Nadler Michelle, Al-Attar Hyder, Warner Ellen, Martel Anne L, Balasingham Sharmila, Zhang Liying, Lipton Joseph H, Curpen Belinda
Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, M4N 3M5, Canada.
Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, M4N 3M5, Canada; Cross Cancer Institute, Alberta Health Services, University of Alberta, Canada.
Breast. 2017 Aug;34:77-82. doi: 10.1016/j.breast.2017.04.005. Epub 2017 May 18.
The role of surveillance breast MRI for women with mammographically dense breasts, a personal history of breast cancer (BC), atypical hyperplasia (AH), or lobular carcinoma in situ (LCIS) is unclear. We estimated the performance of annual surveillance MRI in women with a combination of these risk factors.
We performed a retrospective review of the clinical, radiological, and pathological parameters of women who received annual concurrent surveillance breast MRI and mammography between 04/2013 and 12/2015 and fulfilled all of the following criteria: 1) age <70; 2) prior diagnosis of AH, LCIS or BC; 3) heterogeneously or extremely dense breast(s); and 4) did not qualify for our provincial breast MRI high risk screening program.
This study included 198 patients (266 MRI exams). MRI detected 15 cancers: 11 invasive stage I and 4 in-situ. All but 1 were mammographically occult and there were no interval cancers. The cancer detection rate (CDR) and false positive (FP) rate were 6.1% and 21% for round one and 4.7% and 12.5% for round two, respectively. Not being on anti-estrogen therapy and having a 1st degree relative with BC significantly increased the likelihood of tumor detection.
The CDR and FP rate of surveillance MRI in this study were comparable to those reported for women with BRCA mutations. The addition of annual MRI to mammography should be considered for surveillance of women with a combination of these risk factors, particularly if they have a family history of BC and are not on anti-estrogen therapy.
对于乳腺钼靶检查显示乳腺致密、有乳腺癌（BC）个人史、非典型增生（AH）或小叶原位癌（LCIS）的女性，监测乳腺MRI的作用尚不清楚。我们评估了具有这些风险因素组合的女性进行年度监测MRI的效能。
我们对2013年4月至2015年12月期间同时接受年度乳腺MRI和钼靶监测且符合以下所有标准的女性的临床、放射学和病理学参数进行了回顾性研究：1）年龄<70岁；2）既往诊断为AH、LCIS或BC；3）乳腺不均匀致密或极度致密；4）不符合我省乳腺MRI高危筛查项目的标准。
本研究纳入了198例患者（266次MRI检查）。MRI检测到15例癌症：11例为I期浸润性癌，4例为原位癌。除1例外，所有癌症在钼靶检查中均未显示，且无间期癌。第一轮的癌症检出率（CDR）和假阳性（FP）率分别为6.1%和21%，第二轮分别为4.7%和12.5%。未接受抗雌激素治疗且有BC一级亲属显著增加了肿瘤检测的可能性。
本研究中监测MRI的CDR和FP率与报道的携带BRCA突变女性的CDR和FP率相当。对于具有这些风险因素组合的女性，尤其是有BC家族史且未接受抗雌激素治疗的女性，应考虑在钼靶检查基础上增加年度MRI监测。
