Norwalk Hospital affiliated with Yale University School of Medicine, Department of Radiology, Norwalk, CT, USA.
Breast J. 2013 Jan-Feb;19(1):64-70. doi: 10.1111/tbj.12053. Epub 2012 Dec 13.
The purpose of this article was to retrospectively evaluate the benefits of screening breast ultrasound in women with dense breast tissue following enactment of Connecticut Bill 458 in October 2009. This bill mandated that women be informed of their breast density and the possible benefit of ultrasound as an additional screening modality. Institutional approval was obtained from the institutional review board for this retrospective study. A total of 5519 women with dense breasts were screened with ultrasound in the year after the law went into effect from October 2009 to September 2010 (post law group). We focused on the women who had negative mammograms and biopsy recommendations based on ultrasound findings (BIRADS 4 and 5). The data were compared with those from a group of 1319 women who were screened with breast ultrasound before the law went into effect between October 2008 and September 2009 (pre law group). Prior to the law, ultrasound studies were performed only at the referring clinician's request. Of the 5,519 women in the post law group, 10 malignant lesions were found, with a cancer detection rate of 0.18%, biopsy rate of 3.3%, and a positive predictive value of 5.5%. The tumor size on ultrasound ranged from 4 to 15 mm; mean 9.7 mm. Sentinel lymph node biopsy was negative in 7 of 10 patients. Of the 1,319 women in the pre law group, 20 biopsies were recommended, all of which were benign. No malignancies were detected in the pre law group. Establishment of a formal screening breast ultrasound program as an adjunct to mammography in women with dense breasts increased our cancer detection rate following enactment of Connecticut Bill 458.
本文旨在回顾评估 2009 年 10 月康涅狄格州法案 458 颁布后，对乳腺组织致密的女性进行乳腺超声筛查的获益。该法案规定告知女性其乳腺密度以及超声作为额外筛查方式的可能获益。本回顾性研究获得了机构审查委员会的机构批准。2009 年 10 月法案生效后至 2010 年 9 月的一年中，共有 5519 例乳腺致密的女性接受了超声筛查（法案后组）。我们重点关注那些超声检查结果为阴性且有乳腺钼靶和活检推荐（BI-RADS 4 和 5）的女性。将这些数据与 2008 年 10 月至 2009 年 9 月法案生效前接受乳腺超声筛查的 1319 例女性（法案前组）的数据进行比较。在该法案实施之前，超声检查仅在临床医生的要求下进行。在法案后组的 5519 例女性中，发现了 10 例恶性病变，癌症检出率为 0.18%，活检率为 3.3%，阳性预测值为 5.5%。超声上肿瘤大小为 4-15mm，平均 9.7mm。7 例患者的前哨淋巴结活检均为阴性。在法案前组的 1319 例女性中，有 20 例建议进行活检，均为良性。在法案前组未发现恶性肿瘤。在乳腺组织致密的女性中建立了正式的筛查性乳腺超声检查项目，作为乳腺钼靶检查的辅助手段，在康涅狄格州法案 458 颁布后提高了我们的癌症检出率。
