Lamas A M, Horwitz R I, Peck D
JAMA. 1984 Dec 7;252(21):2999-3002.
We evaluated the clinical usefulness of mammography in postmenopausal women by conducting a "vertical" analysis using indexes of sensitivity and specificity, and a separate "horizontal" analysis assessing the relationship between the mammographic test result and the occurrence of specific clinical management decisions. The patients included 105 women with breast cancer, 104 women with fibrocystic breast disease, and 103 women with clinically benign breasts. Our study confirmed the generally accepted high values reported for the sensitivity and for the specificity of mammography as a test for breast cancer, while also helping to reconcile the widely varying indexes of test efficacy reported in some studies. We also observed that physicians' management decisions vary according to the mammographic interpretation, and include such distinctive clinical strategies as watchful expectancy (observe and follow), repeated mammograms, or breast biopsy. Future studies will need to determine reasons for specific management decisions, especially when they appear to contradict authoritative recommendations.
我们通过使用敏感性和特异性指标进行“纵向”分析，并通过单独的“横向”分析评估乳房X线检查结果与特定临床管理决策发生之间的关系，来评估乳房X线检查在绝经后女性中的临床实用性。患者包括105名乳腺癌女性、104名纤维囊性乳腺病女性和103名临床诊断为乳房良性的女性。我们的研究证实了乳房X线检查作为乳腺癌检测手段所报告的普遍公认的高敏感性和高特异性值，同时也有助于协调一些研究中报告的差异很大的检测效能指标。我们还观察到，医生的管理决策会根据乳房X线检查的解读而有所不同，包括观察等待（观察并随访）、重复乳房X线检查或乳房活检等独特的临床策略。未来的研究需要确定特定管理决策的原因，尤其是当这些决策似乎与权威建议相矛盾时。
