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【medical-news】筛查乳腺癌是MRI好?还是钼靶好?

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这个帖子发布于13年零247天前,其中的信息可能已发生改变或有所发展。
Debate Heats Up Over Breast MRI vs Mammogram



June 28, 2007 (Chicago) — Deliberations over breast cancer screening are back in the news again after German researchers at the American Society of Clinical Oncology 43rd Annual Meeting presented data in favor of magnetic resonance imaging (MRI). "MRI has been in the news a lot lately," moderator Julie Gralow, MD, from the University of Washington in Seattle, said during a press briefing. "A lot of women are asking us, should I be getting an MRI?"

New American Cancer Society screening guidelines recommend MRI for women at the highest risk for breast cancer. And data published in a recent New England Journal of Medicine paper seemed to stack up in favor of MRI, suggesting that screening at the time of diagnosis of 1 breast cancer can lead to finding a second breast cancer (Lehman CD et al. New Engl J Med 2007;356:1295-1303.)

But not everyone has been as enthusiastic about breast MRI. The latest National Comprehensive Cancer Network (NCCN) guidelines caution against relying too heavily on MRI and using laboratory testing as the sole determinant for therapy. Presenting at the group's annual meeting in March and reported at the time by Medscape, Beryl McCormick, MD, from the Memorial Sloan-Kettering Cancer Center, in New York, spoke of the challenges of MRI screening.

"Unfortunately, not all breast MRIs are created equal," Dr. McCormick said. "We are seeing an increasing number of newly diagnosed breast cancer cases at Memorial who come in with MRIs performed outside. Most are not of use to us, and a radiologist won't even read them," she said. "We want to emphasize that MRI is an adjunct to other breast imaging and should not be used in place of standard breast imaging with mammography and ultrasound," Dr. McCormick suggested. "There's no population-based screening information on the use of MRI; it's not for that."

Lack of Standardization in MRI a Key Barrier

Dr. Gralow agreed that standardization in breast MRI has been a problem. "It's a great tool in the right hands, but we don't yet have the quality control as we do for screening mammography. We hope soon to have at least a partial rectification of this," she said. The American College of Radiology is currently putting together a voluntary accreditation program and, within the next year or so, is planning to initiate standards at a number of centers. "I think it would be fair to say that programs that take this are at least attempting to create a standard with reproducible results," Dr. Gralow said.

At the NCCN meeting, Dr. McCormick said that MRI could be helpful in evaluating the extent of biopsy-proven invasive lobular cancer, which can be difficult to define on mammogram and ultrasound. And in cases where recurrence is suspected and the mammogram is inconclusive, an MRI may help.

But in Germany, MRI screening is reaching new heights. Highly standardized and more widely accepted, Dr. Gralow says it is not surprising that researchers there have been able to present such a compelling case in favor of MRI. Mammography highlights calcifications around ductal carcinoma in situ, while MRI detects areas of increased vascularization, a process more commonly found around high-grade carcinomas.

During a news conference presenting the findings, lead investigator Christiane Kuhl, MD, from the University of Bonn, in Germany, pointed out that with growing concern about overdiagnosis and unnecessary treatments in women with lesions that may never progress to cancer, MRI offers interesting potential.

Dr. Gralow agreed. Speaking to reporters, she concurred that MRI may help physicians distinguish between patient groups and help identify who should be treated.

In this prospective study, more than 5000 consecutive women were referred to a dedicated breast unit for screening or for diagnostic assessment. Patients had bilateral mammography with at least 2 views plus spot-compression views where appropriate and a high-resolution bilateral MRI.

Sensitivity for Ductal Carcinoma in Situ

Ductal Carcinoma in Situ--- Mammography, n (%)--- MRI, n (%)

Positive (n=167)-------------- 93 (56)------------------- 153 (92)


Sensitivity by Ductal Carcinoma in-Situ Grading

Ductal Carcinoma in Situ--- Mammography (%)--- MRI (%)

Non–high grade ----------------- 61 ------------------ 85

High grade ---------------------- 52 -------------------- 98


"MRI is much more sensitive than mammography for diagnosing ductal carcinoma in general and aggressive carcinoma in particular," Dr. Kuhl told reporters. "MRI doubled the sensitivity for ductal carcinoma overall," she said, and "half of high-grade ductal carcinomas in situ were diagnosed only by MRI."

American Society of Clinical Oncology 43rd Annual Meeting: Abstract 4000. Presented June 5, 2007
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本人已认领该文编译,48小时后若未提交译文,请其他战友自由认领。
2007-06-30 10:34
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Debate Heats Up Over Breast MRI vs Mammogram
筛查乳腺癌是乳腺MRI好?还是钼钯片好?
June 28, 2007 (Chicago) — Deliberations over breast cancer screening are back in the news again after German researchers at the American Society of Clinical Oncology 43rd Annual Meeting presented data in favor of magnetic resonance imaging (MRI). "MRI has been in the news a lot lately," moderator Julie Gralow, MD, from the University of Washington in Seattle, said during a press briefing. "A lot of women are asking us, should I be getting an MRI?"
2007年6月28日(芝加哥)-德国研究者在美国临床肿瘤学会第43届年会上报告的研究数据支持核磁共振影像学筛查乳腺癌,“最近,有关MRI的新闻很多,许多女性询问我们,她们是否应该行乳房MRI检查”大会主席Julie Gralow博士在一个杂志简报时说,来自西雅图华盛顿大学。
New American Cancer Society screening guidelines recommend MRI for women at the highest risk for breast cancer. And data published in a recent New England Journal of Medicine paper seemed to stack up in favor of MRI, suggesting that screening at the time of diagnosis of 1 breast cancer can lead to finding a second breast cancer (Lehman CD et al. New Engl J Med 2007;356:1295-1303.)
新的美国癌症学会筛查指南推荐乳腺癌极高危妇女行MRI检查。近来《新英格兰医学杂志》发表的一篇论文数据支持MRI筛查,并建议在单个位置乳腺癌诊断时行MRI检查有助于发现第2处乳腺癌(Lehman CD et al. New Engl J Med 2007;356:1295-1303.)
But not everyone has been as enthusiastic about breast MRI. The latest National Comprehensive Cancer Network (NCCN) guidelines caution against relying too heavily on MRI and using laboratory testing as the sole determinant for therapy. Presenting at the group's annual meeting in March and reported at the time by Medscape, Beryl McCormick, MD, from the Memorial Sloan-Kettering Cancer Center, in New York, spoke of the challenges of MRI screening.
但是,并非每个人对乳腺MRI都有狂热爱好。最新的NCCN指南警告不要过分依赖MRI检查,还是利用实验室试验结果作为治疗参考的唯一决定因素。美国纽约Memorial Sloan-Kettering癌症中心Medscape, Beryl McCormick博士在三月份出席小组年会时谈及MRI检查带来的挑战时说。
"Unfortunately, not all breast MRIs are created equal," Dr. McCormick said. "We are seeing an increasing number of newly diagnosed breast cancer cases at Memorial who come in with MRIs performed outside. Most are not of use to us, and a radiologist won't even read them," she said. "We want to emphasize that MRI is an adjunct to other breast imaging and should not be used in place of standard breast imaging with mammography and ultrasound," Dr. McCormick suggested. "There's no population-based screening information on the use of MRI; it's not for that."
McCormick 博士说“不幸的是,并不是所有患者都适合行乳腺MRI检查”“在Memorial癌症中心我们看到越来越多新诊断乳腺癌患者进来时带着外院做的乳腺核磁共振成像图,对我们来说,其中大多数图片没有用处,有的图片甚至连放射科医师都无法读懂”她继续说“我们想要强调MRI仅是一个辅助影像检查,不应将它代替乳腺钼钯和超声成像检查”并建议“就使用MRI检查而言,现在还没有基于大规模人口筛选资料可用,不推荐常规使用它”
Lack of Standardization in MRI a Key Barrier
缺乏MRI的标准是主要的障碍
Dr. Gralow agreed that standardization in breast MRI has been a problem. "It's a great tool in the right hands, but we don't yet have the quality control as we do for screening mammography. We hope soon to have at least a partial rectification of this," she said. The American College of Radiology is currently putting together a voluntary accreditation program and, within the next year or so, is planning to initiate standards at a number of centers. "I think it would be fair to say that programs that take this are at least attempting to create a standard with reproducible results," Dr. Gralow said.
Gralow博士同意乳腺MRI检查的标准化一直是有待解决的问题这一观点。她继续说“这是我们手中很好的设备,只是我们还没有在乳腺筛查成像方面质量控制。”美国放射医学院目前正在整理一个自愿委派书大纲,大约在明年,计划在很多中心执行新标准。“我认为该大纲至少试图创造一个有可重复性结果的标准很好”。
At the NCCN meeting, Dr. McCormick said that MRI could be helpful in evaluating the extent of biopsy-proven invasive lobular cancer, which can be difficult to define on mammogram and ultrasound. And in cases where recurrence is suspected and the mammogram is inconclusive, an MRI may help.
在NCCN会议上,McCormick博士说“MRI检查有助于评估浸润性小叶癌活检范围,乳腺钼钯和超声检查对此很难确定。对可疑复发病例和钼钯检查结果不确定病例,行MRI检查可能有帮助。
But in Germany, MRI screening is reaching new heights. Highly standardized and more widely accepted, Dr. Gralow says it is not surprising that researchers there have been able to present such a compelling case in favor of MRI. Mammography highlights calcifications around ductal carcinoma in situ, while MRI detects areas of increased vascularization, a process more commonly found around high-grade carcinomas.
在德国,MRI检查正在迈向新高度、高标准、被更广范围的接受。Gralow博士说研究者能完成令人瞩目的支持MRI检查的研究计划,这不足为奇。钼钯强调的是导管原位癌周围的钙化,而MRI主要检测增强的血管化区域、在高分级癌常见的一个病变过程。
During a news conference presenting the findings, lead investigator Christiane Kuhl, MD, from the University of Bonn, in Germany, pointed out that with growing concern about overdiagnosis and unnecessary treatments in women with lesions that may never progress to cancer, MRI offers interesting potential.
在新闻发布会上, 该研究领导人Christiane Kuhl博士,来自德国波昂大学,他指出“人们越来越关心妇女癌前病变的过度诊断和不必要治疗,MRI提供了有趣的潜力”。
Dr. Gralow agreed. Speaking to reporters, she concurred that MRI may help physicians distinguish between patient groups and help identify who should be treated.
Gralow博士告诉记者,她同意“MRI检查可帮助医生鉴别疾病并辨别谁将接受治疗”这一观点。
In this prospective study, more than 5000 consecutive women were referred to a dedicated breast unit for screening or for diagnostic assessment. Patients had bilateral mammography with at least 2 views plus spot-compression views where appropriate and a high-resolution bilateral MRI.
在本前瞻性研究中,连续的、超过5000例女性给予了筛查或诊断评估。患者行双侧乳房造影,包括至少2视图加点压缩视图,和高分辨率双侧MRI成像。
Sensitivity for Ductal Carcinoma in Situ
对导管原位癌的诊断敏感性
Ductal Carcinoma in Situ--- Mammography, n (%)--- MRI, n (%)

Positive (n=167)-------------- 93 (56)------------------- 153 (92)

Sensitivity by Ductal Carcinoma in-Situ Grading
对不同级别导管原位癌的筛查敏感性
Ductal Carcinoma in Situ--- Mammography (%)--- MRI (%)

Non–high grade ----------------- 61 ------------------ 85

High grade ---------------------- 52 -------------------- 98

"MRI is much more sensitive than mammography for diagnosing ductal carcinoma in general and aggressive carcinoma in particular," Dr. Kuhl told reporters. "MRI doubled the sensitivity for ductal carcinoma overall," she said, and "half of high-grade ductal carcinomas in situ were diagnosed only by MRI."
“一般来讲诊断乳腺导管癌MRI检查比钼钯检查要敏感的多,特别是针对侵袭性强的癌” Kuhl博士告诉记者,她继续说:“MRI检查使得总的导管癌诊断敏感性加倍了”“一半的高分级导管原位癌仅能通过MRI检查诊断”。
American Society of Clinical Oncology 43rd Annual Meeting: Abstract 4000. Presented June 5, 2007

编译:中文字数(1243)

筛查乳腺癌是乳腺MRI好?还是钼钯片好?

2007年6月28日(芝加哥)-德国研究者在美国临床肿瘤学会第43届年会上报告的研究数据支持核磁共振影像学筛查乳腺癌,“最近,有关MRI的新闻很多,许多女性询问我们,她们是否应该行乳房MRI检查”大会主席Julie Gralow博士在一个杂志简报时说,他来自西雅图华盛顿大学。
新的美国癌症学会筛查指南推荐乳腺癌极高危妇女行MRI检查。而近来《新英格兰医学杂志》发表的一篇论文数据支持MRI筛查,并建议在单个位置乳腺癌诊断时行MRI检查有助于发现第2处乳腺癌(Lehman CD et al. New Engl J Med 2007;356:1295-1303.)
但是,并非每个人对乳腺MRI都有狂热爱好。最新的NCCN指南警告不要过分依赖MRI检查,还是利用实验室试验结果作为治疗参考的唯一决定因素。美国纽约Memorial Sloan-Kettering癌症中心Medscape, Beryl McCormick博士在三月份出席小组年会时谈及MRI检查带来的挑战时说。
McCormick 博士说“不幸的是,并不是所有患者都适合行乳腺MRI检查”“在Memorial癌症中心我们看到越来越多新诊断乳腺癌患者进来时带着外院做的乳腺核磁共振成像图,对我们来说,其中大多数图片没有用处,有的图片甚至连放射科医师都无法读懂”她继续说“我们想要强调MRI仅是一个辅助影像检查,不应将它代替乳腺钼钯和超声成像检查”并建议“就使用MRI检查而言,现在还没有基于大规模人口筛选资料可用,不推荐常规使用它”。
缺乏标准是MRI检查的主要障碍?
Gralow博士同意乳腺MRI检查的标准化一直是丞待解决的问题这一观点。她继续说“这是我们手中很好的设备,只是我们还没有在乳腺筛查成像方面质量控制。”美国放射医学院目前正在整理一个自愿委派书大纲,大约在明年,计划在很多中心执行新标准。“我认为该大纲很好,至少试图创造一个有可重复性结果的标准”。在NCCN会议上,McCormick博士说“MRI检查有助于评估浸润性小叶癌活检范围,乳腺钼钯和超声检查对此很难确定。对可疑复发病例和钼钯检查结果不确定病例,行MRI检查可能有帮助。Gralow博士告诉记者,她也同意“MRI检查可帮助医生鉴别疾病并辨别谁将接受治疗”这一观点。
在德国,MRI检查正在迈向新高度、高标准、被更广范围的接受。Gralow博士说研究者在此能完成令人瞩目的支持MRI筛查的研究,这不足为奇。钼钯强调的是导管原位癌周围的钙化,而MRI主要检测增强的血管化区域、在高分级癌常见的一个病变过程。
在新闻发布会上, 该研究领导人Christiane Kuhl博士,来自德国波昂大学,他指出“人们越来越关心妇女癌前病变的过度诊断和不必要治疗,MRI提供了有趣的潜力”。“一般来讲诊断乳腺导管癌MRI检查比钼钯检查要敏感的多,特别是针对侵袭性强的癌” Kuhl博士告诉记者,她继续说:“MRI检查使得总的导管癌诊断敏感性加倍了”“一半的高分级导管原位癌仅能通过MRI检查诊断”。见表1和表2。
在此前瞻性研究中,连续的、超过5000例女性给予了筛查或诊断评估。患者行双侧乳房造影成像(包括至少2视图加点压缩视图)和高分辨率双侧MRI成像。

表1 不同方法对导管原位癌的筛查敏感性
筛查出导管原位癌  钼钯筛查出人数  MRI筛查出人数
人数  n(%)  n(%)
167  93(56)  153(92)
表2 不同方法对分级不同的导管原位癌的筛查敏感性
不同级别导管原位癌 钼钯诊断人数(%)  MRI诊断人数(%)
非高分级   61   85
高分级   52   98
2007-06-30 16:52
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fanqingdong2004 编辑于 2007-06-30 16:56
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Over Breast MRI vs Mammogram
is
higher cost vs lower cost

=================================
and by the way about the PRESS BRIEFING
=================================

外交部副部长王毅记者招待会将于6月26日举行( Press Briefing by Vice-minister Wang Yi )
http://www.fmprc.gov.cn/chn/xwfw/wgjzxwzx/2255/t140633.htm

  外交部副部长、第三轮北京六方会谈中方代表团团长王毅记者招待会暂定于2004年6月26日上午11:30分在第三轮北京六方会谈新闻中心钓鱼台大酒店举行。

  The press briefing by Vice Minister Wang Yi is temporarily scheduled at 11:30
2007-07-01 15:37
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tcmwjr 编辑于 2007-07-07 15:39
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