Horst Kathleen C, Fero Katherine E, Hancock Steven L, Advani Ranjana H, Ikeda Debra M, Daniel Bruce, Rosenberg Saul A, Donaldson Sarah S, Hoppe Richard T
Departments of *Radiation Oncology †Medicine ‡Radiology, Division of Medical Oncology, Stanford University School of Medicine, Stanford, CA.
Am J Clin Oncol. 2016 Apr;39(2):114-9. doi: 10.1097/COC.0000000000000025.
Women treated with mantle irradiation for Hodgkin lymphoma (HL) are at an increased risk of developing breast cancer (BC). Current guidelines recommend screening breast magnetic resonance imaging (MRI) as an adjunct to mammography (M) in these patients. There are limited data, however, as to the impact of breast MRI on cancer detection rates. The aim of the current study is to evaluate the use of breast MRI in survivors of HL treated and followed at a single institution.
We retrospectively reviewed 980 female patients treated with mantle irradiation for HL between 1961 and 2008. Records were reviewed to determine age at radiotherapy treatment, radiotherapy dose, breast imaging (including M and breast MRI), biopsy results if applicable, and incidence of BC.
A total of 118 patients had breast imaging performed at our institution. Median age at HL diagnosis was 28 years (range, 10 to 69 y). Median radiotherapy dose was 36 Gy (range, 20 to 45 Gy). Seventy-nine patients (67%) underwent M screening only, 1 (1%) breast MRI only, and 38 (32%) both M and breast MRI. Of these 38, 19 (50%) underwent 54 screening MRI studies (range per patient=1 to 8), 13 (34%) underwent preoperative MRI for workup of BC, and 6 (16%) initiated screening MRI of the contralateral breast only after diagnosed with BC. Fifty-nine biopsies were performed: 47 were prompted by suspicious M findings only, 10 by palpable findings on physical examination (PE), and 2 by suspicious breast MRI findings. Of the 47 biopsies prompted by M, 24 revealed malignant disease, whereas 23 proved to be benign. All 10 biopsies performed by palpation were malignant. Both biopsies prompted by MRI findings were benign. With M, there were 34 true-positive findings in 32 patients, 23 false-positive findings, and 1 false-negative finding. With screening MRI, there were 2 false-positive findings, 1 false-negative finding, and no true-positive findings.
The role of screening breast MRI in women previously irradiated for HL is evolving. Further education of patients and physicians is important to increase awareness of more sensitive BC screening modalities in this high-risk population. Future studies are necessary to determine the appropriate integration of screening breast MRI into the ongoing follow-up of these women.
接受霍奇金淋巴瘤（HL）斗篷野照射治疗的女性患乳腺癌（BC）的风险增加。当前指南建议对这些患者采用乳腺磁共振成像（MRI）作为乳房X线摄影（M）的辅助检查手段。然而，关于乳腺MRI对癌症检出率的影响的数据有限。本研究的目的是评估在单一机构接受治疗和随访的HL幸存者中乳腺MRI的应用情况。
我们回顾性分析了1961年至2008年间980例接受HL斗篷野照射治疗的女性患者。查阅记录以确定放疗时的年龄、放疗剂量、乳腺影像学检查（包括M和乳腺MRI）、必要时的活检结果以及BC的发病率。
共有118例患者在我们机构进行了乳腺影像学检查。HL诊断时的中位年龄为28岁（范围10至69岁）。中位放疗剂量为36 Gy（范围20至45 Gy）。79例患者（67%）仅接受了M筛查，1例（1%）仅接受了乳腺MRI检查，38例（32%）同时接受了M和乳腺MRI检查。在这38例患者中，19例（50%）接受了54次筛查MRI检查（每位患者1至8次），13例（34%）因BC的术前检查接受了MRI检查，6例（16%）仅在被诊断为BC后才开始对侧乳腺的筛查MRI检查。共进行了59次活检：47次是由M的可疑发现引起的，10次是由体格检查（PE）可触及的发现引起的，2次是由乳腺MRI的可疑发现引起的。在由M引起的47次活检中，24次显示为恶性疾病，而23次被证明是良性的。所有10次通过触诊进行的活检均为恶性。由MRI发现引起的2次活检均为良性。对于M，在32例患者中有34次真阳性发现，23次假阳性发现，1次假阴性发现。对于筛查MRI，有2次假阳性发现，1次假阴性发现，无真阳性发现。
筛查乳腺MRI在既往接受HL照射的女性中的作用正在不断演变。对患者和医生进行进一步教育对于提高该高危人群对更敏感的BC筛查方式的认识很重要。未来有必要开展研究以确定将筛查乳腺MRI合理纳入这些女性的持续随访中。
