Wang Shi-Yi, Long Jessica B, Killelea Brigid K, Evans Suzanne B, Roberts Kenneth B, Silber Andrea, Gross Cary P
Department of Chronic Disease Epidemiology, Yale University School of Public Health, 60 College Street, P.O. Box 208034, New Haven, CT, 06520, USA.
Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT, USA.
Breast Cancer Res Treat. 2016 Jul;158(1):139-148. doi: 10.1007/s10549-016-3858-0. Epub 2016 Jun 10.
Although preoperative magnetic resonance imaging (MRI) can detect mammographically occult contralateral breast cancers (CBCs) among women with ductal carcinoma in situ (DCIS), the impact of MRI on the incidence of subsequent CBC events is unclear. We examined whether MRI use decreases CBC occurrences and detection of invasive disease among women who develop a CBC. Utilizing the Surveillance, Epidemiology, and End Results-Medicare dataset, we assessed overall, synchronous (<6 months after primary cancer diagnosis), and subsequent (≥6 months after diagnosis, i.e., metachronous) CBC occurrence in women aged 67-94 years diagnosed with DCIS during 2004-2009, with follow-up through 2011. We applied a matched propensity score approach to compare the stage-specific incidence rate of CBC according to MRI use. Our sample consisted of 9166 beneficiaries, 1258 (13.7 %) of whom received preoperative MRI. After propensity score matching, preoperative MRI use was significantly associated with a higher synchronous CBC detection rate (108.6 vs. 29.7 per 1000 person-years; hazard ratio [HR] = 3.65; p < .001) with no significant differences in subsequent CBC rate (6.7 vs. 6.8 per 1000 person-years; HR = 0.90; p = .71). The 6-year cumulative incidence of any CBC (in situ plus invasive) remained significantly higher among women undergoing MRI, compared with those not undergoing MRI (9 vs. 4 %, p < .001). Women undergoing MRI also had a higher incidence of invasive CBC (4 vs. 3 %, p = .04). MRI use resulted in an increased detection of synchronous CBC but did not prevent subsequent CBC occurrence, suggesting that many of the undetected CBC lesions may not become clinically evident.
尽管术前磁共振成像（MRI）能够在导管原位癌（DCIS）女性患者中检测出乳腺钼靶检查隐匿的对侧乳腺癌（CBC），但MRI对后续CBC事件发生率的影响尚不清楚。我们研究了MRI检查的应用是否会减少发生CBC的女性患者中CBC的发生以及浸润性疾病的检出。利用监测、流行病学和最终结果-医疗保险数据集，我们评估了2004年至2009年期间诊断为DCIS的67至94岁女性患者中CBC的总体、同步性（原发癌诊断后<6个月）和后续（诊断后≥6个月，即异时性）发生率，并随访至2011年。我们采用匹配倾向评分方法，根据MRI的使用情况比较CBC的分期特异性发病率。我们的样本包括9166名受益人，其中1258名（13.7%）接受了术前MRI检查。倾向评分匹配后，术前MRI的使用与更高的同步性CBC检出率显著相关（每1000人年108.6例对29.7例；风险比[HR]=3.65；p<0.001），而异时性CBC发生率无显著差异（每1000人年6.7例对6.8例；HR=0.90；p=0.71）。与未接受MRI检查的女性相比，接受MRI检查的女性中任何CBC（原位癌加浸润性癌）的6年累积发病率仍然显著更高（9%对4%，p<0.001）。接受MRI检查的女性浸润性CBC的发生率也更高（4%对3%，p=0.04）。MRI检查的应用导致同步性CBC的检出增加，但并未预防后续CBC的发生，这表明许多未检测到的CBC病变可能不会在临床上显现出来。
