MRI和乳腺X线摄影对有家族性或遗传易感性女性进行乳腺癌筛查的效能。

Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition.

作者信息

Kriege Mieke, Brekelmans Cecile T M, Boetes Carla, Besnard Peter E, Zonderland Harmine M, Obdeijn Inge Marie, Manoliu Radu A, Kok Theo, Peterse Hans, Tilanus-Linthorst Madeleine M A, Muller Sara H, Meijer Sybren, Oosterwijk Jan C, Beex Louk V A M, Tollenaar Rob A E M, de Koning Harry J, Rutgers Emiel J T, Klijn Jan G M

机构信息

Rotterdam Family Cancer Clinic, Department of Medical Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.

出版信息

N Engl J Med. 2004 Jul 29;351(5):427-37. doi: 10.1056/NEJMoa031759.

DOI:10.1056/NEJMoa031759

PMID:15282350

Abstract

BACKGROUND

The value of regular surveillance for breast cancer in women with a genetic or familial predisposition to breast cancer is currently unproven. We compared the efficacy of magnetic resonance imaging (MRI) with that of mammography for screening in this group of high-risk women.

METHODS

Women who had a cumulative lifetime risk of breast cancer of 15 percent or more were screened every six months with a clinical breast examination and once a year by mammography and MRI, with independent readings. The characteristics of the cancers that were detected were compared with the characteristics of those in two different age-matched control groups.

RESULTS

We screened 1909 eligible women, including 358 carriers of germ-line mutations. Within a median follow-up period of 2.9 years, 51 tumors (44 invasive cancers, 6 ductal carcinomas in situ, and 1 lymphoma) and 1 lobular carcinoma in situ were detected. The sensitivity of clinical breast examination, mammography, and MRI for detecting invasive breast cancer was 17.9 percent, 33.3 percent, and 79.5 percent, respectively, and the specificity was 98.1 percent, 95.0 percent, and 89.8 percent, respectively. The overall discriminating capacity of MRI was significantly better than that of mammography (P<0.05). The proportion of invasive tumors that were 10 mm or less in diameter was significantly greater in our surveillance group (43.2 percent) than in either control group (14.0 percent [P<0.001] and 12.5 percent [P=0.04], respectively). The combined incidence of positive axillary nodes and micrometastases in invasive cancers in our study was 21.4 percent, as compared with 52.4 percent (P<0.001) and 56.4 percent (P=0.001) in the two control groups.

CONCLUSIONS

MRI appears to be more sensitive than mammography in detecting tumors in women with an inherited susceptibility to breast cancer.

摘要

背景

对于有乳腺癌遗传或家族易感性的女性，定期进行乳腺癌监测的价值目前尚未得到证实。我们比较了磁共振成像（MRI）与乳房X线摄影术在这组高危女性中的筛查效果。

方法

对终生患乳腺癌累积风险达15%或更高的女性，每六个月进行一次临床乳腺检查，每年进行一次乳房X线摄影术和MRI检查，并由独立人员阅片。将检测到的癌症特征与两个年龄匹配的不同对照组中的癌症特征进行比较。

结果

我们筛查了1909名符合条件的女性，其中包括358名种系突变携带者。在中位随访期2.9年期间，共检测到51个肿瘤（44例浸润性癌、6例导管原位癌和1例淋巴瘤）以及1例小叶原位癌。临床乳腺检查、乳房X线摄影术和MRI检测浸润性乳腺癌的敏感性分别为17.9%、33.3%和79.5%，特异性分别为98.1%、95.0%和89.8%。MRI的总体鉴别能力明显优于乳房X线摄影术（P<0.05）。在我们的监测组中，直径为10毫米或更小的浸润性肿瘤比例（43.2%）明显高于两个对照组（分别为14.0%[P<0.001]和12.5%[P=0.04]）。在我们的研究中，浸润性癌腋窝淋巴结阳性和微转移的合并发生率为21.4%，而两个对照组分别为52.4%（P<0.001）和56.4%（P=0.001）。