Department of Radiology, Massachusetts General Hospital, Boston, MA (CDL); Department of Radiology, University of Washington Medical Center, Seattle, WA (JML, DSH, GK, SCP); Seattle Cancer Care Alliance, Seattle, WA (JML, SCP); Department of Radiology, University of Wisconsin-Madison, Madison, WI (WBD); Department of Pathology, University of Washington Medical Center, Seattle, WA (MHR); Fred Hutchinson Cancer Research Center, Seattle, WA, (PP, JG); Department of Medical Oncology, University of Washington Medical Center, Seattle, WA (JG).
J Natl Cancer Inst. 2016 Jan 7;108(3). doi: 10.1093/jnci/djv349. Print 2016 Mar.
Screening MRI is recommended for individuals at high risk for breast cancer, based on genetic risk or family history (GFH); however, there is insufficient evidence to support screening MRI for women with a personal history (PH) of breast cancer. We compared screening MRI performance in women with PH vs GFH of breast cancer.
We analyzed case-series registry data, collected at time of MRI and at 12-month follow-up, from our regional Clinical Oncology Data Integration project. MRI performance was compared in women with PH with those with GFH. Chi-square testing was used to identify associations between age, prior history of MRI, and clinical indication with MRI performance; logistic regression was used to determine the combined contribution of these variables in predicting risk of a false-positive exam. All statistical tests were two-sided.
Of 1521 women who underwent screening MRI from July 2004 to November 2011, 915 had PH and 606 had GFH of breast cancer. Overall, MRI sensitivity was 79.4% for all cancers and 88.5% for invasive cancers. False-positive exams were lower in the PH vs GFH groups (12.3% vs 21.6%, P < .001), specificity was higher (94.0% vs 86.0%, P < .001), and sensitivity and cancer detection rate were not statistically different (P > .99). Age (P < .001), prior MRI (P < .001), and clinical indication (P < .001) were individually associated with initial false-positive rate; age and prior MRI remained statistically significant in multivariable modeling (P = .001 and P < .001, respectively).
MRI performance is superior in women with PH compared with women with GFH. Screening MRI warrants consideration as an adjunct to mammography in women with a PH of breast cancer.
基于遗传风险或家族史（GFH），建议对乳腺癌高危个体进行筛查 MRI；然而，目前尚无足够证据支持对有乳腺癌个人史（PH）的女性进行筛查 MRI。我们比较了 PH 与 GFH 乳腺癌女性的筛查 MRI 表现。
我们分析了我们区域性临床肿瘤学数据整合项目中在 MRI 检查时和 12 个月随访时收集的病例系列登记数据。比较了 PH 女性和 GFH 女性的 MRI 表现。采用卡方检验识别年龄、既往 MRI 史和临床指征与 MRI 表现之间的关联；采用逻辑回归确定这些变量联合预测假阳性检查的风险。所有统计检验均为双侧。
在 2004 年 7 月至 2011 年 11 月期间进行筛查 MRI 的 1521 名女性中，915 名有 PH，606 名有 GFH。总体而言，所有癌症的 MRI 敏感性为 79.4%，浸润性癌症为 88.5%。PH 组的假阳性检查率低于 GFH 组（12.3%比 21.6%，P<0.001），特异性更高（94.0%比 86.0%，P<0.001），且敏感性和癌症检出率无统计学差异（P>.99）。年龄（P<0.001）、既往 MRI（P<0.001）和临床指征（P<0.001）单独与初始假阳性率相关；在多变量模型中，年龄和既往 MRI 仍具有统计学意义（P=0.001 和 P<0.001）。
与 GFH 女性相比，PH 女性的 MRI 表现更优。对于有乳腺癌 PH 的女性，MRI 筛查值得考虑作为乳房 X 线摄影的辅助手段。
