Sitges Carla, Mann Ritse M
Department of Radiology, Imaging Diagnostic Center, Hospital Clínic Barcelona, Barcelona, Spain.
Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
J Magn Reson Imaging. 2025 Jul;62(1):58-72. doi: 10.1002/jmri.29716. Epub 2025 Jan 24.
Women with extremely dense breasts are at a higher risk of breast cancer, and the sensitivity of mammography in this group is reduced due to the masking effect of overlapping tissue. This review examines supplemental screening methods to improve detection in this population, with a focus on MRI. Morphologic techniques offer limited benefits, digital breast tomosynthesis (DBT) shows inconsistent results, and ultrasound (US), while improving cancer detection rates (CDR), results in a higher rate of false positives. Functional imaging techniques show better performance, molecular breast imaging increases CDR but is limited in availability, and contrast-enhanced mammography is promising, with good results and as an accessible technique, but requires further validation. MRI, with sensitivity ranging from 81% to 100%, is the most supported modality. Despite strong evidence for MRI in this population, high costs, use of contrast, and longer scan times hinder widespread use. Abbreviated MRI protocols aim to overcome these barriers by reducing costs and scan duration. As personalized screening becomes a future focus, MRI remains the most effective option for women with extremely dense breasts. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY: Stage 5.
乳房极度致密的女性患乳腺癌的风险更高，由于重叠组织的掩盖效应，该群体中乳腺钼靶检查的敏感性降低。本综述探讨了补充筛查方法以提高该人群的检测率，重点是磁共振成像（MRI）。形态学技术的益处有限，数字乳腺断层合成（DBT）结果不一，超声（US）虽然提高了癌症检测率（CDR），但假阳性率较高。功能成像技术表现更佳，分子乳腺成像提高了CDR，但可用性有限，对比增强乳腺钼靶检查前景良好，效果不错且是一种可及的技术，但需要进一步验证。MRI的敏感性在81%至100%之间，是最受支持的检查方式。尽管有强有力的证据支持在该人群中使用MRI，但高成本、使用造影剂以及较长的扫描时间阻碍了其广泛应用。简化的MRI方案旨在通过降低成本和缩短扫描时间来克服这些障碍。随着个性化筛查成为未来的重点，MRI仍然是乳房极度致密女性最有效的选择。证据级别：1 技术效能：5级
