Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Department of Computer Science, Arizona State University, Tempe, AZ.
J Clin Oncol. 2020 Nov 20;38(33):3874-3882. doi: 10.1200/JCO.19.02198. Epub 2020 Sep 15.
Although mammography is the standard of care for breast cancer screening, dense breast tissue decreases mammographic sensitivity. We report the prevalent cancer detection rate (CDR) from the first clinical implementation of abbreviated breast magnetic resonance imaging (AB-MR) as a supplemental screening test in women with dense breasts.
The study was approved by the institutional review board and is Health Insurance Portability and Accountability Act complaint. This retrospective review includes women who were imaged between January 1, 2016 and February 28, 2019. On a 1.5 Tesla magnet, the imaging protocol consisted of three sequences: Short-TI Inversion Recovery (STIR), precontrast, and postcontrast. A subtraction sequence and a maximum intensity projection were generated. We report the patient-level CDR and the positive predictive value of AB-MR examinations after negative/benign digital breast tomosynthesis (DBT).
Out of 511 prevalent rounds of AB-MR examinations, 36 women were excluded. The remaining 475 asymptomatic women with dense breasts had negative/benign DBT examinations before the AB-MR. There were 420 of 475 (88.4%) benign/negative examinations, 13 of 475 (2.7%) follow-up recommendations, and 42 biopsy recommendations. Thirty-nine biopsies were completed, resulting in 12/39 (30.8%) malignancies in 12 women: seven invasive carcinomas and five ductal carcinoma in situ. One additional patient was diagnosed with invasive ductal carcinoma at the time of 6-month follow-up. The CDR was 27.4 per 1,000 (13 of 475; 95% CI, 16.1 to 46.3). The size of invasive carcinomas ranged from 0.6-1.0 cm (mean, 0.5 cm). Of the seven women who underwent surgical evaluation of the axilla, zero of seven patients had positive nodes. There were no interval cancers at 1-year follow-up.
Preliminary results from clinical implementation of screening AB-MR resulted in a CDR of 27.4/1,000 at the patient level after DBT in women with dense breasts. Additional evaluation is warranted.
虽然乳腺 X 线摄影是乳腺癌筛查的标准，但致密的乳腺组织会降低乳腺 X 线摄影的敏感性。我们报告了在致密乳腺女性中，作为补充筛查试验的简化乳腺磁共振成像（AB-MR）首次临床实施后的常见癌症检出率（CDR）。
该研究经机构审查委员会批准，并符合《健康保险携带和责任法案》的规定。这是一项回顾性研究，纳入了 2016 年 1 月 1 日至 2019 年 2 月 28 日期间进行影像学检查的女性。在 1.5T 磁共振仪上，成像方案包括三个序列：短 TI 反转恢复（STIR）、对比前和对比后。生成一个减影序列和一个最大强度投影。我们报告了患者水平的 CDR，以及在阴性/良性数字乳腺断层合成（DBT）后 AB-MR 检查的阳性预测值。
在 511 例 AB-MR 检查中，有 36 例患者被排除。其余 475 例有致密乳腺的无症状女性在进行 AB-MR 之前进行了阴性/良性 DBT 检查。其中 420 例为 475 例的良性/阴性检查，13 例为 475 例的随访建议，42 例为活检建议。完成了 39 例活检，导致 12 例女性中的 13 例恶性肿瘤：7 例浸润性癌和 5 例导管原位癌。另一名患者在 6 个月随访时被诊断为浸润性导管癌。CDR 为 27.4/1000（475 例中有 13 例；95%置信区间，16.1 至 46.3）。浸润性癌的大小范围为 0.6-1.0cm（平均 0.5cm）。在接受腋窝手术评估的 7 名女性中，7 名患者的淋巴结均为阴性。在 1 年随访时无间期癌。
在致密乳腺女性中，DBT 后行简化乳腺筛查 AB-MR 的初步临床实施结果显示，患者水平的 CDR 为 27.4/1000。需要进一步评估。
