乳腺癌病史女性的简化筛查性 MRI：与全协议乳腺 MRI 的比较。

Abbreviated Screening MRI for Women with a History of Breast Cancer: Comparison with Full-Protocol Breast MRI.

机构信息

From the Department of Radiology (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.), Medical Research Collaborating Center (H.H.), Seoul National University Hospital, Seoul, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.Y.K., N.C., Y.L., H.Y., Y.S.K., A.R.P., S.M.H., S.H.L., J.M.C., W.K.M.).

出版信息

Radiology. 2022 Oct;305(1):36-45. doi: 10.1148/radiol.213310. Epub 2022 Jun 14.

DOI:10.1148/radiol.213310

PMID:35699580

Abstract

Background Few studies have compared abbreviated breast MRI with full-protocol MRI in women with a personal history of breast cancer (PHBC), and they have not adjusted for confounding variables. Purpose To compare abbreviated breast MRI with full-protocol MRI in women with PHBC by using propensity score matching to adjust for confounding variables. Materials and Methods In this single-center retrospective study, women with PHBC who underwent full-protocol MRI (January 2008-August 2017) or abbreviated MRI (September 2017-April 2019) were identified. With use of a propensity score-matched cohort, screening performances were compared between the two MRI groups with the McNemar test or a propensity score-adjusted generalized estimating equation. The coprimary analyses were sensitivity and specificity. The secondary analyses were the cancer detection rate, interval cancer rate, positive predictive value for biopsies performed (PPV3), and Breast Imaging Reporting and Data System (BI-RADS) category 3 short-term follow-up rate. Results There were 726 women allocated to each MRI group (mean age ± SD, 50 years ± 8 for both groups). Abbreviated MRI and full-protocol MRI showed comparable sensitivity (15 of 15 cancers [100%; 95% CI: 78, 100] vs nine of 13 cancers [69%; 95% CI: 39, 91], respectively; = .17). Abbreviated MRI showed higher specificity than full-protocol MRI (660 of 711 examinations [93%; 95% CI: 91, 95] vs 612 of 713 examinations [86%; 95% CI: 83, 88], respectively; < .001). The cancer detection rate (21 vs 12 per 1000 examinations), interval cancer rate (0 vs five per 1000 examinations), and PPV3 (61% [14 of 23 examinations] vs 41% [nine of 22 examinations]) were comparable (all < .05). The BI-RADS category 3 short-term follow-up rate of abbreviated MRI was less than half that of full-protocol MRI (5% [36 of 726 examinations] vs 12% [84 of 726 examinations], respectively; < .001). Ninety-three percent (14 of 15) of cancers detected at abbreviated MRI were node-negative T1-invasive cancers ( = 6) or ductal carcinoma in situ ( = 8). Conclusion Abbreviated breast MRI showed comparable sensitivity and superior specificity to full-protocol MRI in breast cancer detection in women with a personal history of breast cancer. © RSNA, 2022 .

摘要

背景很少有研究比较过有乳腺癌个人病史（PHBC）的女性中简化乳腺 MRI 与全协议 MRI，且这些研究并未针对混杂因素进行调整。

目的本研究旨在使用倾向评分匹配来调整混杂因素，比较 PHBC 女性中简化乳腺 MRI 与全协议 MRI 的检测性能。

材料与方法本单中心回顾性研究纳入了接受全协议 MRI（2008 年 1 月至 2017 年 8 月）或简化 MRI（2017 年 9 月至 2019 年 4 月）检查的 PHBC 女性。采用倾向评分匹配队列，使用 McNemar 检验或倾向评分调整的广义估计方程比较两组 MRI 的筛查性能。主要分析指标为敏感度和特异度。次要分析指标包括癌症检出率、间期癌发生率、活检阳性预测值（PPV3）和乳腺影像报告和数据系统（BI-RADS）类别 3 短期随访率。

结果两组 MRI 各有 726 例女性（平均年龄±标准差，两组均为 50 岁±8 岁）。简化 MRI 和全协议 MRI 的敏感度相当（15 例癌症均为 100%[95%CI：78%，100%]，13 例癌症中有 9 例为 69%[95%CI：39%，91%]； =.17）。简化 MRI 的特异度高于全协议 MRI（660 例检查中有 612 例为 93%[95%CI：91%，95%]，713 例检查中有 612 例为 86%[95%CI：83%，88%]； <.001）。癌症检出率（每 1000 例检查中 21 例 vs 12 例）、间期癌发生率（每 1000 例检查中 0 例 vs 5 例）和 PPV3（61%[23 例检查中的 14 例] vs 41%[22 例检查中的 9 例]）相当（均 <.05）。简化 MRI 的 BI-RADS 类别 3 短期随访率低于全协议 MRI（5%[726 例检查中的 36 例] vs 12%[726 例检查中的 84 例]； <.001）。简化 MRI 检出的 15 例癌症中，93%（14 例）为无淋巴结转移的 T1 期浸润性癌（ = 6）或导管原位癌（ = 8）。

结论在有乳腺癌个人病史的女性中，简化乳腺 MRI 的癌症检出敏感度与全协议 MRI 相当，而特异度更高。