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La radiologia medica

, Volume 121, Issue 11, pp 834–837 | Cite as

Mammography and MRI for screening women who underwent chest radiation therapy (lymphoma survivors): recommendations for surveillance from the Italian College of Breast Radiologists by SIRM

  • Giovanna Mariscotti
  • Paolo Belli
  • Daniela Bernardi
  • Beniamino Brancato
  • Massimo Calabrese
  • Luca A. Carbonaro
  • Beatrice Cavallo-Marincola
  • Francesca Caumo
  • Paola Clauser
  • Laura Martinchich
  • Stefania Montemezzi
  • Pietro Panizza
  • Federica Pediconi
  • Alberto Tagliafico
  • Rubina M. Trimboli
  • Chiara Zuiani
  • Francesco Sardanelli
BREAST RADIOLOGY

Abstract

Women who underwent chest radiation therapy (CRT) during pediatric/young-adult age (typically, lymphoma survivors) have an increased breast cancer risk, in particular for high doses. The cumulative incidence from 40 to 45 years of age is 13–20 %, similar to that of BRCA mutation carriers for whom contrast-enhanced magnetic resonance imaging (MRI) is recommended. However, in women who underwent CRT, MRI sensitivity is lower (63–80 %) and that of mammography higher (67–70 %) than those observed in women with hereditary predisposition, due to a higher incidence of ductal carcinoma in situ with microcalcifications and low neoangiogenesis. A sensitivity close to 95 % can be obtained only using mammography as an adjunct to MRI. Considering the available evidence, women who underwent CRT before 30 receiving a cumulative dose ≥10 Gy should be invited after 25 (or, at least, 8 years after CRT) to attend the following program: 1. interview about individual risk profile and potential of breast imaging; 2. annual MRI using the same protocol recommended for women with hereditary predisposition; 3. annual bilateral two-view full-field digital mammography or digital breast tomosynthesis (DBT) with synthetic 2D reconstructions. Mammography and MRI can be performed at once or alternately every 6 months. In the case of MRI or contrast material contraindications, ultrasound will be performed instead of MRI. Reporting using BI-RADS is recommended. At the age for entering population screening, the individual risk profile will be discussed with the woman about opting for only mammography/DBT screening or for continuing the intensive protocol.

Keywords

Breast cancer Screening Lymphoma survivors MRI 

Riassunto

Le donne sottoposte a radioterapia toracica (RTT) in età pediatrica o giovane-adulta, tipicamente per linfoma di Hodgkin, hanno un rischio aumentato di sviluppare tumore mammario (TM), in particolare quelle trattate con RTT ad alte dosi. L’incidenza cumulativa di TM tra 40 e 45 anni è del 13–20 %, simile a quella delle donne BRCA mutate, per le quali è ormai consolidata l’indicazione alla risonanza magnetica (RM) con mezzo di contrasto (MdC) annuale. Tuttavia, rispetto agli studi di screening delle donne ad elevato rischio eredo-familiare, nelle donne sottoposte a RTT si è osservata una sensibilità relativamente maggiore della mammografia e relativamente minore della RM con MdC, correlate alla maggiore incidenza di carcinoma duttale in situ con microcalcificazioni e minore neoangiogenesi. Sulla base dell’evidenza disponibile, le donne sottoposte a RTT prima dei 30 anni di età con dose cumulativa ≥10 Gy dovrebbero essere invitate a partire dai 25 anni o almeno da 8 anni dopo la RTT a partecipare a un programma di sorveglianza che preveda: 1. colloquio informativo finalizzato all’informazione della donna sul proprio livello di rischio correlato alla RTT e ad eventuali altri fattori e sul potenziale delle tecniche di imaging; 2. RM con MdC bilaterale annuale con il medesimo protocollo raccomandato per lo screening delle donne ad elevato rischio eredo-familiare; 3. mammografia digitale bilaterale annuale o tomosintesi con ricostruzioni 2D (proiezioni cranio-caudale e medio-laterale obliqua). Mammografia e RM possono essere eseguite contestualmente o alternate a cadenza semestrale. Reperti ed indagini mammografiche e RM saranno classificati secondo la scala categoriale BI-RADS. Nel caso di controindicazioni alla RM o alla somministrazione di MdC paramagnetico, sarà eseguita ecografia mammaria bilaterale anche in presenza di mammografia negativa, contestualmente alla mammografia o con alternanza semestrale. Al raggiungimento dell’età per l’invito ai programmi di screening organizzato, il profilo di rischio della donna sarà rivalutato e discusso al fine di decidere se optare per l’adesione al protocollo di screening basato su mammografia (eventualmente tomosintesi) annuale o biennale o per la prosecuzione dello screening intensivo con mammografia e RM annuali. Si raccomanda che il presente protocollo di sorveglianza sia effettuato presso centri di radiologia senologica che rispettino i requisiti quali/quantitativi definiti da linee-guida internazionali e che tutti i dati relativi all’applicazione del protocollo, ivi compresi i cancri d’intervallo, siano raccolti mediante database informatizzato al fine di consentire analisi di performance diagnostica e di efficacia su scala multicentrica.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare no funding and no conflict of interest for this article.

Ethical statement

This article does not contain any studies with human participants or animals performed by any of the authors.

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Copyright information

© Italian Society of Medical Radiology 2016

Authors and Affiliations

  • Giovanna Mariscotti
    • 1
  • Paolo Belli
    • 2
  • Daniela Bernardi
    • 3
  • Beniamino Brancato
    • 4
  • Massimo Calabrese
    • 5
  • Luca A. Carbonaro
    • 6
  • Beatrice Cavallo-Marincola
    • 7
  • Francesca Caumo
    • 8
  • Paola Clauser
    • 9
    • 10
  • Laura Martinchich
    • 11
  • Stefania Montemezzi
    • 12
  • Pietro Panizza
    • 13
  • Federica Pediconi
    • 7
  • Alberto Tagliafico
    • 14
  • Rubina M. Trimboli
    • 6
  • Chiara Zuiani
    • 10
  • Francesco Sardanelli
    • 6
    • 15
  1. 1.Radiologia 1U, Dipartimento di Diagnostica per Immagini, A. O. U. Città della Salute e della Scienza di TorinoUniversità di TorinoTurinItaly
  2. 2.Dipartimento di Scienze RadiologicheUniversità Cattolica del Sacro CuoreRomeItaly
  3. 3.U.O. Senologia Clinica e Screening Mammografico, Dipartimento di Radiologia, APSSCentro per i Servizi SanitariTrentoItaly
  4. 4.Istituto per lo Studio e la Prevenzione Oncologica (ISPO)FlorenceItaly
  5. 5.UOC Senologia DiagnosticaIRCCS AOU San Martino-ISTGenoaItaly
  6. 6.Unit of RadiologyIRCCS Policlinico San DonatoSan Donato MilaneseItaly
  7. 7.Dipartimento di Scienze Radiologiche, Oncologiche ed Anatomo-patologiche, Policlinico Umberto ISapienza Università di RomaRomeItaly
  8. 8.UOSD Breast Unit ULSS20VeronaItaly
  9. 9.Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender ImagingMedical University of Vienna/Vienna General HospitalViennaAustria
  10. 10.Institute of RadiologyUniversity of UdineUdineItaly
  11. 11.Unit of RadiologyInstitute for Cancer Research and Treatment (IRCC)-FPOCandiolo, TurinItaly
  12. 12.DAI Patologia e DiagnosticaAzienda Ospedaliera Universitaria IntegrataVeronaItaly
  13. 13.U.O. Radiologia SenologicaIRCCS Ospedale San RaffaeleMilanItaly
  14. 14.Department of Experimental Medicine, DIMES, Institute of AnatomyUniversity of GenovaGenoaItaly
  15. 15.Unit of Radiology, IRCCS Policlinico San Donato, Department of Biomedical Sciences for HealthUniversità degli Studi di MilanoSan Donato MilaneseItaly

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