Diagnosis and Staging of Breast Cancer: When and How to Use Mammography, Tomosynthesis, Ultrasound, Contrast-Enhanced Mammography, and Magnetic Resonance Imaging
Diagnosis and Staging of Breast Cancer: When and How to Use Mammography, Tomosynthesis, Ultrasound, Contrast-Enhanced Mammography, and Magnetic Resonance Imaging
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DOI：
10.1007/978-3-030-11149-6_13
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发表时间：
2019-01-01
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影响因子：
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通讯作者：
Pinker-Domenig, Katja
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作者：
Gilbert, Fiona J.;Pinker-Domenig, Katja
乳腺癌是西方世界女性癌症死亡的最常见原因，早期发现癌症对于改善预后和生存至关重要。乳腺X线摄影是乳腺癌筛查和诊断的主要手段[1-3]。乳腺X线摄影是一种二维图像，依赖于对可疑乳腺癌的形态学发现的鉴别（图13.1）。这些发现包括肿块、成组钙化、不对称和结构变形区域。标准的筛查性乳房X线照片包括每个乳房的内外侧斜位（MLO）和头尾位（CC）视图。筛查检查的目的仅仅是发现可疑的发现，之后妇女将返回进行额外的诊断检查。诊断性乳腺摄影视图可能包括点压缩、放大、滚动、扩展视图和真实侧视图等，以表征和定位异常。乳腺成像报告和数据系统（BIRADS）由美国放射学会开发，旨在规范描述乳腺X线摄影结果的术语[4]。BIRADS图谱还概述了筛查乳腺X射线摄影程序的可接受性能指标，例如癌症检出率≥ 2.5个癌症/1000个筛查，召回率在5%至12%之间。性能基准也可用于诊断性乳腺X射线摄影，例如活检的阳性预测值在20%至45%之间。随机对照试验发现，筛查性乳房X光检查使乳腺癌死亡率降低了30%[1]。然而，由于灵敏度约为70%，乳房X线摄影有其局限性。特别是在乳腺致密的女性中，癌症可能在乳房X线摄影中是隐匿的[5]。美国和欧洲目前对乳腺癌筛查的建议有些不同。乳腺成像学会、美国放射学会和国家综合癌症网络建议，对于乳腺癌平均风险的女性，从40岁开始每年进行筛查性乳房X光检查。由于对筛查益处和危害的判断不同，美国妇产科医师学会指南与美国预防服务工作组、美国癌症协会、国家综合癌症网络和美国放射学会/乳腺成像协会发布的建议不同（表13.1）。建议乳腺癌风险增加（即，≥ 20%的终生风险）的女性除接受乳腺X线摄影和乳腺MRI检查外，还接受补充筛查[6，7]。BRCA 1/2基因突变携带者或未接受检测但具有同等风险的女性（TP 53 Li Fraumeni综合征、AT纯合子或膈上放射性其他疾病），
Breast cancer is the most common cause of female cancer deaths in the western world, with early detection of cancer being pivotal for an improved prognosis and survival. Mammography is the mainstay of breast cancer screening and diagnosis [1–3]. Mammography is a two-dimensional image and relies on the identification of morphologic findings that are suspicious for breast cancer (Fig. 13.1). These findings include masses, grouped calcifications, asymmetries, and areas of architectural distortion. A standard screening mammogram consists of mediolateral oblique (MLO) and craniocaudal (CC) views of each breast. The screening exam is intended solely to detect suspicious findings after which the woman would return for additional diagnostic views. Diagnostic mammographic views may include spot compression, magnification, rolled, extended views, and true lateral views among others in order to characterize and localize abnormalities. The Breast Imaging Reporting and Data System (BIRADS) was developed by the American College of Radiology in order to standardize terminology describing mammographic findings [4]. The BIRADS atlas also outlines acceptable performance metrics for screening mammography programs such as a cancer detection rate of≥ 2.5 cancers/1000 screens and a recall rate between 5 and 12%. Performance benchmarks are also available for diagnostic mammography, such as a positive predictive value of biopsy of between 20 and 45%. Randomized controlled trials have found that screening mammography has decreased the mortality for breast cancer by 30%[1]. However, with a sensitivity of approximately 70%, mammography has its limitations. Particularly in women with dense breasts, cancers might be occult on mammography [5]. Current recommendations for breast cancer screening in the United States and Europe are somewhat variable. The Society of Breast Imaging, the American College of Radiology, and the National Comprehensive Cancer Network recommend annual screening mammography beginning at the age of 40 years for women at average risk for breast cancer. Due to varying judgments of the benefits and harms of screening, the American College of Obstetricians and Gynecologists guidelines differ from the recommendations issued by the US Preventive Services Task Force, the American Cancer Society, the National Comprehensive Cancer Network, and the American College of Radiology/Society of Breast Imaging (Table 13.1). Women at increased risk for breast cancer (ie,≥ 20% lifetime risk) are recommended to undergo supplemental screening in addition to mammography with breast MRI [6, 7]. Women who are BRCA1/2 gene mutation carriers or who are not tested but have an equivalent risk (with TP53 Li Fraumeni syndrome, AT homozygote or supradiaphragmatic radiother-