Triple-modality screening trial for familial breast cancer underlines the importance of magnetic resonance imaging and questions the role of mammography and ultrasound regardless of patient mutation status, age, and breast density.
Triple-modality screening trial for familial breast cancer underlines the importance of magnetic resonance imaging and questions the role of mammography and ultrasound regardless of patient mutation status, age, and breast density.
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DOI：
10.1200/jco.2014.56.8626
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发表时间：
2015-04-01
期刊：
影响因子：
--
通讯作者：
Helbich TH
中科院分区：
文献类型：
--
作者：
Riedl CC;Luft N;Bernhart C;Weber M;Bernathova M;Tea MK;Rudas M;Singer CF;Helbich TH
评价乳腺X线摄影、超声和磁共振成像（MRI）在高危人群和不同人群亚组中的乳腺癌筛查效果。在一项单中心、前瞻性、非随机对照研究中，BRCA突变携带者和具有乳腺癌高家族风险（>20%终身风险）的女性每12个月接受一次乳腺X线摄影、超声和MRI筛查。诊断性能进行了比较之间的个别模式和它们的组合。进一步的比较是基于筛选轮次、突变状态、年龄和乳腺密度二分的亚群。本研究纳入了559名女性，完成了1，365轮成像。MRI的敏感性（90.0%）明显高于钼靶摄影（37.5%）和超声（37.5%）（P<0.001）。在40例肿瘤中，18例（45.0%）仅通过MRI检出。仅通过乳房X线摄影发现了两种癌症（具有微浸润的原位导管癌[DCIS]和具有<10 mm浸润区域的DCIS）。与单独使用MRI相比，这并未导致灵敏度显著增加（P = 0.15）。仅通过超声波没有检测到癌症。同样，在14例DCIS中，所有DCIS均通过MRI检测到，而乳房X线摄影和超声各检测到5例DCIS（35.7%）。年龄、突变状态和乳腺密度对MRI的灵敏度没有影响，也不影响MRI相对于乳房X光检查和超声的优越性。MRI可以早期发现家族性乳腺癌，无论患者年龄，乳腺密度或风险状态如何。乳房X光检查的附加值有限，在接受MRI筛查的妇女中，超声没有附加值。
To evaluate the breast cancer screening efficacy of mammography, ultrasound, and magnetic resonance imaging (MRI) in a high-risk population and in various population subgroups. In a single-center, prospective, nonrandomized comparison study, BRCA mutation carriers and women with a high familial risk (>20% lifetime risk) for breast cancer were offered screening with mammography, ultrasound, and MRI every 12 months. Diagnostic performance was compared between individual modalities and their combinations. Further comparisons were based on subpopulations dichotomized by screening rounds, mutation status, age, and breast density. There were 559 women with 1,365 complete imaging rounds included in this study. The sensitivity of MRI (90.0%) was significantly higher (P<.001) than that of mammography (37.5%) and ultrasound (37.5%). Of 40 cancers, 18 (45.0%) were detected by MRI alone. Two cancers were found by mammography alone (a ductal carcinoma in situ [DCIS] with microinvasion and a DCIS with <10-mm invasive areas). This did not lead to a significant increase of sensitivity compared with using MRI alone (P =.15). No cancers were detected by ultrasound alone. Similarly, of 14 DCISs, all were detected by MRI, whereas mammography and ultrasound each detected five DCISs (35.7%). Age, mutation status, and breast density had no influence on the sensitivity of MRI and did not affect the superiority of MRI over mammography and ultrasound. MRI allows early detection of familial breast cancer regardless of patient age, breast density, or risk status. The added value of mammography is limited, and there is no added value of ultrasound in women undergoing MRI for screening.