探討台灣東部乳房磁振造影篩檢計畫成果

Study on the Results of Breast Magnetic Resonance Imaging Screening Project in Eastern Taiwan

自2004年以來，政府開始正式推動乳房X光攝影篩檢計劃，於2010年，針對45-69歲婦女的乳癌檢測率為4.7‰，此處所指乳癌檢測率系指篩檢為陽性並經病理確認為惡性之案例；然而，直到2015年，乳癌之死亡率的趨勢仍在上升。另一方面，台東的乳癌死亡率在台灣所有地區中佔最高。巧合的是，我們發現台東的乳從2012年高峰開始有下降的趨勢，這個時期與台東地區(Breast Magnetic Resonance Imaging, bMRI)(簡稱BMRISP)篩檢項目的進行可能有相關。本研究是針對2013年至2015年，在台東聖母醫院針對3,420名台灣台東地區婦女提供了使用螺旋圈地脈衝序列(spiral rodeo pulse sequence)的乳房磁振造影篩檢，並提供衛教計劃。MRI檢查的高靈敏度可以在早期偵測出乳房組織的輕微異常變化(70%)。本篩檢結果無症狀案例者為2,294例，BMRISP篩檢後共召回了27.9%的案例；其中，45例確診乳癌，相當於乳癌檢測率19.6‰。活檢率為7.67%，惡性活檢率為30.11%，其中乳腺管原位癌(Ductal Carcinoma In Situ, DCIS)佔14例(31.1%)，侵襲性乳腺管癌(Invasive Ductal Carcinoma, IDC)31例(68.9%)。根據結果，在本研究期間，台東乳房磁振造影篩檢在早期乳腺癌檢出率的比例高於2013年至2015年台灣的相同比例。因此，我們推斷，為了檢測早期乳癌，乳房磁振造影篩檢應被視為乳房X光攝影篩檢的替代方案。

A national mammography screening program has been provided to Taiwanese women since 2004. In 2010, the breast cancer detection rate of the mammography screening program, for women aged 45-69 years was 4.7%. However, breast cancer mortality continued to increase until 2015. Altogether, 3,420 women have received breast magnetic resonance imaging (bMRI) screening using spiral RODEO pulse sequence (BMRISP). At St. Mary Hospital in Taitung, Taiwan, women were provided an additional health education program. MRI examination, known to be highly sensitive, capture minor abnormal changes in breast tissues at early stages (70%). Between 2013 and 2015, we identified 2,294 asymptomatic cases, recalling 27.9% BMRISP screening. Of these that were recalled, 45 cases were diagnosed as having breast cancer, a breast cancer detection rate of 19.6%. The rate of biopsy was 7.67%. Malignant biopsy rate was 30.11%, with 14 cases (31.1%) found to have ductal carcinoma in situ and 31(68.9%) invasive ductal carcinoma. During the study period, the detection rate for early stage breast cancer using the BMRISP screening program in Taitung was found to be higher that of screening mammography in Taiwan, from 2013 to 2015. Therefore, BMRISP should be considered as an alternative to mammographic screening for the detection of early breast cancer.