Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
JAMA Oncol. 2017 Nov 1;3(11):1495-1502. doi: 10.1001/jamaoncol.2017.1256.
Younger women (aged ≤50 years) who underwent breast conservation therapy may benefit from breast magnetic resonance imaging (MRI) screening as an adjunct to mammography.
To prospectively determine the cancer yield and tumor characteristics of combined mammography with MRI or ultrasonography screening in women who underwent breast conservation therapy for breast cancers and who were 50 years or younger at initial diagnosis.
DESIGN, SETTING, AND PARTICIPANTS: This multicenter, prospective, nonrandomized study was conducted from December 1, 2010, to January 31, 2016, at 6 academic institutions. Seven hundred fifty-four women who were 50 years or younger at initial diagnosis and who had undergone breast conservation therapy for breast cancer were recruited to participate in the study. Reference standard was defined as a combination of pathology and 12-month follow-up.
Participants underwent 3 annual MRI screenings of the conserved and contralateral breasts in addition to mammography and ultrasonography, with independent readings.
Cancer detection rate, sensitivity, specificity, interval cancer rate, and characteristics of detected cancers.
A total of 754 women underwent 2065 mammograms, ultrasonography, and MRI screenings. Seventeen cancers were diagnosed, and most of the detected cancers (13 of 17 [76%]) were stage 0 or stage 1. Overall cancer detection rate (8.2 vs 4.4 per 1000; P = .003) or sensitivity (100% vs 53%; P = .01) of mammography with MRI was higher than that of mammography alone. After the addition of ultrasonography, the cancer detection rate was higher than that by mammography alone (6.8 vs 4.4 per 1000; P = .03). The specificity of mammography with MRI or ultrasonography was lower than that by mammography alone (87% or 88% vs 96%; P < .001). No interval cancer was found.
After breast conservation therapy in women 50 years or younger, the addition of MRI to annual mammography screening improves detection of early-stage but biologically aggressive breast cancers at acceptable specificity. Results from this study can inform patient decision making on screening methods after breast conservation therapy.
接受保乳治疗的年轻女性（年龄≤50 岁）可能受益于乳房磁共振成像（MRI）筛查作为乳房 X 线摄影的辅助手段。
前瞻性确定在初始诊断时年龄为 50 岁或以下且接受保乳治疗的乳腺癌患者中，联合乳房 X 线摄影与 MRI 或超声筛查的癌症检出率和肿瘤特征。
设计、设置和参与者：这项多中心、前瞻性、非随机研究于 2010 年 12 月 1 日至 2016 年 1 月 31 日在 6 个学术机构进行。招募了 754 名初始诊断年龄为 50 岁或以下且接受保乳治疗的乳腺癌患者参加该研究。参考标准定义为病理学和 12 个月随访的组合。
参与者接受了 3 次年度 MRI 筛查，对保留的和对侧乳房进行筛查，包括乳房 X 线摄影和超声检查，并进行独立的阅读。
癌症检出率、敏感性、特异性、间期癌症率和检出癌症的特征。
共对 754 名女性进行了 2065 次乳房 X 线摄影、超声和 MRI 筛查。诊断出 17 例癌症，大多数检出的癌症（17 例中的 13 例[76%]）为 0 期或 1 期。与单独进行乳房 X 线摄影相比，MRI 联合乳房 X 线摄影的总体癌症检出率（8.2 比 4.4/1000；P=0.003）或敏感性（100%比 53%；P=0.01）更高。在加入超声检查后，癌症检出率高于单独进行乳房 X 线摄影（6.8 比 4.4/1000；P=0.03）。MRI 联合乳房 X 线摄影或超声检查的特异性低于单独进行乳房 X 线摄影（87%或 88%比 96%；P<0.001）。未发现间期癌症。
在 50 岁或以下的女性接受保乳治疗后，将 MRI 加入到年度乳房 X 线摄影筛查中可以提高早期但生物学侵袭性乳腺癌的检出率，同时保持可接受的特异性。本研究的结果可以为保乳治疗后的患者提供有关筛查方法的决策信息。
