Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104.
AJR Am J Roentgenol. 2024 Jul;223(1):e2431098. doi: 10.2214/AJR.24.31098. Epub 2024 May 22.
Abbreviated breast MRI (AB-MRI) achieves a higher cancer detection rate (CDR) than digital breast tomosynthesis when applied for baseline (i.e., first-round) supplemental screening of individuals with dense breasts. Limited literature has evaluated subsequent (i.e., sequential) AB-MRI screening rounds. This study aimed to compare outcomes between baseline and subsequent rounds of screening AB-MRI in individuals with dense breasts who otherwise had an average risk for breast cancer. This retrospective study included patients with dense breasts who otherwise had an average risk for breast cancer and underwent AB-MRI for supplemental screening between December 20, 2016, and May 10, 2023. The clinical interpretations and results of recommended biopsies for AB-MRI examinations were extracted from the EMR. Baseline and subsequent-round AB-MRI examinations were compared. The final sample included 2585 AB-MRI examinations (2007 baseline and 578 subsequent-round examinations) performed for supplemental screening of 2007 women (mean age, 57.1 years old) with dense breasts. Of 2007 baseline examinations, 1658 (82.6%) were assessed as BI-RADS category 1 or 2, 171 (8.5%) as BI-RADS category 3, and 178 (8.9%) as BI-RADS category 4 or 5. Of 578 subsequent-round examinations, 533 (92.2%) were assessed as BI-RADS category 1 or 2, 20 (3.5%) as BI-RADS category 3, and 25 (4.3%) as BI-RADS category 4 or 5 ( < .001). The abnormal interpretation rate (AIR) was 17.4% (349/2007) for baseline examinations versus 7.8% (45/578) for subsequent-round examinations ( < .001). For baseline examinations, PPV2 was 21.3% (38/178), PPV3 was 26.6% (38/143), and the CDR was 18.9 cancers per 1000 examinations (38/2007). For subsequent-round examinations, PPV2 was 28.0% (7/25) ( = .45), PPV3 was 29.2% (7/24) ( = .81), and the CDR was 12.1 cancers per 1000 examinations (7/578) ( = .37). All 45 cancers diagnosed by baseline or subsequent-round AB-MRI were stage 0 or 1. Seven cancers diagnosed by subsequent-round AB-MRI had a mean interval of 872 ± 373 (SD) days since prior AB-MRI and node-negative status at surgical axillary evaluation; six had an invasive component, all measuring 1.2 cm or less. Subsequent rounds of AB-MRI screening of individuals with dense breasts had lower AIR than baseline examinations while maintaining a high CDR. All cancers detected by subsequent-round examinations were early-stage node-negative cancers. The findings support sequential AB-MRI for supplemental screening in individuals with dense breasts. Further investigations are warranted to optimize the screening interval.
与数字乳腺断层合成术相比，在致密乳腺的个体中进行基线（即首轮）补充筛查时，缩短型乳腺 MRI（AB-MRI）的癌症检出率（CDR）更高。有限的文献评估了后续（即连续）AB-MRI 筛查轮次。本研究旨在比较致密乳腺中平均乳腺癌风险个体的基线和后续 AB-MRI 筛查轮次之间的结果。本回顾性研究纳入了平均乳腺癌风险的致密乳腺患者，并于 2016 年 12 月 20 日至 2023 年 5 月 10 日期间接受 AB-MRI 进行补充筛查。从 EMR 中提取 AB-MRI 检查的临床解释和推荐活检结果。比较了基线和后续轮次的 AB-MRI 检查。最终样本包括 2585 次 AB-MRI 检查（2007 年基线和 578 次后续轮次检查），用于 2007 名（平均年龄 57.1 岁）致密乳腺女性的补充筛查。在 2007 年的基线检查中，1658 次（82.6%）评估为 BI-RADS 类别 1 或 2，171 次（8.5%）为 BI-RADS 类别 3，178 次（8.9%）为 BI-RADS 类别 4 或 5。在 578 次后续轮次检查中，533 次（92.2%）评估为 BI-RADS 类别 1 或 2，20 次（3.5%）为 BI-RADS 类别 3，25 次（4.3%）为 BI-RADS 类别 4 或 5（<0.001）。基线检查的异常解释率（AIR）为 17.4%（349/2007），后续轮次检查的 AIR 为 7.8%（45/578）（<0.001）。对于基线检查，PPV2 为 21.3%（38/178），PPV3 为 26.6%（38/143），CDR 为每 1000 次检查 18.9 例癌症（38/2007）。对于后续轮次检查，PPV2 为 28.0%（7/25）（=0.45），PPV3 为 29.2%（7/24）（=0.81），CDR 为每 1000 次检查 12.1 例癌症（7/578）（=0.37）。通过基线或后续轮次 AB-MRI 诊断的所有 45 例癌症均为 0 期或 1 期。在后续轮次 AB-MRI 诊断的 7 例癌症中，自上次 AB-MRI 以来的平均间隔时间为 872±373（SD）天，且手术腋窝评估时淋巴结阴性；其中 6 例有浸润成分，均为 1.2 厘米或更小。与基线检查相比，致密乳腺个体后续轮次 AB-MRI 筛查的 AIR 较低，同时保持较高的 CDR。通过后续轮次检查发现的所有癌症均为早期、淋巴结阴性的癌症。这些发现支持在致密乳腺患者中进行连续 AB-MRI 补充筛查。需要进一步研究以优化筛查间隔。
