Lehman Constance D, DeMartini Wendy, Anderson Benjamin O, Edge Stephen B
Department of Radiology, University of Washington, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington 98109, USA.
J Natl Compr Canc Netw. 2009 Feb;7(2):193-201. doi: 10.6004/jnccn.2009.0013.
Use of breast MRI in the preoperative evaluation of patients recently diagnosed with breast cancer has increased significantly over the past 10 years because of its well-documented high sensitivity for detecting otherwise occult breast cancer in the affected and contralateral breasts. However, published research reports on the impact of this improved cancer detection are limited. Equally important are growing concerns that the quality of breast MRI may vary significantly across practice sites, and therefore the published value of MRI may not be achieved for many patients. This article describes the peer-reviewed, published clinical research trials evaluating breast MRI in patients with newly diagnosed breast cancer on which the National Comprehensive Cancer Network (NCCN) practice guidelines are based. The current NCCN guidelines recommend that breast MRI be considered for patients with a newly diagnosed breast cancer to evaluate the extent of ipsilateral disease and to screen the contralateral breast, particularly for women at increased risk for mammographically occult disease. In addition, the guidelines indicate that breast MRI may be used for patients with axillary nodal adenocarcinoma to identify the primary malignancy. The guidelines stress the importance of having proper equipment, imaging technique, and provider training necessary to achieve high-quality breast MRI, and emphasize that MRI practice sites should have the ability to perform MRI-guided biopsy or needle localization. In addition to describing the data regarding use of breast MRI in women with newly diagnosed cancer, this article provides recommendations for the performance of high-quality breast MRI and suggestions for future research.
在过去10年中，乳腺MRI在最近诊断为乳腺癌的患者术前评估中的应用显著增加，因为其对检测患侧和对侧乳房中隐匿性乳腺癌的高敏感性已有充分记录。然而，关于这种改进的癌症检测影响的已发表研究报告有限。同样重要的是，人们越来越担心乳腺MRI的质量在不同的医疗机构可能有很大差异，因此许多患者可能无法实现已发表的MRI价值。本文描述了经同行评审并发表的关于乳腺MRI在新诊断乳腺癌患者中的临床研究试验，这些试验是美国国立综合癌症网络（NCCN）实践指南的基础。当前的NCCN指南建议，对于新诊断为乳腺癌的患者，应考虑使用乳腺MRI来评估同侧疾病的范围并筛查对侧乳房，特别是对于乳腺钼靶隐匿性疾病风险增加的女性。此外，指南指出乳腺MRI可用于腋窝淋巴结腺癌患者以识别原发性恶性肿瘤。指南强调了拥有高质量乳腺MRI所需的适当设备、成像技术和提供者培训的重要性，并强调MRI实践场所应具备进行MRI引导活检或针定位的能力。除了描述关于乳腺MRI在新诊断癌症女性中的应用数据外，本文还提供了高质量乳腺MRI的性能建议以及未来研究的建议。
