Der Radiologe

, Volume 50, Issue 11, pp 955–963

Neues zum Hochrisikomammascreening

  • C.C. Riedl
  • L. Ponhold
  • R. Gruber
  • K. Pinker
  • T.H. Helbich
Leitthema

Zusammenfassung

Frauen mit erhöhtem Brustkrebsrisko benötigen ein frühzeitig einsetzendes und intensives Brustkrebsscreening. Ein solches Hochriskoscreening divergiert deutlich vom Brustkrebsscreening in der Normalbevölkerung. Nach Evaluierung des genauen Risikos durch einen Experten sollte, angepasst an die individuelle Risikokategorie, spätestens ab dem 30. Lebensjahr zumindest einmal pro Jahr eine Brust-MRT angeboten werden, ergänzende Mammographien erst ab dem 35. Lebensjahr. Die zusätzliche Ultraschalluntersuchung wird nicht mehr empfohlen. Um eine hohe Sensitivität und Spezifität zu gewährleisten, soll das Hochrisikoscreening ausschließlich in akkreditierten Brustzentren durchgeführt werden. Ausreichende Kenntnisse über die phänotypischen Eigenheiten des familiären Brustkrebses sind essenziell. Dazu gehören neben den herkömmlichen malignen Phänotypen eine häufig benigne imponierende Morphologie (runde oder ovale Form, glatte Begrenzung) und eine niedrige Prävalenz von Kalzifikationen. In der MRT-Bildgebung kommen häufig eine benigne Kontrastmittelkinetik sowie eine nicht solide Anreicherung mit fokalem, regionalem oder segmentalem Enhancement zur Darstellung.

Schlüsselwörter

Brustkrebs Screening MRT Breast-cancer-Gen (BRCA-Gen) Erhöhtes Risiko 

New information on high risk breast screening

Abstract

Women with an elevated risk for breast cancer require intensified screening beginning at an early age. Such high risk screening differs considerably from screening in the general population. After an expert has evaluated the exact risk a breast MRI examination should be offered at least once a year and beginning latest at the age of 30 depending on the patients risk category. Complementary mammograms should not be performed before the age of 35. An additional ultrasound examination is no longer recommended. To ensure a high sensitivity and specificity high risk screening should be performed only at a nationally or regionally approved and audited service. Adequate knowledge about the phenotypical characteristics of familial breast cancer is essential. Besides the common malignant phenotypes, benign morphologies (round or oval shape and smooth margins) as well as a low prevalence of calcifications have been described. Using MRI benign contrast media kinetics as well as non-solid lesions with focal, regional and segmental enhancement can often be visualized.

Keywords

Breast cancer Screening Magnetic resonance imaging BRCA genes High risk factors 

Literatur

  1. 1.
    American College of Radiology (ACR) (2004) Breast imaging and reporting data system (BI-RADS). 4th edn. ACR Education Center, Reston, USAGoogle Scholar
  2. 2.
    Berg WA, Blume JD, Cormack JB et al (2008) Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer. JAMA 299:2151–2163CrossRefPubMedGoogle Scholar
  3. 3.
    Brekelmans CT, Seynaeve C, Bartels CC et al (2001) Effectiveness of breast cancer surveillance in BRCA1/2 gene mutation carriers and women with high familial risk. J Clin Oncol 19:924–930PubMedGoogle Scholar
  4. 4.
    Claus EB, Risch N, Thompson WD (1994) Autosomal dominant inheritance of early-onset breast cancer. Implications for risk prediction. Cancer 73:643–651CrossRefPubMedGoogle Scholar
  5. 5.
    Gilbert FJ, Warren RM, Kwan-Lim G et al (2009) Cancers in BRCA1 and BRCA2 carriers and in women at high risk for breast cancer: MR imaging and mammographic features. Radiology 252:358–368CrossRefPubMedGoogle Scholar
  6. 6.
    Hendrick RE, Pisano ED, Averbukh A et al (2010) Comparison of acquisition parameters and breast dose in digital mammography and screen-film mammography in the American College of Radiology Imaging Network digital mammographic imaging screening trial. AJR Am J Roentgenol 194:362–369CrossRefPubMedGoogle Scholar
  7. 7.
    Humphrey LL, Helfand M, Chan BK et al (2002) Breast cancer screening: a summary of the evidence for the U.S. preventive services task force. Ann Intern Med 137:347–360PubMedGoogle Scholar
  8. 8.
    Kaas R, Kroger R, Hendriks JH et al (2004) The significance of circumscribed malignant mammographic masses in the surveillance of BRCA 1/2 gene mutation carriers. Eur Radiol 14:1647–1653CrossRefPubMedGoogle Scholar
  9. 9.
    Kolb TM, Lichy J, Newhouse JH (2002) Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations. Radiology 225:165–175CrossRefPubMedGoogle Scholar
  10. 10.
    Komenaka IK, Ditkoff BA, Joseph KA et al (2004) The development of interval breast malignancies in patients with BRCA mutations. Cancer 100:2079–2083CrossRefPubMedGoogle Scholar
  11. 11.
    Kriege M, Brekelmans CT, Boetes C et al (2004) Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. N Engl J Med 351:427–437CrossRefPubMedGoogle Scholar
  12. 12.
    Kuhl C, Weigel S, Schrading S et al (2010) Prospective multicenter cohort study to refine management recommendations for women at elevated familial risk of breast cancer: the EVA trial. J Clin Oncol 28:1450–1457CrossRefPubMedGoogle Scholar
  13. 13.
    Kuhl CK, Schmutzler RK, Leutner CC et al (2000) Breast MR imaging screening in 192 women proved or suspected to be carriers of a breast cancer susceptibility gene: preliminary results. Radiology 215:267–279PubMedGoogle Scholar
  14. 14.
    Kuhl CK, Schrading S, Leutner CC et al (2005) Mammography, breast ultrasound, and magnetic resonance imaging for surveillance of women at high familial risk for breast cancer. J Clin Oncol 23:8469–8476CrossRefPubMedGoogle Scholar
  15. 15.
    Leach MO, Boggis CR, Dixon AK et al (2005) Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of breast cancer: a prospective multicentre cohort study (MARIBS). Lancet 365:1769–1778CrossRefPubMedGoogle Scholar
  16. 16.
    Lehman CD, Blume JD, Weatherall P et al (2005) Screening women at high risk for breast cancer with mammography and magnetic resonance imaging. Cancer 103:1898–1905CrossRefPubMedGoogle Scholar
  17. 17.
    Pisano ED, Hendrick RE, Yaffe MJ et al (2008) Diagnostic accuracy of digital versus film mammography: exploratory analysis of selected population subgroups in DMIST. Radiology 246:376–383CrossRefPubMedGoogle Scholar
  18. 18.
    Riedl CC, Ponhold L, Flory D et al (2007) Magnetic resonance imaging of the breast improves detection of invasive cancer, preinvasive cancer, and premalignant lesions during surveillance of women at high risk for breast cancer. Clin Cancer Res 13:6144–6152CrossRefPubMedGoogle Scholar
  19. 19.
    Robson M, Offit K (2007) Clinical practice. Management of an inherited predisposition to breast cancer. N Engl J Med 357:154–162CrossRefPubMedGoogle Scholar
  20. 20.
    Sardanelli F, Boetes C, Borisch B et al (2010) Magnetic resonance imaging of the breast: recommendations from the EUSOMA working group. Eur J Cancer 46:1296–1316CrossRefPubMedGoogle Scholar
  21. 21.
    Sardanelli F, Podo F, D’Agnolo G et al (2007) Multicenter comparative multimodality surveillance of women at genetic-familial high risk for breast cancer (HIBCRIT study): interim results. Radiology 242:698–715CrossRefPubMedGoogle Scholar
  22. 22.
    Saslow D, Boetes C, Burke W et al (2007) American cancer society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin 57:75–89CrossRefPubMedGoogle Scholar
  23. 23.
    Schrading S, Kuhl CK (2008) Mammographic, US, and MR imaging phenotypes of familial breast cancer. Radiology 246:58–70PubMedGoogle Scholar
  24. 24.
    Sickles EA (1994) Nonpalpable, circumscribed, noncalcified solid breast masses: likelihood of malignancy based on lesion size and age of patient. Radiology 192:439–442PubMedGoogle Scholar
  25. 25.
    Sim LS, Hendriks JH, Bult P et al (2005) US correlation for MRI-detected breast lesions in women with familial risk of breast cancer. Clin Radiol 60:801–806CrossRefPubMedGoogle Scholar
  26. 26.
    Stoutjesdijk MJ, Boetes C, Jager GJ et al (2001) Magnetic resonance imaging and mammography in women with a hereditary risk of breast cancer. J Natl Cancer Inst 93:1095–1102CrossRefPubMedGoogle Scholar
  27. 27.
    Tilanus-Linthorst MM, Obdeijn IM, Bartels KC et al (2000) First experiences in screening women at high risk for breast cancer with MR imaging. Breast Cancer Res Treat 63:53–60CrossRefPubMedGoogle Scholar
  28. 28.
    Veltman J, Mann R, Kok T et al (2008) Breast tumor characteristics of BRCA1 and BRCA2 gene mutation carriers on MRI. Eur Radiol 18:931–938CrossRefPubMedGoogle Scholar
  29. 29.
    Warner E, Plewes DB, Hill KA et al (2004) Surveillance of BRCA1 and BRCA2 mutation carriers with magnetic resonance imaging, ultrasound, mammography, and clinical breast examination. JAMA 292:1317–1325CrossRefPubMedGoogle Scholar
  30. 30.
    Weinstein SP, Localio AR, Conant EF et al (2009) Multimodality screening of high-risk women: a prospective cohort study. J Clin Oncol 27:6124–612CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • C.C. Riedl
    • 1
  • L. Ponhold
    • 1
  • R. Gruber
    • 1
  • K. Pinker
    • 1
  • T.H. Helbich
    • 1
  1. 1.Abteilung für Allgemeine Radiologie und Kinderradiologie, Division für Molekulare und Gender-Bildgebung, Universitätsklinik für RadiodiagnostikMedizinische Universität WienWienÖsterreich

Personalised recommendations