Feigin Kimberly N, Keating Delia M, Telford Patricia M, Cohen Michael A
Guttman Diagnostic Center, Memorial Sloan-Kettering Cancer Center, 55 Fifth Ave, 12th Floor, New York, NY 10003, USA.
Radiology. 2006 Sep;240(3):650-5. doi: 10.1148/radiol.2403051377.
To retrospectively evaluate the cost of clinical breast examination (CBE) and its contribution to screening mammography in the detection of breast cancer.
The study received a waiver of authorization from the institutional review board, informed patient consent was not required, and the study was compliant with HIPAA regulations. The records of 60 027 consecutive asymptomatic patients who underwent screening mammography were retrospectively reviewed. CBE was performed on all patients by a nurse practitioner. Patients with positive CBE findings were required to convert from screening to diagnostic evaluation; the number of cancer diagnoses that resulted was determined. The reports, four-view mammograms, or both of patients requiring conversion to diagnostic evaluation were reviewed to determine those patients likely to undergo diagnostic imaging on the basis of screening mammographic findings alone. The cost of CBE was calculated and divided by the number of cancers detected solely with CBE to determine the cost of CBE per additional cancer detected.
Four hundred seventy-four (age range, 32-95) of 60 027 asymptomatic patients had positive CBE findings which required conversion to diagnostic evaluation. Forty-six cancers in 44 patients were subsequently diagnosed; 32 would have been detected with mammography alone, whereas 14 were imperceptible at screening mammography. The cost of CBE was $122 598 per cancer detected solely with positive CBE findings.
CBE performed by nurse practitioners led to the diagnosis of 14 cancers in 13 patients with mammographically occult tumors (0.02% of the screening population and approximately 3% of all cancers diagnosed at the facility during this study). The cost of detecting these additional cancers is estimated to be $122 598 per cancer.
回顾性评估临床乳腺检查（CBE）的成本及其在乳腺癌筛查钼靶检查中的作用。
本研究获得机构审查委员会的授权豁免，无需患者知情同意，且该研究符合《健康保险流通与责任法案》（HIPAA）规定。对60027例连续接受筛查钼靶检查的无症状患者的记录进行回顾性分析。所有患者均由执业护士进行CBE。CBE结果呈阳性的患者需从筛查转为诊断性评估；确定由此导致的癌症诊断数量。对需要转为诊断性评估的患者的报告、四视图钼靶照片或两者进行审查，以确定仅根据筛查钼靶检查结果可能接受诊断性成像的患者。计算CBE的成本，并除以仅通过CBE检测到的癌症数量，以确定每多检测出一例癌症的CBE成本。
60027例无症状患者中有474例（年龄范围32 - 95岁）CBE结果呈阳性，需要转为诊断性评估。随后在44例患者中诊断出46例癌症；其中32例仅通过钼靶检查即可检测到，而14例在筛查钼靶检查中无法检测到。仅通过CBE结果呈阳性检测到的癌症，CBE成本为每例122598美元。
执业护士进行的CBE导致13例钼靶检查未发现肿瘤的患者被诊断出14例癌症（占筛查人群的0.02%，约占本研究期间该机构所有诊断出癌症的3%）。检测这些额外癌症的成本估计为每例癌症122598美元。
