Magnetic resonance imaging of the breast prior to biopsy
Magnetic resonance imaging of the breast prior to biopsy
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DOI：
10.1001/jama.292.22.2735
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发表时间：
2004-12-08
影响因子：
120.7
通讯作者：
Schnall, MD
中科院分区：
文献类型：
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作者：
Bluemke, DA;Gatsonis, CA;Schnall, MD
背景乳腺磁共振成像(MRI)已被证明对癌症检测具有很高的敏感性，并越来越多地被用于评估可疑的乳房病变。目的确定联合使用乳腺MRI和乳房X光检查来检测可疑乳房X线片或临床发现的乳腺癌的准确性。设计、设置和患者前瞻性多中心调查国际乳房MR联合体从1998年6月2日至2001年10月31日在北美和欧洲的14所大学医院进行了821例因美国放射学会4或5级乳房X光检查或可疑的临床或超声检查而转诊为乳房活检的患者。结果821例乳腺MRI检查中，共发现恶性指标404个，其中导管原位癌63个，浸润性癌341个。在417个非恶性指标性病变中，良性病变366个，不典型组织学病变47个，小叶原位癌4个。所有机构汇总的AUC为0.88(95%可信区间为0.86-0.91)。在404例肿瘤(DCIS或浸润性癌)中，356例MRI正确诊断为癌，其敏感性为88.1%(95%CI，84.6%-91.1%)，417例非癌患者中281例为阴性，特异性为67.7%(95%CI，62.7%-71.9%)。乳腺X光摄影、肿瘤组织学或绝经状态对MRI表现没有显著影响。492例中356例阳性预测值为72.4%(95%CI，68.2%~76.3%)，695例中367例阳性预测值为52.8%(95%CI，49.0%~56.6%)(P
Context Breast magnetic resonance imaging (MRI) has been shown to have high sensitivity for cancer detection and is increasingly used following mammography to evaluate suspicious breast lesions.Objective To determine the accuracy of breast MRI in conjunction with mammography for the detection of breast cancer in patients with suspicious mammographic or clinical findings.Design, Setting, and Patients Prospective multicenter investigation of the International Breast MR Consortium conducted at 14 university hospitals in North America and Europe from June 2, 1998, through October 31, 2001, of 821 patients referred for breast biopsy for American College of Radiology category 4 or 5 mammographic assessment or suspicious clinical or ultrasound finding.Interventions MRI examinations performed prior to breast biopsy; MRI results were interpreted at each site, which were blinded to pathological results.Main Outcome Measures Area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of breast MRI.Results Among the 821 patients, there were 404 malignant index lesions, of which 63 were ductal carcinoma in situ (DCIS) and 341 were invasive carcinoma. Of the 417 nonmalignant index lesions, 366 were benign, 47 showed atypical histology, and 4 were lobular carcinoma in situ. The AUC pooled over all institutions was 0.88 (95% confidence interval [CI], 0.86-0.91). MRI correctly detected cancer in 356 of 404 cancer cases (DCIS or invasive cancer), resulting in a sensitivity of 88.1% (95% CI, 84.6%-91.1%), and correctly identified as negative for cancer 281 of 417 cases without cancer, resulting in a specificity of 67.7% (95% CI, 62.7%-71.9%). MRI performance was not significantly affected by mammographic breast density, tumor histology, or menopausal status. The positive predictive values for 356 of 492 patients was 72.4% (95% CI, 68.2%-76.3%) and of mammography for 367 of 695 patients was 52.8% (95% CI, 49.0%-56.6%) (P