Hartman Anne-Renee, Daniel Bruce L, Kurian Allison W, Mills Meredith A, Nowels Kent W, Dirbas Frederick M, Kingham Kerry E, Chun Nicki M, Herfkens Robert J, Ford James M, Plevritis Sylvia K
Department of Medicine, Stanford University School of Medicine, Stanford, California 94305-5458, USA.
Cancer. 2004 Feb 1;100(3):479-89. doi: 10.1002/cncr.11926.
Intensive screening is an alternative to prophylactic mastectomy in women at high risk for developing breast carcinoma. The current article reports preliminary results from a screening protocol using high-quality magnetic resonance imaging (MRI), ductal lavage (DL), clinical breast examination, and mammography to identify early malignancy and high-risk lesions in women at increased genetic risk of breast carcinoma.
Women with inherited BRCA1 or BRCA2 mutations or women with a >10% risk of developing breast carcinoma at 10 years, as estimated by the Claus model, were eligible. Patients were accrued from September 2001 to May 2003. Enrolled patients underwent biannual clinical breast examinations and annual mammography, breast MRI, and DL.
Forty-one women underwent an initial screen. Fifteen of 41 enrolled women (36.6%) either had undergone previous bilateral oophorectomy and/or were on tamoxifen at the time of the initial screen. One patient who was a BRCA1 carrier had high-grade ductal carcinoma in situ (DCIS) that was screen detected by MRI but that was missed on mammography. High-risk lesions that were screen detected by MRI in three women included radial scars and atypical lobular hyperplasia. DL detected seven women with cellular atypia, including one woman who had a normal MRI and mammogram.
Breast MRI identified high-grade DCIS and high-risk lesions that were missed by mammography. DL detected cytologic atypia in a high-risk cohort. A larger screening trial is needed to determine which subgroups of high-risk women will benefit and whether the identification of malignant and high-risk lesions at an early stage will impact breast carcinoma incidence and mortality.
强化筛查是高危乳腺癌女性预防性乳房切除术的替代方案。本文报告了一项筛查方案的初步结果，该方案使用高质量磁共振成像（MRI）、导管灌洗（DL）、临床乳腺检查和乳房X线摄影来识别遗传性乳腺癌风险增加的女性中的早期恶性肿瘤和高危病变。
符合条件的女性为携带遗传性BRCA1或BRCA2突变者，或根据克劳斯模型估计10年内患乳腺癌风险大于10%者。患者于2001年9月至2003年5月入组。入组患者每半年接受一次临床乳腺检查，每年接受一次乳房X线摄影、乳腺MRI和DL检查。
41名女性接受了初次筛查。41名入组女性中有15名（36.6%）在初次筛查时已接受过双侧卵巢切除术和/或正在服用他莫昔芬。一名BRCA1携带者患者患有高级别导管原位癌（DCIS），通过MRI筛查发现，但乳房X线摄影未发现。三名女性通过MRI筛查出的高危病变包括放射状瘢痕和非典型小叶增生。DL检测出7名细胞异型性女性，其中一名女性MRI和乳房X线摄影均正常。
乳腺MRI识别出乳房X线摄影遗漏的高级别DCIS和高危病变。DL在高危人群中检测出细胞学异型性。需要进行更大规模的筛查试验，以确定哪些高危女性亚组将从中受益，以及早期识别恶性和高危病变是否会影响乳腺癌的发病率和死亡率。
