Brown M L, Houn F, Sickles E A, Kessler L G
Applied Research Branch, National Cancer Institute, Bethesda, MD 20892-7344, USA.
AJR Am J Roentgenol. 1995 Dec;165(6):1373-7. doi: 10.2214/ajr.165.6.7484568.
The purpose of this study was to gather from 50 community mammography practices that were included in the National Survey of Mammography Facilities data concerning abnormal findings on screening mammograms to determine the frequency of various recommendations made for patients who had abnormal findings and to compare these recommendations with the frequency with which the procedures were actually performed. We also determined the positive predictive value of screening mammograms (the number of cancers detected per 100 abnormal findings) and the yield (the number of cancers detected per 100 procedures done) of various diagnostic procedures done because of abnormal findings.
We identified 1717 screening mammograms done in the last half of 1991 that had abnormal findings. Radiologic recommendations and follow-up procedures, including repeat standard (screening) mammography, additional mammographic views, sonography, clinical breast examination, needle aspiration, needle biopsy, and open biopsy, were identified for all of the cases from the radiologic records, and follow-up data were obtained from referring physicians. The positive predictive value and yield in the National Survey of Mammography Facilities were compared with data from the mammography screening practice of the University of California at San Francisco (UCSF), a facility noted for its clinical efficiency.
We estimate that 11% of all screening mammograms resulted in a recommendation for further diagnostic procedures. These 1717 mammograms with abnormal findings led to the following recommendations and procedures: repeat standard (screening) mammography, 610 (recommended)/635 (performed); additional mammographic views, 785/707; sonography, 400/345; biopsy, 189/229; and needle aspiration, 21/51. More procedures were done than were recommended in some cases because the results of certain procedures often led to the performance of other, additional procedures. The positive predictive value for screening examinations with abnormal findings was 3.5%, and the yield for open biopsy was 21%. In the UCSF data base, the positive predictive value for examinations with abnormal findings was 10%, and the yield for open biopsy was 34%.
The positive predictive value for examinations with abnormal findings and the yield for diagnostic procedures performed as a result of abnormal findings in 50 community radiologic facilities were higher than those reported in some earlier studies, a fact that raised concern about the induced cost of screening mammography. However, these values were low compared with those in the UCSF data base. This fact was particularly true of repeat standard (screening) mammography.
本研究的目的是从纳入全国乳腺X线摄影设施调查的50家社区乳腺X线摄影机构收集有关筛查乳腺X线摄影异常发现的数据，以确定针对有异常发现的患者给出的各种建议的频率，并将这些建议与实际执行的程序的频率进行比较。我们还确定了筛查乳腺X线摄影的阳性预测值（每100例异常发现中检测到的癌症数量）以及因异常发现而进行的各种诊断程序的检出率（每100例检查中检测到的癌症数量）。
我们识别出1991年下半年进行的1717例有异常发现的筛查乳腺X线摄影。从放射学记录中为所有病例确定放射学建议和后续程序，包括重复标准（筛查）乳腺X线摄影、额外的乳腺X线摄影视图、超声检查、临床乳腺检查、针吸活检、针芯活检和开放活检，并从转诊医生处获得随访数据。将全国乳腺X线摄影设施调查中的阳性预测值和检出率与以临床效率著称的加利福尼亚大学旧金山分校（UCSF）乳腺X线摄影筛查实践的数据进行比较。
我们估计所有筛查乳腺X线摄影中有11%导致建议进行进一步的诊断程序。这1717例有异常发现的乳腺X线摄影导致了以下建议和程序：重复标准（筛查）乳腺X线摄影，610例（建议）/635例（执行）；额外的乳腺X线摄影视图，785例/707例；超声检查，400例/345例；活检，189例/229例；针吸活检，21例/51例。在某些情况下，执行的程序比建议的多，因为某些程序的结果常常导致执行其他额外的程序。有异常发现的筛查检查的阳性预测值为3.5%，开放活检的检出率为21%。在UCSF数据库中，有异常发现的检查的阳性预测值为10%，开放活检的检出率为34%。
50家社区放射学机构中有异常发现的检查的阳性预测值以及因异常发现而进行的诊断程序的检出率高于一些早期研究报告的值，这一事实引发了对筛查乳腺X线摄影诱导成本的担忧。然而，与UCSF数据库中的值相比，这些值较低。重复标准（筛查）乳腺X线摄影尤其如此。
