Kolb Thomas M, Lichy Jacob, Newhouse Jeffrey H
Department of Radiology, Columbia-Presbyterian Medical Center, New York, NY, USA.
Radiology. 2002 Oct;225(1):165-75. doi: 10.1148/radiol.2251011667.
To (a) determine the performance of screening mammography, ultrasonography (US), and physical examination (PE); (b) analyze the influence of age, hormonal status, and breast density; (c) compare the size and stage of tumors detected with each modality; and (d) determine which modality or combination of modalities optimize cancer detection.
A total of 11,130 asymptomatic women underwent 27,825 screening sessions, (mammography and subsequent PE). Women with dense breasts subsequently underwent screening US. Abnormalities were deemed positive if biopsy findings revealed malignancy and negative if findings from biopsy or all screening examinations were negative.
In 221 women, 246 cancers were found. Sensitivity, specificity, negative and positive predictive values, and accuracy of mammography were 77.6%, 98.8%, 99.8%, 35.8%, and 98.6%, respectively; those of PE, 27.6%, 99.4%, 99.4%, 28.9%, and 98.8%, respectively; and those of US, 75.3%, 96.8%, 99.7%, 20.5%, and 96.6%, respectively. Screening breast US increased the number of women diagnosed with nonpalpable invasive cancers by 42% (30 of 71). Mammographic sensitivity declined significantly with increasing breast density (P <.01) (48% for the densest breasts) and in younger women with dense breasts (P =.02); the effects were independent. Mammography and US together had significantly higher sensitivity (97%) than did mammography and PE together (74%) (P <.001). Tumors detected at mammography and/or US were significantly smaller (P =.01) and of lower stage (P =.01) than those detected at PE.
Mammographic sensitivity for breast cancer declines significantly with increasing breast density and is independently higher in older women with dense breasts. Addition of screening US significantly increases detection of small cancers and depicts significantly more cancers and at smaller size and lower stage than does PE, which detects independently extremely few cancers. Hormonal status has no significant effect on effectiveness of screening independent of breast density.
(a) 确定乳腺钼靶筛查、超声检查（US）和体格检查（PE）的性能；(b) 分析年龄、激素状态和乳腺密度的影响；(c) 比较每种检查方式检测出的肿瘤大小和分期；(d) 确定哪种检查方式或检查方式的组合能优化癌症检测。
共有11130名无症状女性接受了27825次筛查（乳腺钼靶检查及后续的体格检查）。乳腺致密的女性随后接受超声筛查。如果活检结果显示为恶性，则异常被视为阳性；如果活检结果或所有筛查检查结果为阴性，则视为阴性。
在221名女性中发现了246例癌症。乳腺钼靶检查的敏感性、特异性、阴性和阳性预测值以及准确性分别为77.6%、98.8%、99.8%、35.8%和98.6%；体格检查的分别为27.6%、99.4%、99.4%、28.9%和98.8%；超声检查的分别为75.3%、96.8%、99.7%、20.5%和96.6%。乳腺超声筛查使被诊断为不可触及的浸润性癌症的女性人数增加了42%（71例中的30例）。乳腺钼靶检查的敏感性随着乳腺密度的增加而显著下降（P<.01）（最致密乳腺的敏感性为48%），在乳腺致密的年轻女性中也显著下降（P =.02）；这些影响是独立的。乳腺钼靶检查和超声检查联合使用时的敏感性（97%）显著高于乳腺钼靶检查和体格检查联合使用时的敏感性（74%）（P<.001）。乳腺钼靶检查和/或超声检查检测出的肿瘤明显更小（P =.01）且分期更低（P =.01），比体格检查检测出的肿瘤小。
乳腺癌的乳腺钼靶检查敏感性随着乳腺密度的增加而显著下降，在乳腺致密的老年女性中独立地更高。增加超声筛查显著提高了小癌症的检出率，与体格检查相比，能检测出更多的癌症，且癌症的大小更小、分期更低，而体格检查独立检测出的癌症极少。激素状态对独立于乳腺密度的筛查有效性没有显著影响。
Zotero 插件