Mushlin A I, Kouides R W, Shapiro D E
Department of Community and Preventive Medicine, University of Rochester Medical Center, NY 14642, USA.
Am J Prev Med. 1998 Feb;14(2):143-53. doi: 10.1016/s0749-3797(97)00019-6.
To estimate the accuracy of mammographic screening.
A meta-analysis of published literature.
Published English-language randomized controlled trials, case-control studies, and demonstration projects involving screening mammography were identified using recent review articles. We found additional references using MEDLINE searches combining the MeSH terms "mammography," "screening," and/or study authors and locations.
We included all studies that provided information to calculate the true-positive rate (TPR) and the false-positive rate (FPR) for breast cancer screening.
Reported data were reviewed independently by the authors; calculations were compared and discrepancies resolved. We calculated the sensitivity as the number of breast cancers detected during the first round of screening (true positives) divided by the sum of the true positives and the false negatives (defined as cancer discovered within 1 year of screening). False-positives were determined by biopsy.
TPR and FPR values from each study were plotted in receiver operating characteristic (ROC) space. Tests of homogeneity were performed to assess the validity of using summary ROC curves or a single point to summarize the data. The reported TPR and FPR of mammography ranged from 83% to 95% and 0.9% to 6.5%, respectively. The sensitivity of mammography is higher in women over the age of 50 years.
The accuracy of mammography should be recognized and included in discussions about policies for screening for breast cancer. This meta-analysis, by quantifying the expected TPR/FPR, should assist program planners, physicians, and women to understand better the cost and clinical implications of such screening programs.
评估乳腺钼靶筛查的准确性。
已发表文献的荟萃分析。
使用近期综述文章，识别已发表的英文随机对照试验、病例对照研究以及涉及乳腺钼靶筛查的示范项目。我们通过结合医学主题词“乳腺钼靶摄影”“筛查”和/或研究作者及地点的MEDLINE检索，找到了其他参考文献。
我们纳入了所有提供信息以计算乳腺癌筛查真阳性率（TPR）和假阳性率（FPR）的研究。
作者独立审查报告的数据；比较计算结果并解决差异。我们将敏感性计算为第一轮筛查中检测到的乳腺癌数量（真阳性）除以真阳性与假阴性之和（假阴性定义为筛查后1年内发现的癌症）。假阳性通过活检确定。
将每项研究的TPR和FPR值绘制在受试者操作特征（ROC）空间中。进行同质性检验以评估使用汇总ROC曲线或单个点汇总数据的有效性。乳腺钼靶摄影报告的TPR和FPR分别为83%至95%和0.9%至6.5%。50岁以上女性乳腺钼靶摄影的敏感性更高。
应认识到乳腺钼靶摄影的准确性，并将其纳入关于乳腺癌筛查政策的讨论中。这项荟萃分析通过量化预期的TPR/FPR，应有助于项目规划者、医生和女性更好地理解此类筛查项目的成本和临床意义。
