磁共振成像在乳腺癌影像学筛查中的应用:2010 ACR与SBI乳腺影像学筛查实践指南解读

Application of breast MRI in breast cancer screening:interpretation of the latest breast imaging screening guideline issued by ACR & SBI in 2010

影像学能够在临床出现可触及肿块之前早期发现乳腺癌已经成为不争的事实。在多种影像学检查中,乳腺X线摄影是惟一被偱证研究证实的能够早期发现乳腺癌而降低死亡率的影像学方法,但由于存在局限性,因而近年来大量临床研究致力于评估乳腺磁共振成像及乳腺超声在乳腺癌筛查中应用的可行性和效能。为进一步提高乳腺癌早期检出率,乳腺癌筛查方案日趋多样化和复杂化。2010年美国放射学院与乳腺影像协会的专家们在综合回顾了大量临床证据,包括最新的临床试验结果的基础上制定了新的乳腺癌影像学筛查指南,针对不同乳腺癌发生的危险性对各种影像学方法筛查的实施和所适应的人群提出了建议,特别是明确提出了乳腺MRI筛查主要用于特定的高危人群。本文以磁共振影像为核心,就该指南的内容及相关偱证资料、理论知识予以介绍,并提出了作者的认识和思考供读者参考。

It is well demonstrated that breast cancer is able to be early detected by imaging before palpated.Among all breast imaging modalities,mammography screening is the solely one that was demonstrated to reduce mortality of breast cancer.However,it is not perfect.Due to limitations of mammography,there have been many investigations to explore feasibility and validity of breast imaging beyond mammography,such as ultrasound and MRI.Consequently,screening protocols are getting more variable and complex.In 2010,American College of Radiology and Society of Breast Imaging updated the guideline of imaging screening,on the bases of board review of existed evidence and expertise consensus.Recommendations on screening using Mammography,Ultrasound and MRI according to breast cancer risk evaluation of women were issued.Specifically,breast MRI screening should be limited in high risk women.This article interpret the guideline,illustrate the contents,provide relevant evidence and knowledge and address some important points with authors sight,in order to help in Chinese medical practice.