MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer
MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer
复制标题
DOI：
10.1056/nejmoa065447
复制
发表时间：
2007-03-29
影响因子：
158.5
通讯作者：
Soulen, R.
中科院分区：
文献类型：
--
作者：
Lehman, Constance D.;Gatsonis, Constantine;Soulen, R.
即使经过仔细的临床和乳房X线检查评估，在接受单侧乳腺癌治疗的女性中，高达10%的对侧乳房发现癌症。我们进行了一项研究，以确定磁共振成像（MRI）是否可以提高临床乳腺检查和乳房X线检查在检测对侧乳腺癌后不久，初步诊断单侧乳腺cancer.METHODSA共969名妇女最近诊断为单侧乳腺癌，并没有异常的乳房X线检查和临床检查对侧乳腺进行了乳腺MRI。在研究入组后12个月内通过活检确认MRI检测到的癌症诊断。乳腺癌的情况下，确定通过活检，重复成像和临床检查的阳性结果的情况下，或两者在1年的follow-up. CRTTSMRI检测临床和乳房X线摄影隐匿性乳腺癌在对侧乳房中的30 969名妇女谁参加了这项研究（3.1%）。对侧乳腺MRI诊断乳腺癌的敏感性为91%，特异性为88%。MRI阴性预测值为99%。在969名女性中的121名（12.5%）中，根据阳性MRI结果进行活检，其中30名样本为癌症阳性（24.8%）; 30名样本中有18名为浸润性癌症阳性。浸润性肿瘤检测的平均直径为10.9毫米。检测到的癌症的额外数量不受乳腺密度，绝经状态，或原发tumor.CONCLUSIONSMRI的组织学特征的影响，可以检测到癌症在对侧乳腺钼靶X线摄影和临床检查在最初的乳腺癌诊断时错过。
BACKGROUNDEven after careful clinical and mammographic evaluation, cancer is found in the contralateral breast in up to 10% of women who have received treatment for unilateral breast cancer. We conducted a study to determine whether magnetic resonance imaging (MRI) could improve on clinical breast examination and mammography in detecting contralateral breast cancer soon after the initial diagnosis of unilateral breast cancer.METHODSA total of 969 women with a recent diagnosis of unilateral breast cancer and no abnormalities on mammographic and clinical examination of the contralateral breast underwent breast MRI. The diagnosis of MRI-detected cancer was confirmed by means of biopsy within 12 months after study entry. The absence of breast cancer was determined by means of biopsy, the absence of positive findings on repeat imaging and clinical examination, or both at 1 year of follow-up.RESULTSMRI detected clinically and mammographically occult breast cancer in the contralateral breast in 30 of 969 women who were enrolled in the study (3.1%). The sensitivity of MRI in the contralateral breast was 91%, and the specificity was 88%. The negative predictive value of MRI was 99%. A biopsy was performed on the basis of a positive MRI finding in 121 of the 969 women (12.5%), 30 of whom had specimens that were positive for cancer (24.8%); 18 of the 30 specimens were positive for invasive cancer. The mean diameter of the invasive tumors detected was 10.9 mm. The additional number of cancers detected was not influenced by breast density, menopausal status, or the histologic features of the primary tumor.CONCLUSIONSMRI can detect cancer in the contralateral breast that is missed by mammography and clinical examination at the time of the initial breast-cancer diagnosis.