超音波生検後に診断された乳癌に対する造影スペクトラルマンモグラフィの術前評価：造影磁気共鳴画像との相関と術後5年経過観察

Preoperative assessment of contrast-enhanced spectral mammography of diagnosed breast cancers after sonographic biopsy: Correlation to contrast-enhanced magnetic resonance imaging and 5-year postoperative follow-up.

• Yun-Chung Cheung
• Yu-Hsiang Juan
• Yung-Feng Lo
• Yu-Ching Lin
• Chih-Hua Yeh
• Shir-Hwa Ueng

抄録

当院の施設審査委員会の承認を得て、術前にCESMと造影磁気共鳴画像法（CE-MRI）を受け、術後5年以上経過した乳癌患者のデータをレトロスペクティブに検討した。マンモグラフィを行わずに超音波ガイド付き生検で乳癌と診断された患者を解析対象とした。低エネルギーマンモグラフィ（LE-MG）、再結合減算マンモグラフィ（RSM）、CE-MRIでの癌の大きさと数を記録し、顕微鏡的病理組織学的データおよび少なくとも5年間の臨床フォローアップデータと比較した。解析対象となった46例のがん乳房は51例で、すべての主要ながんはRSMまたはCE-MRIで検出できたが、LE-MGで検出できたのは45例のみであった。顕微鏡での大きさのピアソン相関係数は、LE-MGで0.44、RSMで0.77、CE-MRIで0.84であった（いずれもP値≦0.001）。顕微鏡での報告については、RSMまたはCE-MRIは多中心癌に対して感度100％、陽性予測値63.6％であった。CESMは，超音波生検後に乳癌と診断された患者の二次検査として，癌の進展と多中心癌の評価に有効であった．

To assess the feasibility of using contrast-enhanced spectral mammography (CESM) for operative planning of patients with breast cancers who were initially diagnosed by sonographic guided biopsy.With the approval of the Institutional Review Board of our hospital, we retrospectively reviewed the data on patients with breast cancers who underwent CESM and contrast-enhanced magnetic resonance imaging (CE-MRI) prior to operation and were followed up for at least 5 years postoperatively. The patients with breast cancer diagnosed by sonographic guided biopsy without mammography were included for analysis. The size and number of cancers on low-energy mammograms (LE-MG), recombined subtracted mammograms (RSM), and CE-MRI were recorded and compared with microscopic histopathologic data and at least 5 years of clinical follow-up data.Fifty-one cancerous breasts of 46 patients were included in the analysis. All the principal cancers could be detected by RSM or CE-MRI; however, only 45 were by LE-MG. The Pearson correlation coefficients for the size on microscopy were 0.44 for LE-MG, 0.77 for RSM, and 0.84 for CE-MRI (all P-values ≤.001). Regarding the microscopic reports, RSM or CE-MRI had sensitivities of 100% and a positive predictive value of 63.6% for multicentric cancers. One breast cancer with partial mastectomy recurred after 3 years of follow-up.CESM was feasible for assessing the cancer extension and multicentric cancers as secondary examination in patients with diagnosed breast cancers after sonographic biopsy.