Seattle Cancer Care Alliance, Seattle, Washington 98109, USA.
J Natl Compr Canc Netw. 2009 Nov;7(10):1109-15. doi: 10.6004/jnccn.2009.0072.
The 2009 NCCN Clinical Practice Guidelines in Oncology for Breast Cancer Screening and Diagnosis include significant updates for the role of MRI in screening women at increased risk for breast cancer. The NCCN now recommends considering breast MRI as an adjunct to annual mammography and clinical breast examination for women who have a BRCA1 or -2 mutation or who have a first-degree relative who has a BRCA1 or -2 mutation but who have not undergone genetic testing themselves; those who are determined to have a lifetime risk greater than 20% based on models that are highly dependent on family history; and those with a history of lobular carcinoma in situ. MRI is also recommended for patients who underwent radiation treatment to the chest between 10 and 30 years of age, and in those who carry or have a first-degree relative who carries a genetic mutation in the TP53 or PTEN genes (Li-Fraumeni, Cowden, and Bannahyan-Riley-Ruvalcaba syndromes). MRI is specifically not recommended for screening women at average risk for breast cancer. This article describes the peer-reviewed, published clinical research trials evaluating breast MRI in high-risk patients, on which the NCCN guidelines were based, and provides suggestions for future research.
2009 年 NCCN 肿瘤学临床实践指南中的乳腺癌筛查和诊断部分，对 MRI 在高风险乳腺癌女性筛查中的作用进行了重大更新。NCCN 现在建议对以下女性考虑使用乳房 MRI 作为年度乳房 X 线摄影和临床乳房检查的辅助手段：BRCA1 或 -2 基因突变者；一级亲属有 BRCA1 或 -2 基因突变但本人尚未接受基因检测者；基于高度依赖家族史的模型，预计终生风险大于 20%者；有小叶原位癌病史者。乳房 MRI 也推荐用于胸部接受过 10 至 30 年放射治疗的患者，以及携带 TP53 或 PTEN 基因突变或一级亲属携带该基因突变者（Li-Fraumeni、Cowden 和 Bannahyan-Riley-Ruvalcaba 综合征）。MRI 不建议用于筛查一般风险的乳腺癌女性。本文介绍了 NCCN 指南所依据的，针对高危患者的乳房 MRI 进行评估的同行评审、已发表的临床研究试验，并对未来研究提出了建议。
