Mammography, breast ultrasound, and magnetic resonance imaging for surveillance of women at high familial risk for breast cancer
Mammography, breast ultrasound, and magnetic resonance imaging for surveillance of women at high familial risk for breast cancer
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DOI：
10.1200/jco.2004.00.4960
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发表时间：
2005-11-20
影响因子：
45.3
通讯作者：
Schild, HH
中科院分区：
文献类型：
--
作者：
Kuhl, CK;Schrading, S;Schild, HH
目的比较乳腺X线摄影、乳腺超声和磁共振成像（MRI）在监测乳腺癌家族风险增加的妇女中的有效性患者和方法我们对529名无症状妇女进行了一项监测队列研究，这些妇女根据她们的家族史和/或突变分析，被怀疑或证实携带乳腺癌，易感基因（BRCA）。共完成了1,542轮年度监测，平均随访时间为5.3年。单独使用或在不同的combinations.Results的三种成像模式的诊断准确性被确定在总队列（34侵入性，9导管原位癌）。诊断成像的总体灵敏度为93%（43例乳腺癌中的40例）;总体淋巴结阳性率为16%，发生1例间隔癌（43例癌症中的1例，或2%）。在按方式进行的分析中，乳腺X线摄影（33%）和超声（40%）或两者结合（49%）的灵敏度较低。MRI提供了显著更高的灵敏度（91%）。乳腺X线摄影在高危人群中的敏感性为25%，而MRI为100%。结论对于有或无BRCA基因突变的家族性乳腺癌高危人群，单纯钼靶X线检查或钼靶X线检查结合乳腺超声检查均不足以早期诊断乳腺癌。如果使用MRI进行监测，则可以在更有利的阶段以显着更高的灵敏度实现导管内和侵袭性家族性或遗传性癌症的诊断。
Purpose To compare the effectiveness of mammography, breast ultrasound, and magnetic resonance imaging (MRI) for surveillance of women at increased familial risk for breast cancer (lifetime risk of 20% or more).Patients and Methods We conducted a surveillance cohort study of 529 asymptomatic women who, based on their family history and/or mutational analysis, were suspected or proven to carry a breast cancer, susceptibility gene (BRCA). A total of 1,542 annual surveillance rounds were completed with a mean follow-up of 5.3 years. Diagnostic accuracies of the three imaging modalities used alone or in different combinations were compared.Results Forty-three breast cancers were identified in the total cohort (34 invasive, nine ductal carcinoma-in-situ). Overall sensitivity of diagnostic imaging was 93% (40 of 43 breast cancers); overall node-positive rate was 16%, and one interval cancer occurred (one of 43 cancers, or 2%). In the analysis by modality, sensitivity was low for mammography (33%) and ultrasound (40%) or the combination of both (49%). MRI offered a significantly higher sensitivity (91%). The sensitivity of mammography in the higher risk groups was 25%, compared with 100% for MRI. Specificity of MRI (97.2%) was equivalent to that of mammography (96.8%).Conclusion Mammography alone, and also mammography combined with breast ultrasound, seems insufficient for early diagnosis of breast cancer in women who are at increased familial risk with or without documented BRCA mutation. If MRI is used for surveillance, diagnosis of intraductal and invasive familial or hereditary cancer is achieved with a significantly higher sensitivity and at a more favorable stage.