Lam Diana L, Houssami Nehmat, Lee Janie M
1 Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 825 Eastlake Ave East, G2-600, Seattle, WA 98109-1023.
2 Screening and Test Evaluation Program, Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia.
AJR Am J Roentgenol. 2017 Mar;208(3):676-686. doi: 10.2214/AJR.16.16300. Epub 2017 Jan 11.
Current clinical guidelines are consistent in supporting annual mammography for women after treatment of primary breast cancer. Surveillance imaging beyond standard digital mammography, including digital breast tomosynthesis (DBT), breast ultrasound, and MRI, may improve outcomes. This article reviews the evidence on the performance and effectiveness of breast imaging modalities available for surveillance after treatment of sporadic unilateral primary breast cancer and identifies additional factors to be considered when selecting an imaging surveillance regimen.
Evidence review supports the use of mammography for surveillance after primary breast cancer treatment. Variability exists in guideline recommendations for surveillance initiation, interval, and cessation. DBT offers the most promise as a potential modality to replace standard digital mammography as a front-line surveillance test; a single published study to date has shown a significant decrease in recall rates compared with standard digital mammography alone. Most guidelines do not support the use of whole-breast ultrasound in breast cancer surveillance, and further studies are needed to define the characteristics of women who may benefit from MRI surveillance. The emerging evidence about surveillance imaging outcomes suggests that additional factors, including patient and imaging characteristics, tumor biology and gene expression profile, and choice of treatment, warrant consideration in selecting personalized posttreatment imaging surveillance regimens.
当前临床指南一致支持对原发性乳腺癌治疗后的女性进行年度乳腺钼靶检查。除标准数字乳腺钼靶检查外的监测成像，包括数字乳腺断层合成（DBT）、乳腺超声和MRI，可能会改善治疗效果。本文回顾了散发性单侧原发性乳腺癌治疗后可用于监测的乳腺成像模式的性能和有效性的证据，并确定了选择成像监测方案时需考虑的其他因素。
证据审查支持在原发性乳腺癌治疗后使用乳腺钼靶进行监测。在监测开始、间隔和停止的指南建议方面存在差异。DBT作为一种潜在的模式最有希望取代标准数字乳腺钼靶作为一线监测检查；迄今为止一项已发表的研究表明，与单独使用标准数字乳腺钼靶相比，召回率显著降低。大多数指南不支持在乳腺癌监测中使用全乳超声，需要进一步研究来确定可能从MRI监测中获益的女性特征。关于监测成像结果的新证据表明，在选择个性化的治疗后成像监测方案时，包括患者和成像特征、肿瘤生物学和基因表达谱以及治疗选择等其他因素值得考虑。
