Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
Department of Radiology, the Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
J Magn Reson Imaging. 2019 Aug;50(2):377-390. doi: 10.1002/jmri.26654. Epub 2019 Jan 18.
Multiple studies in the first decade of the 21 century have established contrast-enhanced breast MRI as a screening modality for women with a hereditary or familial increased risk for the development of breast cancer. In recent studies, in women with various risk profiles, the sensitivity ranges between 81% and 100%, which is approximately twice as high as the sensitivity of mammography. The specificity increases in follow-up rounds to around 97%, with positive predictive values for biopsy in the same range as for mammography. MRI preferentially detects the more aggressive/invasive types of breast cancer, but has a higher sensitivity than mammography for any type of cancer. This performance implies that in women screened with breast MRI, all other examinations must be regarded as supplemental. Mammography may yield ~5% additional cancers, mostly ductal carcinoma in situ, while slightly decreasing specificity and increasing the costs. Ultrasound has no supplemental value when MRI is used. Evidence is mounting that in other groups of women the performance of MRI is likewise superior to more conventional screening techniques. Particularly in women with a personal history of breast cancer, the gain seems to be high, but also in women with a biopsy history of lobular carcinoma in situ and even women at average risk, similar results are reported. Initial outcome studies show that breast MRI detects cancer earlier, which induces a stage-shift increasing the survival benefit of screening. Cost-effectiveness is still an issue, particularly for women at lower risk. Since costs of the MRI scan itself are a driving factor, efforts to reduce these costs are essential. The use of abbreviated MRI protocols may enable more widespread use of breast MRI for screening. Level of Evidence: 1 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2019;50:377-390.
在 21 世纪的第一个十年中，多项研究已经证实，对比增强型乳腺磁共振成像（breast MRI）是一种用于遗传性或家族性乳腺癌发病风险增加的女性的筛查手段。在最近的研究中，在各种风险特征的女性中，其敏感性范围在 81%到 100%之间，大约是乳房 X 线摄影的两倍。在后续的随访中，特异性增加到约 97%，活检的阳性预测值与乳房 X 线摄影相同。MRI 优先检测侵袭性更高的乳腺癌类型，但对任何类型的癌症的敏感性都高于乳房 X 线摄影。这种性能意味着，在接受乳腺 MRI 筛查的女性中，所有其他检查都必须被视为补充手段。乳房 X 线摄影可能会发现大约 5%的额外癌症，主要是导管原位癌（ductal carcinoma in situ），同时特异性略有下降，成本略有增加。当使用 MRI 时，超声没有补充价值。越来越多的证据表明，在其他女性群体中，MRI 的性能也优于更传统的筛查技术。特别是在有乳腺癌个人病史的女性中，这种优势似乎更高，但在有乳腺小叶原位癌活检史的女性甚至在平均风险的女性中，也有类似的结果报告。初步的结果研究表明，乳腺 MRI 更早地发现癌症，从而引发了分期转移，提高了筛查的生存获益。成本效益仍然是一个问题，特别是对于低风险的女性。由于 MRI 扫描本身的成本是一个驱动因素，因此努力降低这些成本至关重要。使用缩短的 MRI 方案可能会使更多的女性接受乳腺 MRI 筛查。证据等级：1 技术功效：5 级 J. Magn. Reson. Imaging 2019;50:377-390.
