基于人群的 MRI 背景实质增强与未来原发性乳腺癌风险的相关性评估。
Population-Based Assessment of the Association Between Magnetic Resonance Imaging Background Parenchymal Enhancement and Future Primary Breast Cancer Risk.
机构信息
1 Kaiser Permanente Medical Center, Vallejo, CA.
2 University of California, San Francisco, San Francisco, CA.
出版信息
J Clin Oncol. 2019 Apr 20;37(12):954-963. doi: 10.1200/JCO.18.00378. Epub 2019 Jan 9.
PURPOSE
To evaluate comparative associations of breast magnetic resonance imaging (MRI) background parenchymal enhancement (BPE) and mammographic breast density with subsequent breast cancer risk.
PATIENTS AND METHODS
We examined women undergoing breast MRI in the Breast Cancer Surveillance Consortium from 2005 to 2015 (with one exam in 2000) using qualitative BPE assessments of minimal, mild, moderate, or marked. Breast density was assessed on mammography performed within 5 years of MRI. Among women diagnosed with breast cancer, the first BPE assessment was included if it was more than 3 months before their first diagnosis. Breast cancer risk associated with BPE was estimated using Cox proportional hazards regression.
RESULTS
Among 4,247 women, 176 developed breast cancer (invasive, n = 129; ductal carcinoma in situ,n = 47) over a median follow-up time of 2.8 years. More women with cancer had mild, moderate, or marked BPE than women without cancer (80% 66%, respectively). Compared with minimal BPE, increasing BPE levels were associated with significantly increased cancer risk (mild: hazard ratio [HR], 1.80; 95% CI, 1.12 to 2.87; moderate: HR, 2.42; 95% CI, 1.51 to 3.86; and marked: HR, 3.41; 95% CI, 2.05 to 5.66). Compared with women with minimal BPE and almost entirely fatty or scattered fibroglandular breast density, women with mild, moderate, or marked BPE demonstrated elevated cancer risk if they had almost entirely fatty or scattered fibroglandular breast density (HR, 2.30; 95% CI, 1.19 to 4.46) or heterogeneous or extremely dense breasts (HR, 2.61; 95% CI, 1.44 to 4.72), with no significant interaction ( = .82). Combined mild, moderate, and marked BPE demonstrated significantly increased risk of invasive cancer (HR, 2.73; 95% CI, 1.66 to 4.49) but not ductal carcinoma in situ (HR, 1.48; 95% CI, 0.72 to 3.05).
CONCLUSION
BPE is associated with future invasive breast cancer risk independent of breast density. BPE should be considered for risk prediction models for women undergoing breast MRI.
目的
评估乳腺磁共振成像（MRI）背景实质强化（BPE）和乳腺 X 线摄影密度与随后乳腺癌风险的比较关联。
患者和方法
我们使用定性 BPE 评估对 2005 年至 2015 年在乳腺癌监测联盟中接受乳腺 MRI 检查的女性（2000 年进行一次检查）进行了检查，评估结果为轻度、中度、中度或明显。乳腺密度是在 MRI 检查前 5 年内进行的乳腺 X 线摄影检查中评估的。在诊断患有乳腺癌的女性中，如果首次 BPE 评估是在首次诊断前 3 个月以上进行的，则包括该评估。使用 Cox 比例风险回归估计与 BPE 相关的乳腺癌风险。
结果
在 4247 名女性中，有 176 名女性（浸润性癌，n = 129；导管原位癌，n = 47）在中位随访时间 2.8 年内发生乳腺癌。患有癌症的女性中，有更多的人有轻度、中度或明显的 BPE（分别为 80%和 66%）。与轻度 BPE 相比，BPE 水平增加与癌症风险显著增加相关（轻度：风险比[HR]，1.80；95%置信区间[CI]，1.12 至 2.87；中度：HR，2.42；95%CI，1.51 至 3.86；和明显：HR，3.41；95%CI，2.05 至 5.66）。与轻度 BPE 和几乎完全脂肪或散在纤维腺体密度的女性相比，如果有轻度、中度或明显 BPE 的女性具有几乎完全脂肪或散在纤维腺体密度（HR，2.30；95%CI，1.19 至 4.46）或异质性或极其致密的乳房（HR，2.61；95%CI，1.44 至 4.72），则癌症风险升高，无显著交互作用（= 0.82）。联合轻度、中度和明显 BPE 显著增加浸润性乳腺癌的风险（HR，2.73；95%CI，1.66 至 4.49），但不增加导管原位癌的风险（HR，1.48；95%CI，0.72 至 3.05）。
结论
BPE 与乳腺密度无关，与未来的浸润性乳腺癌风险相关。对于接受乳腺 MRI 检查的女性，应考虑将 BPE 用于风险预测模型。
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