1 Department of Radiology, Edith Wolfson Medical Center, Holon, Israel.
AJR Am J Roentgenol. 2013 Oct;201(4):919-27. doi: 10.2214/AJR.11.8450.
American College of Radiology and Society of Breast Imaging guidelines call for routine breast MRI screening only for women with the highest risk profiles for development of breast cancer, suggesting that screening of women at lower risk might result in an increased frequency of false-positive biopsy results. The purpose of this study was to test this assumption by comparing MRI-guided biopsy outcomes of lesions detected at MRI screening of women with a personal history of breast cancer with outcomes among women with genetic or familial high risk.
Outcomes of 130 MRI-guided biopsies were analyzed. One group consisted of women with hereditary (genetic or familial) risk, and the other group consisted of women with a personal history of breast cancer. Biopsies were performed with a 9-gauge vacuum-assisted device or surgically after MRI localization.
Of 130 MRI-guided biopsies, 20 (15%) yielded malignant histologic findings, 14 (11%) yielded high-risk lesions, and 96 (74%) had benign findings. There was a slightly higher malignancy rate for the personal-risk group (19%) compared with the hereditary-risk group (13.5%). There also was a slightly higher combined rate of malignancy and high-risk lesions (34% vs 22%) with no statistically significant difference (p < 0.25, p < 0.12). Patients in the hereditary-risk group were younger (44 ± 1.2 vs 54 ± 1.7 years; p < 0.001) than those in the personal-risk group.
Our preliminary data show no difference between the two risk groups with respect to probability of an MRI-guided biopsy result of malignancy, calling into question the proposed assumption. Further prospective studies of the role of MRI screening combined with MRI-guided biopsy when required for patients with previously treated localized breast cancer may be indicated.
美国放射学院和乳腺成像协会指南呼吁仅对罹患乳腺癌风险最高的女性进行常规乳腺 MRI 筛查，这表明对低风险女性进行筛查可能会导致假阳性活检结果的频率增加。本研究旨在通过比较有乳腺癌既往史的女性在 MRI 筛查中发现的病变的 MRI 引导活检结果与遗传或家族性高危女性的结果来检验这一假设。
分析了 130 例 MRI 引导活检的结果。一组患者为遗传性（遗传或家族性）风险，另一组为有乳腺癌既往史的患者。活检采用 9 号活检枪真空辅助装置或 MRI 定位后手术进行。
在 130 例 MRI 引导活检中，20 例（15%）活检结果为恶性组织学发现，14 例（11%）活检结果为高危病变，96 例（74%）为良性发现。个人风险组的恶性肿瘤发生率略高（19%），而遗传风险组为（13.5%）。恶性肿瘤和高危病变的综合发生率也略高（34%比 22%），但无统计学差异（p<0.25，p<0.12）。遗传风险组的患者年龄较轻（44±1.2 岁比 54±1.7 岁；p<0.001）。
我们的初步数据显示，两个风险组在 MRI 引导活检结果为恶性肿瘤的可能性方面没有差异，这对上述假设提出了质疑。对于接受过局部乳腺癌治疗的患者，可能需要进一步进行前瞻性研究，以确定 MRI 筛查结合 MRI 引导活检的作用。
