Senologie - Zeitschrift für Mammadiagnostik und -therapie 2018; 15(01): 48-60
DOI: 10.1055/s-0043-124853
Wissenschaftliche Arbeit
© Georg Thieme Verlag KG Stuttgart · New York

Senologische Befunde bei CT-Untersuchungen des Thorax: eine retrospektive Auswertung

Focal breast lesions in clinical CT examinations of the chest: a retrospective analysis
Kathrin Barbara Krug
1   Dept. of Diagnostical and Interventional Radiology, University of Cologne Medical School, Cologne, Germany
,
Christian Houbois
1   Dept. of Diagnostical and Interventional Radiology, University of Cologne Medical School, Cologne, Germany
,
Olga Grinstein
1   Dept. of Diagnostical and Interventional Radiology, University of Cologne Medical School, Cologne, Germany
,
Jan Borggrefe
1   Dept. of Diagnostical and Interventional Radiology, University of Cologne Medical School, Cologne, Germany
,
Michael Puesken
1   Dept. of Diagnostical and Interventional Radiology, University of Cologne Medical School, Cologne, Germany
,
Bettina Hanstein
2   Breast Center and Dept. of Obstetrics and Gynecology, University of Cologne Medical School, Cologne, Germany
,
Wolfram Malter
2   Breast Center and Dept. of Obstetrics and Gynecology, University of Cologne Medical School, Cologne, Germany
,
David Maintz
1   Dept. of Diagnostical and Interventional Radiology, University of Cologne Medical School, Cologne, Germany
,
Martin Hellmich
3   Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
14 March 2018 (online)

Zusammenfassung

Ziel Die Rate inzidenteller Mammakarzinomen bei CT-Untersuchungen wird basierend auf Auswertungen der Befundberichte mit ≤ 2 % beziffert. Wegen der ansteigenden Frequenz von CT-Untersuchungen und der hohen Prävalenz von Mammakarzinomen sollten Häufigkeit und Art senologisch falsch negativer CT-Befunde auf der Basis retrospektiver Bildauswertungen überprüft werden.

Material und Methoden Alle erstmalig im Jahre 2012 durchgeführten KM-gestützten CT-Untersuchungen des Thorax bei volljährigen Patientinnen wurden retrospektiv eingeschlossen. Ein Radiologe wertete alle Bilddokumentationen nach BI-RADS hinsichtlich senologischer Herdbefunde aus. Alle BI-RADS ≥ 3 Einstufungen wurden von einem 2. Auswerter überprüft und bei divergierender Einschätzung im Konsens besprochen. Basierend auf allen klinischen, radiologischen und pathologischen Angaben wurden Referenzdiagnosen erarbeitet. Die senologischen Informationen der Befundberichte wurden retrospektiv nach BI-RADS klassifiziert und mit den retrospektiven Konsensauswertungen und den Referenzdiagnosen abgeglichen.

Ergebnisse Das Spektrum der Indikationen umfasste Staging und Verlaufskontrollen von soliden Organtumoren/Lymphomen (N  =  701, 59,9 %) sowie vaskuläre (190, 16,2 %), entzündliche (48, 4,1 %) und pneumologische (22, 1,9 %) Fragestellungen. BI-RADS 1/2 Befunde lagen bei 92,5 % und BI-RADS 6 Befunde bei 1,7 % der 1170 Untersuchungen vor. Bei 68 Untersuchungen (5,8 %) wurden retrospektiv BI-RADS 3 – 5 Befunde beschrieben, die in 57 Fällen als benigne (46; 3,9 %) oder maligne (11; 0,9 %) einzustufen waren. 13 BI-RADS 4/5 Einstufungen (1,1 %) der Konsensauswertungen waren falsch positiv. Die beiden gesicherten falsch negativen CT-Befunde (0,2 %) waren therapeutisch und prognostisch nicht relevant.

Schlussfolgerung Bei der kurativen Diagnostik überwiegend nicht senologischer Fragestellungen betrug die relative Häufigkeit von BI-RADS 3 – 5 Befunden 5,8 %. Die Raten gesicherter falsch positiver retrospektiver BI-RADS 4/5-Befunde (1,1 %) und falsch negativer CT-Befundberichte (0,2 %) weichen naturgemäß von Werten aus einem senologischen Screening ab. Aussagen zur Prävalenz des okkulten Mammakarzinoms sind aufgrund des selektierten Kollektivs, der teils unvollständigen Parenchymerfassung und des retrospektiven Ansatzes nur mit Einschränkungen möglich.

Abstract

Purpose Based on radiological reports, the percentage of breast cancers visualized as incidental findings in routine CT examinations is estimated at ≤ 2 %. In view of the rising number of CT examinations and the high prevalence of breast cancer, it was the goal of the present study to verify the frequency and image morphology of false-negative senological CT findings.

Materials and Methods All first contrast-enhanced CT examinations of the chest in adult female patients carried out in 2012 were retrospectively included. A senior radiologist systematically assessed the presence of breast lesions on all CT images using the BI-RADS system. All BI-RADS ≥ 3 notations were evaluated by a second senior radiologist. A consensus was obtained in case of differing BI-RADS assessments. Reference diagnoses were elaborated based on all available clinical, radiological and pathological data. The findings of the CT reports were classified according to the BI-RADS system and were compared with the retrospective consensus findings as well as with the reference diagnoses.

Results The range of indications comprised a broad spectrum including staging and follow-up examinations of solid tumors/lymphoma (N  =  701, 59.9 %) and vascular (190, 16.2 %), inflammatory (48, 4.1 %) and pulmonologic (22, 1.9 %) issues. BI-RADS 1/2 classifications were present in 92.5 % and BI-RADS 6 classifications were assessed in 1.7 % of the 1170 included examinations. 68 patients (5.8 %) had at least one lesion retrospectively classified as BI-RADS 3 – 5. The histological potential was known in 57 of these lesions as benign (46, 3.9 %) or malignant (11, 0.9 %). 13 BI-RADS 4/5 consensus assessments (1.1 %) were false-positive. 2 of the 10 lesions classified as being malignant based on the further clinical and radiological course were not mentioned in the written CT reports (0.2 %). Both false-negative CT reports were therapeutically and prognostically irrelevant.

Conclusion The relative frequency of BI-RADS 3 – 5 findings was 5.8 %. It reflects the situation encountered in clinical imaging for primarily non-senologic questions and therefore differs from what would be expected in a dedicated screening program. The rates of known false-positive BI-RADS 4/5 findings in the retrospective evaluations (1.1 %) and of false-negative findings in the written CT reports (0.2 %) reflect the different diagnostic approaches of image-based senological screening and radiological examinations indicated in order to solve clinical problems not primarily concerning the breast region. Statements regarding the prevalence of clinically occult breast cancers can only be made with caution in the presented, highly selective group of patients due to the often incomplete visualization of breast tissue and the retrospective approach.

 
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