Department of General Practice, Faculté de medicine, Université Paris Descartes, Paris, France.
Department of General Practice, Faculté de medicine, Université Paris Descartes, Paris, France.
Eur J Obstet Gynecol Reprod Biol. 2019 Jun;237:1-6. doi: 10.1016/j.ejogrb.2019.04.003. Epub 2019 Apr 3.
The guidelines for breast cancer screening with clinical breast examination (CBE) are diverging CBE is recommended in France, whereas it is not recommended in the United States and Canada, given the lack of clear benefit and the risk of overmedication. To assess the accuracy of abnormalities found during CBE for in breast cancer screening.
A cross-sectional study included women over 18 years with no history of breast cancer coming for a mammography at 3 ambulatory radiology practices in Paris. A questionnaire collected the risk of breast cancer on mammography according to the Breast Imaging-Reporting And Data System (Bi-RADS) (high risk: Bi-RADS 4 or 5 versus lower risk: other Bi-RADS categories), the risk factors for breast cancer and the breast clinical abnormalities (none, mass, skin abnormality, oedema, pain, nipple discharge, lymph nodes…) For each abnormality, sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were calculated.
Among the 3218 included patients (mean age 55.1 +/-10 years), 713 (22.2%) had an abnormal CBE and 133 (4.1%) had high-risk mammography. The sensitivity of CBE was 36%[28%;45%] and the specificity was 78%[77%;80%]. The PPV and NPV for each clinical abnormality were low, except for nipple discharge, retraction and lymph nodes, for which the PPV were 10.5[3.7;29.9], 6.6[1.4;31.6], and 5.0[1.5;17.1], respectively, but these abnormalities were rare (0.5%, 0.2% and 0.5% respectively). These values were similar across all age groups.
The accuracy of CBE for breast cancer screening appeared to be low which did not support recommending regular CBE in France.
临床乳房检查（CBE）用于乳腺癌筛查的指南存在差异。在法国，推荐使用 CBE，但在美国和加拿大不推荐使用，因为缺乏明确的获益且存在过度用药的风险。本研究旨在评估 CBE 发现的异常在乳腺癌筛查中的准确性。
本研究为一项横断面研究，纳入了来自巴黎 3 家门诊放射科的年龄在 18 岁以上、无乳腺癌病史的女性。通过乳腺影像报告和数据系统（BI-RADS）问卷调查评估患者的乳腺癌风险（高风险：BI-RADS 4 或 5 与低风险：其他 BI-RADS 类别）、乳腺癌风险因素和乳房临床异常（无、肿块、皮肤异常、水肿、疼痛、乳头溢液、淋巴结肿大等）。对于每个异常，计算了其敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
在纳入的 3218 例患者中（平均年龄 55.1±10 岁），713 例（22.2%）的 CBE 异常，133 例（4.1%）的乳腺 X 线摄影检查为高风险。CBE 的敏感性为 36%[28%；45%]，特异性为 78%[77%；80%]。除乳头溢液、回缩和淋巴结外，每个临床异常的 PPV 和 NPV 均较低，其分别为 10.5[3.7；29.9]、6.6[1.4；31.6]和 5.0[1.5；17.1]，但这些异常均较为罕见（分别为 0.5%、0.2%和 0.5%）。在所有年龄组中，这些值均相似。
CBE 用于乳腺癌筛查的准确性似乎较低，这并不支持在法国常规推荐 CBE。
