated with malignancy included segmantal distribution and wash in wash out curve, but platoe type of curve was present in 53,7% of DCIS. In 60% of DCIS US microcalcifications were visible. ----- Conclusion: based on the results we could reccomend the routine use of targeted «second look» US examination because it is highly sensitive method that permits diagnosis of most MR detected lesions as well as the US guided interventional procedures.

Abstract in Croatian

Cilj rada: Utvrditi osjetljivost ultrazvuka za dijagnosticiranje korelata MR lezijama i analizirati spektar patohistoloških nalaza. ----- Ispitanici i metode istraživanja: uključene su 242 bolesnice s 282 MR lezija karakteriziranih u fokuse, tvorbe i područja «non-mass» imbibicije. Za detaljni opis i ocjenu lezija korištena je BIRADS klasifikacija. UZV lezije karakterizirane su kao UZV tvorbe ili «non-mass lezije» i ocijenjene prema BIRADS-u. ----- Rezultati: 84% MR lezija imalo je pozitivan UZV korelat. Značajno veći broj MR tvorbi (93%) imalo korelat u odnosu na «non-mass» lezije (83%). MR lezije dobro su korelirale s korelatima prema tipu i veličini lezije. Kod 50% ultrazvučnih lezija dokazan je karcinom, 48,7% benigne promjene, a kod 1,3% LCIS. Maligne lezije su u 62,7% bile MR tvorbe, a MR karakteristike povezane s karcinomom su iregularne granice i krivulja «wash-in wash-out» tipa. UZV karakteristike povezane s karcinomom su hipoehogena struktura i iregularne granice. IDC su se značajno češće prezentirali kao MR tvorbe nego DCIS i bili su manjeg promjera. Maligne lezije su u 34,9% slučajeva bile MR «non-mass» lezije, a MR karakteristike povezane s karcinomima bile su segmentalna distribucija i krivulja «wash-in wash-out», ali i tipa «platoa» koja je bila karakteristika 53,7% DCIS-a. Kod 60% dijagnosticiranih DCIS-a bile su UZV vidljive mikrokalcifikacije. ----- Zaključak: preporučuje se uključivanje «second look» UZV pregleda u rutinski dijagnostički algoritam jer svojom visokom osjetljivošću omogućuje karakterizaciju i tkivnu obradu MR dijagnosticiranih lezija.

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