Schoub Peter K
Department of Radiology, Parklane Radiology, Johannesburg, South Africa.
SA J Radiol. 2018 Oct 30;22(2):1353. doi: 10.4102/sajr.v22i2.1353. eCollection 2018.
Magnetic resonance imaging (MRI) of the breast is the most sensitive imaging modality for detecting cancer. With improved scan resolution and correctly applied clinical indications, the specificity of breast MRI has markedly improved in recent years. Current literature indicates an overall sensitivity for breast MRI of 98% - 100% and specificity of 88%. By comparison, the sensitivity and specificity for mammography is in the region of 71% and 98%, respectively. In particular, the very high negative predictive value (NPV) of breast MRI, which approaches 100%, is hugely useful in establishing absence of disease. Furthermore, the ability to accurately delineate viable cancer by way of combining both morphological and functional (contrast enhancement) capabilities means that MRI is the best tool we have in terms of local cancer staging and identifying residual or recurrent disease. The high NPV also means that breast MRI is uniquely capable of ruling out cancer or high-grade ductal carcinoma in situ in appropriate circumstances. I hope that the following guidelines that are based on those of the American College of Radiology and the European Society of Breast Imaging in addition to multiple review articles will provide some assistance to radiologists in terms of the correct indications for breast MRI. There are few formal guidelines in South Africa for the usage of breast MRI. In fact, there is a general paucity of guidelines in the international radiology world. The role of breast MRI in high-risk screening and identification of the primary in occult breast cancer is universally accepted. Thereafter, there is little consensus. By using some general guidelines, and bringing MRI into the discussion of multidisciplinary breast cancer management, good clinical practice and consistent decision-making can be established.
乳腺磁共振成像（MRI）是检测癌症最敏感的成像方式。随着扫描分辨率的提高以及临床适应症的正确应用，近年来乳腺MRI的特异性有了显著提高。当前文献表明，乳腺MRI的总体敏感性为98% - 100%，特异性为88%。相比之下，乳腺钼靶的敏感性和特异性分别约为71%和98%。特别是，乳腺MRI极高的阴性预测值（NPV）接近100%，在确定无疾病方面非常有用。此外，通过结合形态学和功能（对比增强）能力来准确描绘存活癌症的能力意味着，就局部癌症分期和识别残留或复发性疾病而言，MRI是我们拥有的最佳工具。高NPV还意味着乳腺MRI在适当情况下能够独特地排除癌症或高级别导管原位癌。我希望以下基于美国放射学会和欧洲乳腺影像学会的指南以及多篇综述文章制定的指南，能在乳腺MRI的正确适应症方面为放射科医生提供一些帮助。南非关于乳腺MRI使用的正式指南很少。事实上，国际放射学界普遍缺乏指南。乳腺MRI在高危筛查和隐匿性乳腺癌原发灶识别中的作用已得到普遍认可。此后，几乎没有达成共识。通过使用一些通用指南，并将MRI纳入多学科乳腺癌管理的讨论中，可以建立良好的临床实践和一致的决策。
