North Bristol NHS Trust, Southmead Hospital, Southmead Road, Westbury on Trym, Bristol, BS10 5NB, UK.
North Bristol NHS Trust, Southmead Hospital, Southmead Road, Westbury on Trym, Bristol, BS10 5NB, UK.
Clin Radiol. 2021 Feb;76(2):154.e11-154.e22. doi: 10.1016/j.crad.2020.08.032. Epub 2020 Sep 30.
To synthesise evidence comparing abbreviated breast magnetic resonance imaging (abMRI) to full-protocol MRI (fpMRI) in breast cancer screening.
A systematic search was undertaken in multiple databases. Cohort studies without enrichment, presenting accuracy data of abMRI in screening, for any level of risk (population, moderate, high risk) were included. Level of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Meta-analyses (bivariate random effects model) were performed for abMRI, with fpMRI and histology from fpMRI-positive cases as reference standard, and with follow-up to symptomatic detection added to the fpMRI. The review also covers evidence comparing abMRI with mammographic techniques.
The title and abstract review retrieved 23 articles. Five studies (six articles) were included (2,763 women, 3,251 screening rounds). GRADE assessment of the evidence was very low because the reference standard was interpreted with knowledge of the index test and biopsy was not obtained for all abMRI positives. The overall sensitivity for abMRI, with fpMRI (and histology for fpMRI positives) as reference standard, was 94.8% (95% confidence interval [CI] 85.5-98.2) and specificity as 94.6% (95% CI: 91.5-96.6). Three studies (1,450 women, 1,613 screening rounds) presented follow-up data, enabling comparison between abMRI and fpMRI. Sensitivities and specificities for abMRI did not differ significantly from those for fpMRI (p=0.83 and p=0.37, respectively).
A very low level of evidence suggests abMRI could be accurate for breast cancer screening. Research is required, with follow-up to interval cancer, to determine the effect its use could have on clinical outcome.
综合比较乳腺癌筛查中简化乳腺磁共振成像（abMRI）与全协议磁共振成像（fpMRI）的证据。
在多个数据库中进行了系统搜索。纳入了无富集的队列研究，这些研究报告了筛查中 abMRI 的准确性数据，适用于任何风险水平（人群、中度、高风险）。使用推荐评估、制定和评估（GRADE）的分级来评估证据水平。对 abMRI 进行了荟萃分析（双变量随机效应模型），以 fpMRI 和 fpMRI 阳性病例的组织学作为参考标准，并将 fpMRI 后的症状检测结果添加到分析中。该综述还涵盖了比较 abMRI 与乳腺 X 线摄影技术的证据。
标题和摘要的审查共检索到 23 篇文章。有 5 项研究（共 6 篇文章）入选（2763 名女性，3251 个筛查轮次）。由于参考标准是在了解指数试验的情况下进行解释的，并且并非对所有 abMRI 阳性病例都进行了活检，因此对证据的 GRADE 评估非常低。以 fpMRI（以及 fpMRI 阳性病例的组织学）作为参考标准，abMRI 的总体敏感性为 94.8%（95%置信区间[CI]：85.5-98.2），特异性为 94.6%（95%CI：91.5-96.6）。有 3 项研究（1450 名女性，1613 个筛查轮次）提供了随访数据，使 abMRI 与 fpMRI 之间能够进行比较。abMRI 的敏感性和特异性与 fpMRI 无显著差异（p=0.83 和 p=0.37）。
非常低水平的证据表明，abMRI 可能对乳腺癌筛查准确。需要进行研究，随访间隔癌，以确定其使用对临床结果的影响。
