有乳腺癌个人史（PH）的女性行简化磁共振成像（AB-MRI）筛查的可行性。
Feasibility of abbreviated magnetic resonance imaging (AB-MRI) screening in women with a personal history (PH) of breast cancer.
机构信息
Department of Radiology, The Catholic University of Korea, St. Vincent's Hospital, College of Medicine, Suwon-si, Korea.
Department of Radiology, The Catholic University of Korea, Seoul St. Mary's Hospital, College of Medicine, Seoul, Korea.
出版信息
PLoS One. 2020 Mar 12;15(3):e0230347. doi: 10.1371/journal.pone.0230347. eCollection 2020.
PURPOSE
To investigate the feasibility of abbreviated magnetic resonance imaging (AB-MRI) in women with a personal history (PH) of breast cancer as a screening tool.
MATERIALS AND METHODS
We retrospectively reviewed 1880 screening AB-MRIs in 763 women with a PH of breast cancer (median age, 55 years; range, 23-89 years) between October 2015 and October 2016. The total acquisition times of AB-MRI were 8.3 min and 2.8 min with and without T2-weighted imaging, respectively. The tissue diagnosis or one-year follow-up status was used as the reference standard. The characteristics of tumor recurrences detected on AB-MRI screenings were analyzed. The cancer detection rates (CDRs) and additional CDRs for the 1st round and overall rounds of AB-MRI screening were calculated. The recall rate, sensitivity, specificity, positive predictive values for recall (PPV1) and biopsy (PPV3) for the 1st round of AB-MRI screening were calculated. The diagnostic performance of the combination of mammography and ultrasonography was compared with that of AB-MRI by receiver operating characteristic (ROC) curve analysis.
RESULTS
Fifteen of a total of 21 recurrences were detected on the 1st round of AB-MRI screening: 93.3% were node-negative T1 tumors (median tumor size, 1.02 cm; range, 0.1-2 cm) or Tis; 66.7% were high-grade tumors; 8 of these 15 were mammographically and ultrasonographically occult. The CDR and additional CDR for the 1st round of AB-MRI screening were 0.019 and 0.010 per woman, respectively. The sensitivity, specificity, recall rate, PPV1 and PPV3 for the 1st round of AB-MRI screening were 100%, 96.0%, 14.3%, 13.8% and 58.3%, respectively. For detecting secondary cancer, AB-MRI showed a higher sensitivity and PPV than the combination of mammography and ultrasonography (95.2%, 57.1% vs 47.6%, 38.5%). The area under the ROC curve was higher for AB-MRI (0.966; 95% CI: 0.951-0.978) than the combination of mammography and ultrasonography (0.727; 95% CI: 0.694-0.759) (P<0.0001).
CONCLUSION
AB-MRI improved cancer detection with a high specificity, sensitivity and PPV in women with a PH of breast cancer. AB-MRI could be a useful screening tool for detecting secondary cancer considering its high diagnostic performance and short examination time.
目的
探讨简化磁共振成像（AB-MRI）在有乳腺癌个人史（PH）的女性中作为筛查工具的可行性。
材料和方法
我们回顾性分析了 2015 年 10 月至 2016 年 10 月期间 763 名有乳腺癌 PH 的女性共 1880 例筛查 AB-MRI 的资料（中位年龄为 55 岁；范围 23-89 岁）。AB-MRI 的总采集时间分别为 8.3 分钟和 2.8 分钟，有无 T2 加权成像。组织诊断或一年随访情况为参考标准。分析 AB-MRI 筛查中检测到的肿瘤复发的特征。计算 AB-MRI 筛查首轮和整体筛查的癌症检出率（CDR）和额外 CDR。计算 AB-MRI 筛查首轮的召回率、敏感性、特异性、召回的阳性预测值（PPV1）和活检的阳性预测值（PPV3）。通过接收者操作特征（ROC）曲线分析比较乳腺 X 线摄影和超声与 AB-MRI 的诊断性能。
结果
总共 21 例复发中有 15 例在 AB-MRI 筛查首轮中被检出：93.3%为淋巴结阴性 T1 肿瘤（中位肿瘤大小 1.02cm；范围 0.1-2cm）或Tis；66.7%为高级别肿瘤；其中 8 例在乳腺 X 线摄影和超声检查中均为隐匿性。AB-MRI 筛查首轮的 CDR 和额外 CDR 分别为 0.019 和 0.010/女性。AB-MRI 筛查首轮的敏感性、特异性、召回率、PPV1 和 PPV3 分别为 100%、96.0%、14.3%、13.8%和 58.3%。对于检测继发性癌症，AB-MRI 的敏感性和 PPV 均高于乳腺 X 线摄影和超声的组合（95.2%、57.1%比 47.6%、38.5%）。AB-MRI 的 ROC 曲线下面积（AUC）高于乳腺 X 线摄影和超声的组合（0.966；95%CI：0.951-0.978 比 0.727；95%CI：0.694-0.759）（P<0.0001）。
结论
AB-MRI 提高了癌症检测的特异性、敏感性和 PPV，在有乳腺癌 PH 的女性中具有较高的特异性、敏感性和 PPV。考虑到其较高的诊断性能和较短的检查时间，AB-MRI 可以作为一种有用的筛查工具，用于检测继发性癌症。
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