Hou Ming-Feng, Chuang Hung-Yi, Ou-Yang Fu, Wang Chen-Ya, Huang Chyi-Lie, Fan Hui-Mei, Chuang Chieh-Han, Wang Jaw-Yuan, Hsieh Jan-Singh, Liu Gin-Chung, Huang Tsung-Jen
Department of Surgery, Kaohsiung Medical University, No. 100 Shih-Chuan 1st Road, 807 Kaohsiung, Taiwan.
Ultrasound Med Biol. 2002 Apr;28(4):415-20. doi: 10.1016/s0301-5629(02)00483-0.
Recommended surveillance for screening breast cancer, which includes regular mammography and clinical breast examination, has long been established in Western countries. This strategy may be too costly and unnecessary for countries with low incidences of breast cancer. The purpose of the present study is to compare breast mammography, sonography and physical examination in screening female relatives of breast cancer index cases from the hospital, and their relative efficiency. A total of 935 women over 35 years old, who were relatives of breast cancer patients, were invited to an annual screening by means of a combination of mammography, sonography and physical examination on a single day. A biopsy was performed when any of the three investigations indicated a possibility of malignancy. A total of 21 breast cancers, including sixteen invasive cancers and 5 noninvasive cancers, were detected among the 935 high-risk women. Of the cancers, 18, including 16 invasive cancers and 3 noninvasive cancers, were detected by sonography. In contrast, only 11 invasive cancers were detected by mammography, and 7 by physical examination. There were only 14 cancers detected by a combination of mammography and physical examination. The 7 (33.3%) additional cancers were detected when sonography was added. The sensitivity of sonography was 90.4%, which was higher than mammography (52.4%) and physical examination (33.3%), or even a combination of these two modalities (66.7%). This indicates that sonography is a more accurate screening tool for breast cancer in the high-risk group. Although breast sonography has not yet been recommended as a routine screening tool for breast cancer in Western countries, it may be superior to mammography and physical examination for the screening of Taiwanese high-risk female relatives of breast cancer index cases. If it should also be considered as a routine adjunct screening modality for Taiwanese women with lower rates of breast cancer will need further study.
长期以来，西方国家一直采用推荐的乳腺癌筛查监测方法，包括定期乳房X光检查和临床乳房检查。对于乳腺癌发病率较低的国家来说，这种策略可能成本过高且没有必要。本研究的目的是比较乳房X光检查、超声检查和体格检查在筛查医院乳腺癌索引病例的女性亲属中的应用情况及其相对效率。共有935名35岁以上的乳腺癌患者亲属被邀请在同一天通过乳房X光检查、超声检查和体格检查相结合的方式进行年度筛查。当三项检查中的任何一项显示有恶性可能时，进行活检。在935名高危女性中，共检测出21例乳腺癌，其中包括16例浸润性癌和5例非浸润性癌。在这些癌症中，超声检查检测出18例，包括16例浸润性癌和3例非浸润性癌。相比之下，乳房X光检查仅检测出11例浸润性癌，体格检查检测出7例。乳房X光检查和体格检查相结合仅检测出14例癌症。增加超声检查后，额外检测出7例（33.3%）癌症。超声检查的敏感性为90.4%，高于乳房X光检查（52.4%）和体格检查（33.3%），甚至高于这两种检查方式的联合应用（66.7%）。这表明超声检查是高危人群中更准确的乳腺癌筛查工具。尽管在西方国家，乳房超声检查尚未被推荐为乳腺癌的常规筛查工具，但对于台湾乳腺癌索引病例的高危女性亲属筛查，它可能优于乳房X光检查和体格检查。对于乳腺癌发病率较低的台湾女性，是否也应将其视为常规辅助筛查方式，还需要进一步研究。
