Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA, USA.
J Natl Cancer Inst. 2024 Feb 8;116(2):249-257. doi: 10.1093/jnci/djad201.
Examining screening outcomes by breast density for breast magnetic resonance imaging (MRI) with or without mammography could inform discussions about supplemental MRI in women with dense breasts.
We evaluated 52 237 women aged 40-79 years who underwent 2611 screening MRIs alone and 6518 supplemental MRI plus mammography pairs propensity score-matched to 65 810 screening mammograms. Rates per 1000 examinations of interval, advanced, and screen-detected early stage invasive cancers and false-positive recall and biopsy recommendation were estimated by breast density (nondense = almost entirely fatty or scattered fibroglandular densities; dense = heterogeneously/extremely dense) adjusting for registry, examination year, age, race and ethnicity, family history of breast cancer, and prior breast biopsy.
Screen-detected early stage cancer rates were statistically higher for MRI plus mammography vs mammography for nondense (9.3 vs 2.9; difference = 6.4, 95% confidence interval [CI] = 2.5 to 10.3) and dense (7.5 vs 3.5; difference = 4.0, 95% CI = 1.4 to 6.7) breasts and for MRI vs MRI plus mammography for dense breasts (19.2 vs 7.5; difference = 11.7, 95% CI = 4.6 to 18.8). Interval rates were not statistically different for MRI plus mammography vs mammography for nondense (0.8 vs 0.5; difference = 0.4, 95% CI = -0.8 to 1.6) or dense breasts (1.5 vs 1.4; difference = 0.0, 95% CI = -1.2 to 1.3), nor were advanced cancer rates. Interval rates were not statistically different for MRI vs MRI plus mammography for nondense (2.6 vs 0.8; difference = 1.8 (95% CI = -2.0 to 5.5) or dense breasts (0.6 vs 1.5; difference = -0.9, 95% CI = -2.5 to 0.7), nor were advanced cancer rates. False-positive recall and biopsy recommendation rates were statistically higher for MRI groups than mammography alone.
MRI screening with or without mammography increased rates of screen-detected early stage cancer and false-positives for women with dense breasts without a concomitant decrease in advanced or interval cancers.
通过对接受乳腺磁共振成像（MRI）检查的女性进行乳腺密度筛查结果进行评估，或结合乳腺 X 线摄影检查，可为致密型乳腺女性补充 MRI 检查提供参考依据。
我们评估了 52237 名年龄在 40-79 岁之间的女性，她们单独接受了 2611 次筛查性 MRI 检查，以及 6518 次补充性 MRI 检查联合乳腺 X 线摄影检查，并与 65810 次筛查性乳腺 X 线摄影检查进行了倾向评分匹配。通过乳腺密度（非致密型=几乎完全为脂肪或散在纤维腺体密度；致密型=不均匀/非常致密），调整登记、检查年份、年龄、种族和民族、乳腺癌家族史和既往乳腺活检等因素，估计每 1000 次检查的间隔期、进展期和筛查检出的早期浸润性癌症以及假阳性召回和活检推荐的发生率。
与单独接受乳腺 X 线摄影检查相比，致密型乳腺女性接受 MRI 联合乳腺 X 线摄影检查的筛查检出早期癌症的发生率更高（9.3 比 2.9；差异=6.4，95%置信区间[CI]为 2.5 至 10.3）和非致密型乳腺（7.5 比 3.5；差异=4.0，95%CI 为 1.4 至 6.7），而致密型乳腺女性接受 MRI 检查的筛查检出早期癌症的发生率也高于 MRI 联合乳腺 X 线摄影检查（19.2 比 7.5；差异=11.7，95%CI 为 4.6 至 18.8）。与单独接受乳腺 X 线摄影检查相比，MRI 联合乳腺 X 线摄影检查在非致密型乳腺（0.8 比 0.5；差异=0.4，95%CI 为-0.8 至 1.6）或致密型乳腺（1.5 比 1.4；差异=0.0，95%CI 为-1.2 至 1.3）中，间隔期癌症的发生率并无统计学差异，进展期癌症的发生率也没有差异。与单独接受乳腺 X 线摄影检查相比，MRI 检查在非致密型乳腺（2.6 比 0.8；差异=1.8（95%CI 为-2.0 至 5.5）或致密型乳腺（0.6 比 1.5；差异=-0.9，95%CI 为-2.5 至 0.7）中，间隔期癌症的发生率也没有统计学差异，进展期癌症的发生率也没有差异。MRI 组的假阳性召回和活检推荐率明显高于单独接受乳腺 X 线摄影检查组。
对于致密型乳腺女性，与单独接受乳腺 X 线摄影检查相比，MRI 筛查联合或不联合乳腺 X 线摄影检查可提高筛查检出早期癌症和假阳性的发生率，而不会导致进展期或间隔期癌症的发生率相应降低。
