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Evidence-Based Imaging - part 2

cấp II (trung bình bằng chứng) điều tra, cả tương lai và hồi cứu của các tổ chức duy nhất (122-124) đã được giới hạn bởi số bệnh nhân nhỏ, không đầy đủ mammographic theo dõi, và thời gian ngắn tiếp theo (6-20 tháng). Một I cấp độ đơn giản (bằng chứng mạnh mẽ) báo cáo được xuất bản bởi liềm (125) năm 1991. | 44 L.L. Fajardo et al. level II moderate evidence investigations both prospective and retrospective from single institutions 122-124 that were limited by small patient populations incomplete mammographic follow-up and short durations of follow-up 6 to 20 months . A single level I strong evidence report was published by Sickles 125 in 1991. This prospective trial included 3.5 years of mammographic followup in a population of 3184 probably benign breast lesions of which 17 positive predictive value for cancer 0.5 were found to be malignant. These results established the validity of managing mammographically depicted probably benign BIRADS category 3 lesions with periodic mammographic surveillance 125 . A. Special Case Radial Sclerosing Lesions Radial Scars The reported incidence of radial scar is 0.1 to 2.0 per 1000 screening mammograms and 1.7 to 14 of autopsy specimens 126 Fig. 3.1 . Their major significance pertains to an association with atypical ductal hyperplasia and carcinoma that is seen in up to 50 of cases Table 3.6 127 . However multiinstitutional studies of larger patient populations evaluating percutaneous biopsy find a much lower incidence of cancer associated with radial scar than previously reported 128-130 . Although the largest published studies are retrospective level II moderate evidence excisional biopsy is recommended when percutaneous biopsy results show radial scar especially when associated with atypical hyperplasia. Figure 3.1. Radial scar. Right and left cranial-caudal CC A and coned right CC B mammography images demonstrate an ill-defined mass associated with architectural distortion in the left breast right . Image-guided percutaneous biopsy demonstrated sclerosing radial lesion associated with sclerosing adenosis atypical ductal hyperplasia and fibrosis histopathologically. Surgical excision demonstrated a 7-mm tubular carcinoma in addition to the aforementioned findings. Chapter 3 Breast Imaging 45 Table 3.6. Published reports and .