Xuan-Anh Phi, Edwin R. Van den Heuvel, and Geertruida H. de Bock, University of Groningen, University Medical Center Groningen, Groningen; Inge-Marie Obdeijn, Madeleine M.A. Tilanus-Linthorst, and Harry J. de Koning, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands; Nehmat Houssami, School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia; Ellen Warner and Rodica Mandel, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario; Isabelle Trop, Hospital of Montreal, Montreal, Quebec, Canada; Francesco Sardanelli, University of Milan School of Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Milan; Filippo Santoro, Istituto Superiore di Sanità, Rome, Italy; Martin O. Leach and Gek Kwan-Lim, Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, London, United Kingdom; and Christopher C. Riedl and Thomas H. Helbich, Medical University Vienna, Vienna, Austria.
J Clin Oncol. 2015 Feb 1;33(4):349-56. doi: 10.1200/JCO.2014.56.6232. Epub 2014 Dec 22.
There is no consensus on whether magnetic resonance imaging (MRI) should be included in breast screening protocols for women with BRCA1/2 mutations age ≥ 50 years. Therefore, we investigated the evidence on age-related screening accuracy in women with BRCA1/2 mutations using individual patient data (IPD) meta-analysis.
IPD were pooled from six high-risk screening trials including women with BRCA1/2 mutations who had completed at least one screening round with both MRI and mammography. A generalized linear mixed model with repeated measurements and a random effect of studies estimated sensitivity and specificity of MRI, mammography, and the combination in all women and specifically in those age ≥ 50 years.
Pooled analysis showed that in women age ≥ 50 years, screening sensitivity was not different from that in women age < 50 years, whereas screening specificity was. In women age ≥ 50 years, combining MRI and mammography significantly increased screening sensitivity compared with mammography alone (94.1%; 95% CI, 77.7% to 98.7% v 38.1%; 95% CI, 22.4% to 56.7%; P < .001). The combination was not significantly more sensitive than MRI alone (94.1%; 95% CI, 77.7% to 98.7% v 84.4%; 95% CI, 61.8% to 94.8%; P = .28). Combining MRI and mammography in women age ≥ 50 years resulted in sensitivity similar to that in women age < 50 years (94.1%; 95% CI, 77.7% to 98.7% v 93.2%; 95% CI, 79.3% to 98%; P = .79).
Addition of MRI to mammography for screening BRCA1/2 mutation carriers age ≥ 50 years improves screening sensitivity by a magnitude similar to that observed in younger women. Limiting screening MRI in BRCA1/2 carriers age ≥ 50 years should be reconsidered.
对于年龄≥50 岁的携带 BRCA1/2 突变的女性，磁共振成像（MRI）是否应纳入乳腺筛查方案，目前尚无共识。因此，我们使用个体患者数据（IPD）荟萃分析研究了 BRCA1/2 突变患者的年龄相关性筛查准确性的证据。
IPD 来自 6 项高危筛查试验，包括已完成至少一轮 MRI 和乳房 X 线摄影筛查的携带 BRCA1/2 突变的女性。使用具有重复测量和研究随机效应的广义线性混合模型，估计 MRI、乳房 X 线摄影和联合检查在所有女性以及年龄≥50 岁的女性中的敏感性和特异性。
汇总分析显示，在年龄≥50 岁的女性中，筛查敏感性与年龄<50 岁的女性无差异，而筛查特异性则不同。在年龄≥50 岁的女性中，与单独使用乳房 X 线摄影相比，联合使用 MRI 和乳房 X 线摄影可显著提高筛查敏感性（94.1%；95%CI，77.7%至 98.7%比 38.1%；95%CI，22.4%至 56.7%；P<.001）。联合检查并不比单独使用 MRI 更敏感（94.1%；95%CI，77.7%至 98.7%比 84.4%；95%CI，61.8%至 94.8%；P=0.28）。在年龄≥50 岁的女性中，联合使用 MRI 和乳房 X 线摄影可获得与年龄<50 岁女性相似的敏感性（94.1%；95%CI，77.7%至 98.7%比 93.2%；95%CI，79.3%至 98%；P=0.79）。
对于年龄≥50 岁的 BRCA1/2 突变携带者，在乳房 X 线摄影基础上增加 MRI 检查可显著提高筛查敏感性，其幅度与年轻女性相似。对于年龄≥50 岁的 BRCA1/2 携带者，应重新考虑限制筛查 MRI 的应用。
