Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of breast cancer: a prospective multicentre cohort study (MARIBS)

被引:785
作者
Leach, MO [1 ]
Boggis, CRM [1 ]
Dixon, AK [1 ]
Easton, DF [1 ]
Eeles, RA [1 ]
Evans, DGR [1 ]
Gilbert, FF [1 ]
Griebsch, I [1 ]
Hoff, RJC [1 ]
Kessar, P [1 ]
Lakhani, SR [1 ]
Moss, SM [1 ]
Nerurkar, A [1 ]
Padhani, AR [1 ]
Pointon, LJ [1 ]
Thompson, D [1 ]
Warren, RML [1 ]
机构
[1] Inst Canc Res, Sect Magnet Resonance, MARIBS Study Off, Sutton SM2 5PT, Surrey, England
基金
英国医学研究理事会;
关键词
D O I
10.1016/S0140-6736(05)66481-1
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Women genetically predisposed to breast cancer often develop the disease at a young age when dense breast tissue reduces the sensitivity of X-ray mammography. Our aim was, therefore, to compare contrast enhanced magnetic resonance imaging (CE MRI) with mammography for screening. Methods We did a prospective multicentre cohort study in 649 women aged 35-49 years with a strong family history of breast cancer or a high probability of a BRCA1, BRCA2, or TP53 mutation. We recruited participants from 22 centres in the UK, and offered the women annual screening with CE MRI and mammography for 2-7 years. Findings We diagnosed 35 cancers in the 649 women screened with both mammography and CE MRI (1881 screens): 19 by CE MRI only, six by mammography only, and eight by both, with two interval cases. Sensitivity was significantly higher for CE MRI (77%, 95% CI 60-90) than for mammography (40%, 24-58; p=0.01), and was 94% (81-99) when both methods were used. Specificity was 93% (92-95) for mammography, 81% (80-83) for CE MRI (p<0.0001), and 77% (75-79) with both methods. The difference between CE MRI and mammography sensitivities was particularly pronounced in BRCA1 carriers (13 cancers; 92% vs 23%, p=0.004). Interpretation Our findings indicate that CE MRI is more sensitive than mammography for cancer detection. Specificity for both procedures was acceptable. Despite a high proportion of grade 3 cancers, tumours were small and few women were node positive. Annual screening, combining CE MRI and mammography, would detect most tumours in this risk group.
引用
收藏
页码:1769 / 1778
页数:10
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