Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
AJR Am J Roentgenol. 2010 Aug;195(2):510-6. doi: 10.2214/AJR.09.3573.
The purpose of this article is to determine the cancer detection and biopsy rate among women who have breast MRI screening solely on the basis of a personal history of breast cancer.
This retrospective review of 1,699 breast MRI examinations performed from 1999 to 2001 yielded 144 women with prior breast cancer but no family history who commenced breast MRI screening during that time. Minimal breast cancer was defined as ductal carcinoma in situ (DCIS) or node-negative invasive breast cancer < 1 cm in size.
Of 144 women, 44 (31% [95% CI, 15-29%]) underwent biopsies prompted by MRI examination. Biopsies revealed malignancies in 17 women (12% [95% CI, 7-18%]) and benign findings only in 27 women (19% [95% CI, 13-26%]). Of the 17 women in whom cancer was detected, seven also had benign biopsy results. In total, 18 malignancies were found. One woman had two metachronous cancers. MRI screening resulted in a total of 61 biopsies, with a positive predictive value (PPV) of 39% (95% CI, 27-53%). The malignancies found included 17 carcinomas and one myxoid liposarcoma. Of the 17 cancers, 12 (71%) were invasive, five (29%) were DCIS, and 10 (59%) were minimal breast cancers. Of 17 cancers, 10 were detected by MRI only. The 10 cancers detected by MRI only, versus seven cancers later found by other means, were more likely to be DCIS (4/10 [40%] vs 1/7 [14%]; p = 0.25) or minimal breast cancers (7/10 [70%] vs 3/7 [43%]; p = 0.26).
We found that breast MRI screening of women with only a personal history of breast cancer was clinically valuable finding malignancies in 12%, with a reasonable biopsy rate (PPV, 39%).
本文旨在确定仅基于个人乳腺癌病史进行乳腺 MRI 筛查的女性中癌症的检出率和活检率。
本研究回顾性分析了 1999 年至 2001 年期间进行的 1699 例乳腺 MRI 检查，其中有 144 例既往有乳腺癌但无家族史的女性在此期间开始进行乳腺 MRI 筛查。微小乳腺癌定义为导管原位癌（DCIS）或淋巴结阴性的浸润性乳腺癌，肿瘤直径小于 1cm。
在 144 例女性中，44 例（31% [95%置信区间，15%-29%]）因 MRI 检查而接受了活检。活检显示 17 例女性（12% [95%置信区间，7%-18%]）有恶性肿瘤，27 例女性（19% [95%置信区间，13%-26%]）仅有良性发现。在发现癌症的 17 例女性中，有 7 例也有良性活检结果。共发现 18 例恶性肿瘤。有 1 例女性有两个同时性癌症。乳腺 MRI 筛查共进行了 61 次活检，阳性预测值（PPV）为 39%（95%置信区间，27%-53%）。发现的恶性肿瘤包括 17 例癌和 1 例黏液样脂肪肉瘤。在 17 例癌症中，12 例（71%）为浸润性癌，5 例（29%）为 DCIS，10 例（59%）为微小乳腺癌。在 17 例癌症中，有 10 例仅通过 MRI 检测到。与通过其他方法发现的 7 例癌症相比，仅通过 MRI 检测到的 10 例癌症更有可能是 DCIS（4/10 [40%] 与 1/7 [14%]；p = 0.25）或微小乳腺癌（7/10 [70%] 与 3/7 [43%]；p = 0.26）。
我们发现，对仅有个人乳腺癌病史的女性进行乳腺 MRI 筛查具有临床价值，可发现 12%的恶性肿瘤，活检率合理（PPV，39%）。
