Feig Stephen A
Department of Radiological Sciences, University of California Irvine Medical Center, 101 City Drive South, Orange CA 92869-3298.
Acad Radiol. 2015 Aug;22(8):961-6. doi: 10.1016/j.acra.2015.01.020. Epub 2015 Mar 18.
Long-term follow-up of randomized trials provide the most accurate estimates of overdiagnosis. Estimates from follow-up of service screening studies are almost as accurate if there is sufficient adjustment for lead time and risk status. When properly analyzed data from both of these types of trials indicate that the rate of overdiagnosis at screening mammography is clinically negligible: 0-5%. Population trend studies are a potentially highly inaccurate means to estimate overdiagnosis. Most cases of DCIS detected at screening are medium and high grade with substantial potential to become an invasive disease. To avoid overtreatment, clinicians need to tailor their treatment of DCIS to the histologic and molecular characteristics of each case.
随机试验的长期随访提供了关于过度诊断最准确的估计。如果对提前期和风险状况进行了充分调整，服务筛查研究随访得出的估计几乎同样准确。对这两类试验的数据进行恰当分析后发现，乳腺钼靶筛查时的过度诊断率在临床上可忽略不计：0 - 5%。人群趋势研究是估计过度诊断的一种潜在极不准确的方法。筛查时检测出的大多数导管原位癌病例为中高级别，具有发展为浸润性疾病的很大可能性。为避免过度治疗，临床医生需要根据每个病例的组织学和分子特征来调整对导管原位癌的治疗。
