Breast Biopsy Intensity and Findings Following Breast Cancer Screening in Women With and Without a Personal History of Breast Cancer
Breast Biopsy Intensity and Findings Following Breast Cancer Screening in Women With and Without a Personal History of Breast Cancer
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DOI：
10.1001/jamainternmed.2017.8549
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发表时间：
2018-04-01
影响因子：
39
通讯作者：
Onega, Tracy
中科院分区：
文献类型：
--
作者：
Buist, Diana S. M.;Abraham, Linn;Onega, Tracy
重要性在有和没有乳腺癌个人病史(PHBC)的女性中，几乎没有证据表明筛查乳房磁共振成像(MRI)对人群的危害和益处。目的评估筛查后90天内的活检率和收益(乳房X光检查与磁共振成像有或没有乳房X光检查)。设计、设置和参与者对6个乳腺癌监测联盟(BCSC)登记的观察队列研究。2003年至2013年接受筛查的812 164名妇女的基于人群的样本。EXPOSURES总共2 048 994次数字乳房X光检查和/或乳腺MRI筛查(单独进行乳房X光检查与MRI在30天内进行或不进行乳房X光检查)。主要结果和衡量活检强度(手术大于核心大于细针抽吸)和产量(浸润性癌大于原位导管癌大于高危原位癌大于高危良性大于良性)。我们计算了年龄调整后的活组织检查强度(每1000个筛查病例)和活检率(每1000个筛查病例)。根据PHBC和BCSC的5年乳腺癌风险对结果进行分层。结果在有和没有PHBC的妇女中，分别包括101 103和1 939 455次乳房X光检查；MRI筛查包括有PHBC的3763次和没有PHBC的4673次。在PHBC女性患者中，年龄调整后的核心活检率和手术活检率(每1000例)比钼靶摄影(23.6；95%CI，22.4-24.8)翻了一番(57.1；95%可信区间，50.3-65.1)。在没有PHBC的女性中，差异(每1000次)更大：MRI后的差异为84.7(95%CI，75.9-94.9)，乳房X光照相后的差异为14.9(95%CI，14.7-15.0)。乳腺导管原位癌和浸润性活检率(每1000例次)显著高于核磁共振检查(钼靶检查，404.6；95%可信区间，381.2-428.8；磁共振成像，267.6；95%可信区间，208.0-337.8)，但在未患肝癌的女性中无显著升高(钼靶摄影，279.3；95%可信区间，274.2-284.4；核磁共振，214.6；95%可信区间，158.7-280.8)。无论PHBC如何，高危良性病变在MRI检查中更常见。更高的活检率和更低的癌症产率并不是年龄增加或5年乳腺癌风险增加的原因。结论与接受筛查的有无PHBC的女性相比，接受筛查的PHBC患者的活检率更高，而活检后的癌症产率显着低于单纯筛查乳房X光检查。需要进一步的工作来确定将从核磁共振筛查中受益的妇女，以确保可接受的益害比。
IMPORTANCE There is little evidence on population-based harms and benefits of screening breast magnetic resonance imaging (MRI) in women with and without a personal history of breast cancer (PHBC).OBJECTIVE To evaluate biopsy rates and yield in the 90 days following screening (mammography vs magnetic resonance imaging with or without mammography) among women with and without a PHBC.DESIGN, SETTING, AND PARTICIPANTS Observational cohort study of 6 Breast Cancer Surveillance Consortium (BCSC) registries. Population-based sample of 812 164 women undergoing screening, 2003 through 2013.EXPOSURES A total of 2 048 994 digital mammography and/or breast MRI screening episodes (mammogram alone vs MRI with or without screening mammogram within 30 days).MAIN OUTCOMES AND MEASURES Biopsy intensity (surgical greater than core greater than fine-needle aspiration) and yield (invasive cancer greater than ductal carcinoma in situ greater than high-risk benign greater than benign) within 90 days of a screening episode. We computed age-adjusted rates of biopsy intensity (per 1000 screening episodes) and biopsy yield (per 1000 screening episodes with biopsies). Outcomes were stratified by PHBC and by BCSC 5-year breast cancer risk among women without PHBC.RESULTS We included 101 103 and 1 939 455 mammogram screening episodes in women with and without PHBC, respectively; MRI screening episodes included 3763 with PHBC and 4673 without PHBC. Age-adjusted core and surgical biopsy rates (per 1000 episodes) doubled (57.1; 95% CI, 50.3-65.1) following MRI compared with mammography (23.6; 95% CI, 22.4-24.8) in women with PHBC. Differences (per 1000 episodes) were even larger in women without PHBC: 84.7 (95% CI, 75.9-94.9) following MRI and 14.9 (95% CI, 14.7-15.0) following mammography episodes. Ductal carcinoma in situ and invasive biopsy yield (per 1000 episodes) was significantly higher following mammography compared with MRI episodes in women with PHBC (mammography, 404.6; 95% CI, 381.2-428.8; MRI, 267.6; 95% CI, 208.0-337.8) and nonsignificantly higher, but in the same direction, in women without PHBC (mammography, 279.3; 95% CI, 274.2-284.4; MRI, 214.6; 95% CI, 158.7-280.8). High-risk benign lesions were more commonly identified following MRI regardless of PHBC. Higher biopsy rates and lower cancer yield following MRI were not explained by increasing age or higher 5-year breast cancer risk.CONCLUSIONS AND RELEVANCE Women with and without PHBC who undergo screening MRI experience higher biopsy rates coupled with significantly lower cancer yield findings following biopsy compared with screening mammography alone. Further work is needed to identify women who will benefit from screening MRI to ensure an acceptable benefit-to-harm ratio.