Kerlikowske K, Grady D, Barclay J, Sickles E A, Ernster V
Department of Epidemiology and Biostatistics, University of California, San Francisco, USA.
JAMA. 1996 Jul 3;276(1):39-43. doi: 10.1001/jama.276.1.39.
To determine the sensitivity, specificity, and likelihood ratios (LRs) for modern screening mammography by decade of age and mammographic interpretation.
Cross-sectional.
Nine counties in northern California.
A total of 26,057 women aged 30 years and older who underwent a total of 41,747 first and subsequent screening mammographic examinations at the Mobile Mammography Screening Program of the University of California, San Francisco, from April 1985 to September 1991.
Breast cancer risk profile, 2 standard mammographic views per breast, and follow-up of abnormal and normal mammograms of contacting women's physicians and by linkage to the regional Surveillance, Epidemiology, and End Results tumor registry. False-negative examinations were normal examinations that occurred within 13 months of a diagnosis of invasive breast cancer or ductal carcinoma in situ.
The sensitivity of first screening mammography increased with age: 77.3% for ages 30 to 39 years, 86.7% for ages 40 to 49 years, 93.6% for ages 50 to 59 years, 94.1% for ages 60 to 69 years, and 91.2% for ages 70 years and older (P = .04). Specificity was similar for all ages, ranging from 92.6% to 95.2%. Of all abnormal first screening examinations, 92.9% were reported as "additional evaluation needed." The LRs for that category ranged from 5.2 to 8.8 and did not vary with age. Based on the risk of breast cancer before mammography, which increases with age, the risk of breast cancer after mammography associated with these LRs were 0.01 for ages 30 to 39 years, 0.02 for ages 40 to 49 years, 0.05 for ages 50 to 59 years, 0.07 for ages 60 to 69 years, and 0.07 for ages 70 years and older. The LRs for mammography reported as "suspicious for malignancy" ranged from 88 to 144 and did not vary across age groups. These LRs were associated with a risk of breast cancer about 10 times greater than when mammography was reported as "additional evaluation needed."
Most abnormal first screening mammography are interpreted as "additional evaluation needed" and are associated with LRs of about 7. Given this low LR, the risk of breast cancer after mammography is primarily influenced by a woman's age-specific risk of breast cancer before mammography. The LRs for screening mammography interpreted as "suspicious for malignancy" are high (about 124) and are associated with a substantial increase in the risk of breast cancer irrespective of age, but these interpretations comprise only a small proportion of abnormal mammography.
按年龄 decade 和乳房 X 线摄影解读情况确定现代筛查性乳房 X 线摄影的敏感性、特异性和似然比（LRs）。
横断面研究。
加利福尼亚北部的 9 个县。
1985 年 4 月至 1991 年 9 月期间，共有 26057 名 30 岁及以上的女性在加利福尼亚大学旧金山分校的流动乳房 X 线摄影筛查项目中接受了总共 41747 次首次及后续筛查性乳房 X 线摄影检查。
乳腺癌风险概况、每侧乳房 2 张标准乳房 X 线摄影片，并通过联系女性医生对异常和正常乳房 X 线摄影片进行随访，以及与区域监测、流行病学和最终结果肿瘤登记处进行关联。假阴性检查是指在浸润性乳腺癌或原位导管癌诊断前 13 个月内进行的正常检查。
首次筛查性乳房 X 线摄影的敏感性随年龄增加：30 至 39 岁为 77.3%，40 至 49 岁为 86.7%，50 至 59 岁为 93.6%，60 至 69 岁为 94.1%，70 岁及以上为 91.2%（P = 0.04）。各年龄组的特异性相似，范围为 92.6%至 95.2%。在所有异常的首次筛查检查中，92.9%被报告为“需要进一步评估”。该类别的似然比范围为 5.2 至 8.8，且不随年龄变化。根据乳房 X 线摄影前乳腺癌的风险（随年龄增加），与这些似然比相关的乳房 X 线摄影后乳腺癌风险在 30 至 39 岁为 0.01，40 至 49 岁为 0.02，50 至 59 岁为 0.05，60 至 69 岁为 0.07，70 岁及以上为 0.07。报告为“恶性可疑”的乳房 X 线摄影的似然比范围为 88 至 144，且各年龄组间无差异。这些似然比相关的乳腺癌风险比报告为“需要进一步评估”时大约高 10 倍。
大多数异常的首次筛查性乳房 X 线摄影被解释为“需要进一步评估”，且似然比约为 7。鉴于此低似然比，乳房 X 线摄影后乳腺癌的风险主要受女性乳房 X 线摄影前特定年龄的乳腺癌风险影响。被解释为“恶性可疑”的筛查性乳房 X 线摄影的似然比很高（约 124），且无论年龄如何，均与乳腺癌风险大幅增加相关，但这些解读仅占异常乳房 X 线摄影的一小部分。
