Bick Ulrich
Klinik für Radiologie, CCM, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
Radiologe. 2021 Feb;61(2):150-158. doi: 10.1007/s00117-020-00797-w. Epub 2021 Jan 12.
Specialized breast cancer early detection programs with magnetic resonance imaging (MRI) in high-risk patients are by now well established in several countries. In Germany, such a program has been running as part of routine care since 2005.
This review article will summarize current developments in high-risk screening with MRI.
Experiences with the high-risk screening program in Germany over now more than 10 years as well as a review of the current literature will form the basis for this article.
The MRI of the breast is by far the most sensitive imaging modality for the detection of breast cancer and represents the back bone of high-risk screening. More than 90% of cancers detected at high-risk screening are visible on the MRI and more than 30% of cancers are detected primarily by MRI alone. However, a prerequisite for effective screening with MRI is a sufficiently high breast cancer incidence in the screened population. This is demonstrated by the fact that the positive predictive value of screening with MRI in women without a BRCA1/2 mutation in the age group between 30 and 39 years is unacceptably low with 2.9%.
In high-risk screening, MRI is the primary imaging tool with mammography and/or ultrasound added as adjunct if necessary. In women with a strong family history of breast cancer but no proven pathogenic mutation in one of the known risk genes in the index patient in the family, the high-risk screening should not routinely start at age 30, but should be postponed until the 10-year breast cancer risk passes a threshold of 5%.
在高危患者中采用磁共振成像（MRI）的专门乳腺癌早期检测项目目前在多个国家已得到充分确立。在德国，自2005年起这样一个项目就已作为常规医疗的一部分开展。
这篇综述文章将总结MRI高危筛查的当前进展。
德国高危筛查项目超过10年的经验以及对当前文献的综述将构成本文的基础。
乳腺MRI是目前检测乳腺癌最敏感的成像方式，是高危筛查的支柱。在高危筛查中检测出的癌症，超过90%在MRI上可见，超过30%的癌症主要通过MRI单独检测出。然而，用MRI进行有效筛查的一个前提是被筛查人群中有足够高的乳腺癌发病率。这一点从以下事实得到证明：在30至39岁年龄组中无BRCA1/2突变的女性中，MRI筛查的阳性预测值低至2.9%，令人无法接受。
在高危筛查中，MRI是主要的成像工具，必要时可增加乳腺X线摄影和/或超声作为辅助手段。对于有强烈乳腺癌家族史但家族中索引患者已知风险基因中无已证实致病突变的女性，高危筛查不应常规从30岁开始，而应推迟到10年乳腺癌风险超过5%的阈值时。
