Huzarski Tomasz, Górecka-Szyld Barbara, Huzarska Jowita, Psut-Muszyńska Grażyna, Wilk Grażyna, Sibilski Robert, Cybulski Cezary, Kozak-Klonowska Beata, Siołek Monika, Kilar Ewa, Czudowska Dorota, Janiszewska Hanna, Godlewski Dariusz, Mackiewicz Andrzej, Jarkiewicz-Tretyn Joanna, Szabo-Moskal Jadwiga, Gronwald Jacek, Lubiński Jan, Narod Steven A
Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland.
Department of Radiology, Pomeranian Medical University, Szczecin, Poland.
Hered Cancer Clin Pract. 2017 Mar 1;15:4. doi: 10.1186/s13053-017-0064-y. eCollection 2017.
The addition of MRI to mammography and ultrasound for breast cancer screening has been shown to improve screening sensitivity for high risk women, but there is little data to date for women at average or intermediate risk.
Two thousand nine hundred and ninety-five women, aged 40 to 65 years with no previous history of breast cancer were enrolled in a screening program, which consisted of two rounds of MRI, ultrasound and mammography, one year apart. Three hundred and fifty-six women had a mutation, 370 women had a first-degree relative with breast cancer (and no mutation) and 2269 women had neither risk factor. Subjects were followed for breast cancer for three years from the second screening examination.
Twenty-seven invasive epithelial cancers, one angiosarcoma and six cases of DCIS were identified over the four-year period. Of the 27 invasive cancers, 20 were screen-detected, 2 were interval cancers, and five cancers were identified in the second or third follow-up year (i.e., after the end of the screening period). For invasive cancer, the sensitivity of MRI was 86%, the sensitivity of ultrasound was 59% and the sensitivity of mammography was 50%. The number of biopsies incurred by MRI ( = 156) was greater than the number incurred by mammography ( = 35) or ultrasound ( = 57). Of the 19 invasive cancers detected by MRI, 17 (89%) were also detected by ultrasound or mammography.
In terms of sensitivity, MRI is slightly better than the combination of mammography and ultrasound for screening of women at average or intermediate risk of breast cancer. However, because of additional costs incurred by MRI screening, and the small gain in sensitivity, MRI screening is probably not warranted outside of high-risk populations.
在乳腺癌筛查中，将磁共振成像（MRI）与乳房X线摄影和超声检查相结合，已被证明可提高高危女性的筛查敏感性，但目前针对平均风险或中度风险女性的数据较少。
2995名年龄在40至65岁之间、既往无乳腺癌病史的女性参加了一项筛查计划，该计划包括两轮MRI、超声和乳房X线摄影检查，间隔一年。356名女性存在基因突变，370名女性有乳腺癌一级亲属（且无基因突变），2269名女性既无上述风险因素。从第二次筛查检查开始，对受试者进行为期三年的乳腺癌随访。
在四年期间共发现27例浸润性上皮癌、1例血管肉瘤和6例导管原位癌（DCIS）。在27例浸润性癌中，20例为筛查发现，2例为间期癌，5例在第二次或第三次随访年（即筛查期结束后）被发现。对于浸润性癌，MRI的敏感性为86%，超声的敏感性为59%，乳房X线摄影的敏感性为50%。MRI导致的活检次数（=156次）多于乳房X线摄影（=35次）或超声（=57次）。在MRI检测出的19例浸润性癌中，17例（89%）也被超声或乳房X线摄影检测到。
在敏感性方面，对于筛查平均风险或中度风险的乳腺癌女性，MRI略优于乳房X线摄影和超声检查的联合应用。然而，由于MRI筛查会产生额外费用，且敏感性提高幅度较小，除高危人群外，可能不建议进行MRI筛查。
