Niu Meili, Zheng Jie, Feng Xiaoyang, Yan Huijiao, Jia Mengmeng, Qi Shuzhen, Qiao Youlin, Zhao Fanghui, Feng Xiangxian, Li Zhifang
School of Public Health, Shanxi Medical University, Taiyuan, China.
School of Nursing, Changzhi Medical College, Changzhi, China.
J Ultrasound Med. 2025 Sep;44(9):1531-1543. doi: 10.1002/jum.16708. Epub 2025 Apr 30.
Comparing the screening performance of different breast cancer screening methods and exploring the applicability of automated breast ultrasonography (ABUS) in rural areas with low health resources in China.
Women aged 35-64 underwent hand-held ultrasonography (HHUS) and ABUS in Zezhou County, Jincheng City, Shanxi Province, China from 2018 to 2021. Additionally, women aged 45-69 were also screened with mammography (MG). We compared the 3 methods' cancer detection rates, diagnostic accuracy, and overall screening performance, stratified by age groups and breast density. The chi-square test was used to analyze indicators such as sensitivity, specificity, and referral rate.
The mean age of the 9100 women studied was 45 ± 6.42 years, and 25 cases of breast cancer were identified (2.72‰). The proportion of dense breasts is higher among women aged 45-64 years (67.52%). Compared to the non-dense breast group, the detection rate of breast cancer by MG is significantly reduced in the dense breast group (3.42‰ versus 1.97‰). The diagnostic accuracy rate of ABUS and HHUS for lesions is higher than that of MG (P < .05). The kappa coefficient indicates moderate agreement in diagnostic results between HHUS and ABUS. However, the agreement between HHUS/ABUS and MG is poor. There were no statistical differences in sensitivity and specificity among the 3 screening methods. The referral rate and NNR for ultrasound were lower than those for MG (P < .05), but there were no statistically significant differences between ABUS and HHUS.
Among women with denser breasts, ultrasound has a higher diagnostic accuracy rate compared to MG, and it avoids unnecessary biopsies. Compared to HHUS, ABUS can diagnose malignant tumors more objectively and standardized.
比较不同乳腺癌筛查方法的筛查性能，探索自动乳腺超声检查（ABUS）在中国卫生资源匮乏农村地区的适用性。
2018年至2021年，中国山西省晋城市泽州县35至64岁的女性接受了手持超声检查（HHUS）和ABUS检查。此外，45至69岁的女性还接受了乳腺X线摄影（MG）筛查。我们按年龄组和乳腺密度分层，比较了这三种方法的癌症检出率、诊断准确性和整体筛查性能。采用卡方检验分析灵敏度、特异度和转诊率等指标。
研究的9100名女性的平均年龄为45±6.42岁，共确诊25例乳腺癌（2.72‰）。45至64岁女性中致密型乳腺的比例较高（67.52%）。与非致密型乳腺组相比，致密型乳腺组中MG对乳腺癌的检出率显著降低（3.42‰对1.97‰）。ABUS和HHUS对病变的诊断准确率高于MG（P<0.05）。kappa系数表明HHUS和ABUS之间的诊断结果一致性中等。然而，HHUS/ABUS与MG之间的一致性较差。三种筛查方法在灵敏度和特异度方面无统计学差异。超声的转诊率和净转诊率低于MG（P<0.05），但ABUS和HHUS之间无统计学显著差异。
在乳腺密度较高的女性中，超声的诊断准确率高于MG，且避免了不必要的活检。与HHUS相比，ABUS能更客观、标准化地诊断恶性肿瘤。
