Intensive Surveillance with Biannual Dynamic Contrast-Enhanced Magnetic Resonance Imaging Downstages Breast Cancer in BRCA1 Mutation Carriers.
Intensive Surveillance with Biannual Dynamic Contrast-Enhanced Magnetic Resonance Imaging Downstages Breast Cancer in BRCA1 Mutation Carriers.
复制标题
双年度动态对比度增强的磁共振成像在BRCA1突变载体中乳腺癌下降。
DOI：
10.1158/1078-0432.ccr-18-0200
复制
发表时间：
2019-03-15
期刊：
影响因子：
--
通讯作者：
Olopade OI
中科院分区：
文献类型：
--
作者：
Guindalini RSC;Zheng Y;Abe H;Whitaker K;Yoshimatsu TF;Walsh T;Schacht D;Kulkarni K;Sheth D;Verp MS;Bradbury AR;Churpek J;Obeid E;Mueller J;Khramtsova G;Liu F;Raoul A;Cao H;Romero IL;Hong S;Livingston R;Jaskowiak N;Wang X;Debiasi M;Pritchard CC;King MC;Karczmar G;Newstead GM;Huo D;Olopade OI
建立一个接受乳腺癌强化监测的高危妇女队列。我们每6个月进行一次动态对比增强磁共振成像（MRI），每年进行一次乳腺X线摄影（MG）。符合条件的受试者的累积终生乳腺癌风险≥ 20%和/或已知乳腺癌易感基因的致病性突变检测呈阳性。在2004-2016年期间，我们前瞻性地招募了295名女性，包括157名突变携带者（75名BRCA 1，61名BRCA 2）;参与者的平均年龄为43.3岁。后来诊断出17种癌症：4种导管原位癌（DCIS）和13种早期浸润性乳腺癌。15例癌症发生在突变携带者中（11例BRCA 1，3例BRCA 2，1例CDH 1）。浸润性癌的中位大小为0.61 cm。所有患者在确诊时均无淋巴结转移，无浸润性癌发生。半年一次MRI单独诊断的敏感性为88.2%，每年MG加半年一次MRI诊断的敏感性为94.1%。单独的两年一次MRI的癌症检出率为每100次筛查事件0.7%，这与每年MG加两年一次MRI的每100次筛查事件0.7%的癌症检出率相似。通过半年一次的MRI检测一种癌症所需的召回和活检次数在BRCA 1携带者中分别为2.8和1.7，在BRCA 2携带者中分别为12.0和8.0，在非BRCA 1/2携带者中分别为11.7和5.0。在基因组分层的高危女性中，一年两次的MRI对于浸润性乳腺癌的早期检测表现良好。每年一次的MG筛查加上每两年一次的MRI筛查没有任何益处。
To establish a cohort of high-risk women undergoing intensive surveillance for breast cancer. We performed dynamic contrast-enhanced magnetic resonance imaging (MRI) every 6 months in conjunction with annual mammography (MG). Eligible participants had a cumulative lifetime breast cancer risk ≥ 20% and/or tested positive for a pathogenic mutation in a known breast cancer susceptibility gene. Between 2004–2016, we prospectively enrolled 295 women, including 157 mutation carriers (75 BRCA1, 61 BRCA2); participants’ mean age at entry was 43.3 years. Seventeen cancers were later diagnosed: four ductal carcinoma in situ (DCIS) and thirteen early stage invasive breast cancers. Fifteen cancers occurred in mutation carriers (11 BRCA1, 3 BRCA2, 1 CDH1). Median size of the invasive cancers was 0.61 cm. No patients had lymph node metastasis at time of diagnosis and no interval invasive cancers occurred. The sensitivity of bi-annual MRI alone was 88.2% and annual MG plus bi-annual MRI was 94.1%. The cancer detection rate of bi-annual MRI alone was 0.7% per 100 screening episodes, which is similar to the cancer detection rate of 0.7% per 100 screening episodes for annual MG plus bi-annual MRI. The number of recalls and biopsies needed to detect one cancer by bi-annual MRI were 2.8 and 1.7 in BRCA1 carriers, 12.0 and 8.0 in BRCA2 carriers, and 11.7 and 5.0 in non-BRCA1/2 carriers, respectively. Bi-annual MRI performed well for early detection of invasive breast cancer in genomically stratified high-risk women. No benefit was associated with annual MG screening plus bi-annual MRI screening.