Bassett L W, Liu T H, Giuliano A E, Gold R H
Department of Radiological Sciences, UCLA School of Medicine 90024.
AJR Am J Roentgenol. 1991 Jul;157(1):21-4. doi: 10.2214/ajr.157.1.1646562.
Concern over excessive numbers of false-positive mammograms, leading to unnecessary investigations and surgical interventions, has been cited as a barrier to mammographic screening for breast cancer. We compared the biopsy results from palpable vs impalpable, mammographically detected lesions from one experienced breast surgeon's practice from July 1980 through July 1989. Overall, there were 372 biopsies in 346 women. Of 143 biopsies for palpable abnormalities, 48 (34%) yielded a primary malignant lesion. The length of the palpable cancers averaged 3.7 cm (median, 2.8 cm). Sixteen (33%) of the 48 biopsies were in patients who had positive axillary lymph nodes, and five (10%) were in patients who had distant metastases at the time of biopsy. Of 229 biopsies for impalpable, mammographically detected lesions, 72 (31%) yielded a primary breast carcinoma. Excluding 34 carcinomas that had only calcifications, the length of the mammographically detected tumors averaged 2.0 cm (median, 1.5 cm). Eleven (15%) of the 72 biopsies were in patients who had positive axillary nodes, and none were in patients who had distant metastases at the time of biopsy. The positive predictive values (number of cancers detected divided by the number of biopsies recommended) were not significantly different when comparing biopsies indicated for palpable, clinically detected (34%) vs impalpable, mammographically detected (31%) abnormalities (p = .669). However, the mammographically detected cancers were smaller, more often noninvasive (32% vs 4%), less often associated with axillary metastases (15% vs 33%), and without distant metastases (0% vs 10%).
对乳腺钼靶检查出现过多假阳性结果从而导致不必要的检查和外科干预的担忧，被认为是乳腺癌钼靶筛查的一个障碍。我们比较了1980年7月至1989年7月期间，一位经验丰富的乳腺外科医生对可触及与不可触及的、钼靶检查发现的病变进行活检的结果。总体而言，346名女性共进行了372次活检。在针对可触及异常进行的143次活检中，有48次（34%）检出原发性恶性病变。可触及癌症的长度平均为3.7厘米（中位数为2.8厘米）。48次活检中有16次（33%）是在腋窝淋巴结阳性的患者中进行的，5次（10%）是在活检时已有远处转移的患者中进行的。在针对不可触及的、钼靶检查发现的病变进行的229次活检中，有72次（31%）检出原发性乳腺癌。排除仅伴有钙化的34例癌，钼靶检查发现肿瘤的长度平均为2.0厘米（中位数为1.5厘米）。72次活检中有11次（15%）是在腋窝淋巴结阳性的患者中进行的，活检时没有患者出现远处转移。比较针对可触及的、临床检查发现的异常（34%）与不可触及的、钼靶检查发现的异常（31%）所进行的活检时，阳性预测值（检测出的癌症数量除以建议进行活检的数量）无显著差异（p = 0.669）。然而，钼靶检查发现的癌症较小，更多为非侵袭性（32%对4%），较少伴有腋窝转移（15%对33%），且无远处转移（0%对10%）。
