Department of Radiology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul 110-744, Republic of Korea.
Radiology. 2013 Apr;267(1):57-66. doi: 10.1148/radiol.12120629. Epub 2013 Jan 17.
To investigate the clinical effect of a single magnetic resonance (MR) imaging screening examination of the contralateral breast at preoperative evaluation in women with unilateral breast cancer.
The institutional review board approved this study and waived informed consent. Among women with unilateral breast cancer who underwent curative surgery from 2004 to 2008, 1323 women (mean age, 46.8 years; range, 18-81 years) underwent mammography and ultrasonography (US) alone (comparison group) between January 2004 and December 2006; 1771 consecutive women (mean age, 48.2 years; range, 22-85 years) underwent mammography, US, and MR imaging (contralateral MR imaging-screened group) between January 2007 and December 2008. The incidence of synchronous cancer and the incidence of metachronous cancer in the contralateral breast were compared between groups. Multivariate Cox analysis was performed. Median follow-up was 56 months (range, 13-94 months).
Twenty-five synchronous contralateral cancers (13 invasive cancers, 12 ductal carcinomas in situ; mean invasive size, 14 mm [range, 1-35 mm]; 92% [12 of 13] of invasive tumors were node negative) were additionally detected with MR imaging in the MR imaging-screened group. The cumulative incidence of contralateral breast cancer at 45 months was 0.5% (nine of 1771) (95% confidence interval [CI]: 0.23%, 0.96%) for the MR imaging-screened group and 1.4% (18 of 1323) (95% CI: 0.81%, 2.14%) for the comparison group (P = .02). Contralateral MR imaging screening (hazard ratio, 0.37; 95% CI: 0.15, 0.92; P = .03) and estrogen receptor negativity (hazard ratio, 3.98; 95% CI: 1.60, 9.92; P = .003) were associated with risk of contralateral cancer diagnosis in multivariate analysis.
A single MR imaging screening examination of the contralateral breast in women with unilateral breast cancer increased synchronous cancer detection and was associated with decreased diagnosis of metachronous contralateral cancer within 45 months.
探讨单侧乳腺癌术前评估中对侧乳房单次磁共振（MR）成像筛查的临床效果。
本研究经机构审查委员会批准，并豁免了知情同意。在 2004 年至 2008 年间接受根治性手术的单侧乳腺癌女性中，1323 名女性（平均年龄 46.8 岁；范围，18-81 岁）于 2004 年 1 月至 2006 年 12 月间仅行乳腺 X 线摄影和超声检查（对照组）；1771 名连续女性（平均年龄 48.2 岁；范围，22-85 岁）于 2007 年 1 月至 2008 年 12 月间行乳腺 X 线摄影、超声和 MR 成像（对侧 MR 成像筛查组）。比较两组间同侧乳腺癌的同步癌发生率和对侧乳腺癌的异时癌发生率。采用多变量 Cox 分析。中位随访时间为 56 个月（范围，13-94 个月）。
MR 成像筛查组中，25 例（13 例浸润性癌，12 例导管原位癌；平均浸润性肿瘤大小 14mm[范围，1-35mm]；13 例浸润性肿瘤中 92%[12 例]为淋巴结阴性）通过 MR 成像额外检出同侧乳腺癌。MR 成像筛查组在 45 个月时对侧乳腺癌的累积发生率为 0.5%（9/1771）（95%置信区间[CI]：0.23%，0.96%），而对照组为 1.4%（18/1323）（95%CI：0.81%，2.14%）（P=.02）。多变量分析显示，对侧 MR 成像筛查（风险比，0.37；95%CI：0.15，0.92；P=.03）和雌激素受体阴性（风险比，3.98；95%CI：1.60，9.92；P=.003）与对侧癌症诊断风险相关。
单侧乳腺癌女性单次对侧乳房 MR 成像筛查可提高同侧癌的检出率，并与 45 个月内同侧乳腺癌的异时诊断减少相关。
