期刊
INVESTIGATIVE RADIOLOGY
卷 46, 期 2, 页码 94-105出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/RLI.0b013e3181f3fcdf
关键词
breast neoplasms; BRCA1-2; high risk of breast cancer; magnetic resonance imaging (MRI); mammography; ultrasonography
资金
- Italian Ministry of Health
- Ricerca Finalizzata [98/JT/T]
- Istituto Superiore di Sanita
- Ricerca Corrente [C3A3/2004]
- Rete Solidale e Collaborazioni Internazionali (ISS per ACC)
Objectives: To prospectively compare clinical breast examination, mammography, ultrasonography, and contrast-enhanced magnetic resonance imaging (MRI) in a multicenter surveillance of high-risk women. Materials and Methods: We enrolled asymptomatic women aged >= 25: BRCA mutation carriers; first-degree relatives of BRCA mutation carriers, and women with strong family history of breast/ovarian cancer, including those with previous personal breast cancer. Results: A total of 18 centers enrolled 501 women and performed 1592 rounds (3.2 rounds/woman). Forty-nine screen-detected and 3 interval cancers were diagnosed: 44 invasive, 8 ductal carcinoma in situ; only 4 pT2 stage; 32 G3 grade. Of 39 patients explored for nodal status, 28 (72%) were negative. Incidence per year-woman resulted 3.3% overall, 2.1% <50, and 5.4% >50 years (P < 0.001), 4.3% in women with previous personal breast cancer and 2.5% in those without (P = 0.045). MRI was more sensitive (91%) than clinical breast examination (18%), mammography (50%), ultrasonography (52%), or mammography plus ultrasonography (63%) (P < 0.001). Specificity ranged 96% to 99%, positive predictive value 53% to 71%, positive likelihood ratio 24 to 52 (P not significant). MRI showed significantly better negative predictive value (99.6) and negative likelihood ratio (0.09) than those of the other modalities. At receiver operating characteristic analysis, the area under the curve of MRI (0.97) was significantly higher than that of mammography (0.83) or ultrasonography (0.82) and not significantly increased when MRI was combined with mammography and/or ultrasonography. Of 52 cancers, 16 (31%) were diagnosed only by MRI, 8 of 21 (38%) in women < 50, and 8 of 31 (26%) in women >= 50 years of age. Conclusion: MRI largely outperformed mammography, ultrasonography, and their combination for screening high-risk women below and over 50.
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