Supplemental Breast MR Imaging Screening of Women with Average Risk of Breast Cancer
Supplemental Breast MR Imaging Screening of Women with Average Risk of Breast Cancer
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DOI：
10.1148/radiol.2016161444
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发表时间：
2017-05-01
期刊：
影响因子：
19.7
通讯作者：
Schrading, Simone
中科院分区：
文献类型：
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作者：
Kuhl, Christiane K.;Strobel, Kevin;Schrading, Simone
目的：调查乳腺磁共振 (MR) 成像作为乳腺癌平均风险女性的补充筛查工具的实用性和准确性，并调查通过 MR 成像筛查检测到的癌症类型。 材料和方法：这项前瞻性观察研究是在两个学术乳腺中心针对没有乳腺癌相关危险因素（终生风险，15%）的 40-70 岁女性进行的。 2005 年 1 月至 2013 年 12 月期间，至少具有最少残留乳腺组织（美国放射学会类别 A-D）和正常常规影像学结果（筛查乳房 X 光检查，有或没有筛查超声检查 [US]）的女性被邀请接受补充 MR 成像筛查。结果指标包括补充癌症检出率、间隔癌症率、MR 成像检测到的其他癌症的生物学特征，以及 MR 成像筛查的特异性和阳性预测值 (PPV)。采用组织诊断或2年随访来建立参考标准。结果：总共招募了2120名女性，并进行了3861项筛查MR成像研究，覆盖了7007个女性年的观察期。乳房 MR 成像描绘了另外 60 种乳腺癌（导管原位癌，n = 20；浸润性癌，n = 40），总体补充癌症检出率为每 1000 例 15.5 例（95% 置信区间 [CI]：11.9，20.0）。初次筛查时通过 MR 成像检测出另外 48 种癌症（补充癌症检出率为每 1000 例 22.6 例）。在随后的 1741 轮筛查中，仅通过 MR 成像就发现了 13 例癌症中的 12 例（补充癌症检出率，每 1000 例 6.9 例）。一种癌症是通过所有三种方法（乳房X光检查、超声检查和磁共振成像）诊断出来的，没有一种癌症是仅通过乳房X光检查或仅超声诊断的。通过 MR 成像诊断出的癌症较小（中位数为 8 毫米），93.4% 的病例呈淋巴结阴性，在患病率筛查中，41.7% 的病例呈去分化（高级别癌症），在发病率筛查中，46.0% 的病例呈去分化（高级别癌症）。没有观察到间隔癌。 MR 成像筛查具有高特异性 (97.1%; 95% CI: 96.5, 97.6) 和高 PPV (35.7%; 95% CI: 28.9, 43.1)。结论：对于乳腺癌平均风险的女性，MR 成像筛查可改善与预后相关的乳腺癌的早期诊断。
Purpose: To investigate the utility and accuracy of breast magnetic resonance (MR) imaging as a supplemental screening tool in women at average risk for breast cancer and to investigate the types of cancer detected with MR imaging screening.Materials and Methods: This prospective observational study was conducted at two academic breast centers in women aged 40-70 years without breast cancer-associated risk factors (lifetime risk,15%). Between January 2005 and December 2013, women with at least minimal residual breast tissue (American College of Radiology categories A-D) and normal conventional imaging findings (screening mammography with or without screening ultrasonography [US]) were invited to undergo supplemental MR imaging screening. Outcome measures were supplemental cancer detection rates, interval cancer rates, and biologic profiles of MR imaging-detected additional cancers, as well as specificity and positive predictive value (PPV) of MR imaging screening. Tissue diagnoses or 2 years of follow-up were used to establish the reference standard.Results: A total of 2120 women were recruited and underwent 3861 screening MR imaging studies, covering an observation period of 7007 women-years. Breast MR imaging depicted 60 additional breast cancers (ductal carcinoma in situ, n = 20; invasive carcinoma, n = 40) for an overall supplemental cancer detection rate of 15.5 per 1000 cases (95% confidence interval [CI]: 11.9, 20.0). Forty-eight additional cancers were detected with MR imaging at initial screening (supplemental cancer detection rate, 22.6 per 1000 cases). During the 1741 subsequent screening rounds, 12 of 13 incident cancers were found with MR imaging alone (supplemental cancer detection rate, 6.9 per 1000 cases). One cancer was diagnosed with all three methods (mammography, US, and MR imaging), and none were diagnosed with mammography only or US only. Cancers diagnosed with MR imaging were small (median, 8 mm), node negative in 93.4% of cases, and dedifferentiated (high-grade cancer) in 41.7% of cases at prevalence screening and 46.0% of cases at incidence screening. No interval cancers were observed. MR imaging screening offered high specificity (97.1%; 95% CI: 96.5, 97.6) and high PPV (35.7%; 95% CI: 28.9, 43.1).Conclusion: In women at average risk for breast cancer, MR imaging screening improves early diagnosis of prognostically relevant breast cancer.