Supplemental magnetic resonance imaging plus mammography compared with magnetic resonance imaging or mammography by extent of breast density.
Supplemental magnetic resonance imaging plus mammography compared with magnetic resonance imaging or mammography by extent of breast density.
复制标题
补充磁共振成像加乳房X线照相与磁共振成像或乳房X线照相按乳腺密度程度进行比较。
DOI：
10.1093/jnci/djad201
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发表时间：
2024
期刊：
影响因子：
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通讯作者：
Miglioretti,DianaL
中科院分区：
文献类型：
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作者：
Kerlikowske,Karla;Zhu,Weiwei;Su,Yu-Ru;Sprague,BrianL;Stout,NatashaK;Onega,Tracy;O'Meara,EllenS;Henderson,LouiseM;Tosteson,AnnaNA;Wernli,Karen;Miglioretti,DianaL
BackgroundExamining筛查乳腺密度的乳腺磁共振成像（MRI）与或不与乳腺X线摄影可以告知讨论补充MRI在妇女致密breasts.MethodsWe评估了52 237名妇女年龄在40-79岁谁接受了2611筛选MRI单独和6518补充MRI加乳腺X线摄影对倾向评分匹配到65 810筛选乳腺X线摄影。 每1000次检查的间隔率、晚期和筛查发现的早期浸润性癌症以及假阳性回忆率和活检推荐率通过乳腺密度进行估计（非致密=几乎完全是脂肪或分散的纤维腺体密度;密集=异质性/极密集），调整登记、检查年份、年龄、人种和种族、乳腺癌家族史，结果MRI+乳腺X线检查的早期乳腺癌检出率在统计学上高于乳腺X线检查，（9.3 vs 2.9;差异= 6.4，95%置信区间[CI] = 2.5 - 10.3）和密集型（7.5 vs 3.5;差异= 4.0，95% CI = 1.4 - 6.7），MRI vs MRI+乳腺X线摄影用于致密型乳腺（19.2 vs 7.5;差异= 11.7，95% CI = 4.6 - 18.8）。MRI+乳腺X线摄影与乳腺X线摄影对于非致密性（0.8 vs 0.5;差异= 0.4，95% CI = -0.8至1.6）或致密性乳腺（1.5 vs 1.4;差异= 0.0，95% CI = -1.2至1.3）的间期发生率无统计学差异，晚期癌症发生率也无统计学差异。MRI与MRI+乳腺X线摄影在非致密乳腺（2.6 vs 0.8;差异= 1.8（95% CI = -2.0至5.5））或致密乳腺（0.6 vs 1.5;差异=-0.9，95% CI = -2.5至0.7）的间期发生率无统计学差异，晚期癌症发生率也无统计学差异。MRI组的假阳性回忆和活检建议率在统计学上高于乳腺X线摄影单独。ConclusionMRI筛查与或不与乳腺X线摄影增加率的屏幕检测到的早期癌症和假阳性的妇女致密的乳房，而不伴随着减少先进或间隔癌症。
BackgroundExamining screening outcomes by breast density for breast magnetic resonance imaging (MRI) with or without mammography could inform discussions about supplemental MRI in women with dense breasts.MethodsWe evaluated 52 237 women aged 40-79 years who underwent 2611 screening MRIs alone and 6518 supplemental MRI plus mammography pairs propensity score–matched to 65 810 screening mammograms. Rates per 1000 examinations of interval, advanced, and screen-detected early stage invasive cancers and false-positive recall and biopsy recommendation were estimated by breast density (nondense = almost entirely fatty or scattered fibroglandular densities; dense = heterogeneously/extremely dense) adjusting for registry, examination year, age, race and ethnicity, family history of breast cancer, and prior breast biopsy.ResultsScreen-detected early stage cancer rates were statistically higher for MRI plus mammography vs mammography for nondense (9.3 vs 2.9; difference = 6.4, 95% confidence interval [CI] = 2.5 to 10.3) and dense (7.5 vs 3.5; difference = 4.0, 95% CI = 1.4 to 6.7) breasts and for MRI vs MRI plus mammography for dense breasts (19.2 vs 7.5; difference = 11.7, 95% CI = 4.6 to 18.8). Interval rates were not statistically different for MRI plus mammography vs mammography for nondense (0.8 vs 0.5; difference = 0.4, 95% CI = -0.8 to 1.6) or dense breasts (1.5 vs 1.4; difference = 0.0, 95% CI = -1.2 to 1.3), nor were advanced cancer rates. Interval rates were not statistically different for MRI vs MRI plus mammography for nondense (2.6 vs 0.8; difference = 1.8 (95% CI = -2.0 to 5.5) or dense breasts (0.6 vs 1.5; difference = -0.9, 95% CI = -2.5 to 0.7), nor were advanced cancer rates. False-positive recall and biopsy recommendation rates were statistically higher for MRI groups than mammography alone.ConclusionMRI screening with or without mammography increased rates of screen-detected early stage cancer and false-positives for women with dense breasts without a concomitant decrease in advanced or interval cancers.