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首页> 外文期刊>Radiology >Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations.
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Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations.

机译：乳腺钼靶筛查，体格检查和乳腺超声检查的性能比较以及对影响其的因素的评估：对27,825例患者评估的分析。

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PURPOSE: To (a) determine the performance of screening mammography, ultrasonography (US), and physical examination (PE); (b) analyze the influence of age, hormonal status, and breast density; (c) compare the size and stage of tumors detected with each modality; and (d) determine which modality or combination of modalities optimize cancer detection. MATERIALS AND METHODS: A total of 11,130 asymptomatic women underwent 27,825 screening sessions, (mammography and subsequent PE). Women with dense breasts subsequently underwent screening US. Abnormalities were deemed positive if biopsy findings revealed malignancy and negative if findings from biopsy or all screening examinations were negative. RESULTS: In 221 women, 246 cancers were found. Sensitivity, specificity, negative and positive predictive values, and accuracy of mammography were 77.6%, 98.8%, 99.8%, 35.8%, and 98.6%, respectively; those of PE, 27.6%, 99.4%, 99.4%, 28.9%, and 98.8%, respectively; and those of US, 75.3%, 96.8%, 99.7%, 20.5%, and 96.6%, respectively. Screening breast US increased the number of women diagnosed with nonpalpable invasive cancers by 42% (30 of 71). Mammographic sensitivity declined significantly with increasing breast density (P <.01) (48% for the densest breasts) and in younger women with dense breasts (P =.02); the effects were independent. Mammography and US together had significantly higher sensitivity (97%) than did mammography and PE together (74%) (P <.001). Tumors detected at mammography and/or US were significantly smaller (P =.01) and of lower stage (P =.01) than those detected at PE. CONCLUSION: Mammographic sensitivity for breast cancer declines significantly with increasing breast density and is independently higher in older women with dense breasts. Addition of screening US significantly increases detection of small cancers and depicts significantly more cancers and at smaller size and lower stage than does PE, which detects independently extremely few cancers. Hormonal status has no significant effect on effectiveness of screening independent of breast density.
机译：目的：（a）确定乳腺钼靶筛查，超声检查（US）和身体检查（PE）的表现; （b）分析年龄，荷尔蒙状况和乳房密度的影响; （c）比较每种方式检测到的肿瘤的大小和阶段; （d）确定哪种方式或方式的组合可以优化癌症检测。材料与方法：总计11,130名无症状女性接受了27,825次筛查，（钼靶和随后的PE）。随后，对乳房密实的女性进行了美国筛查。如果活检结果显示为恶性，则认为异常为阳性;如果活检结果或所有筛查检查为阴性，则认为异常为阴性。结果：在221名妇女中，发现了246种癌症。乳腺X线摄影的敏感性，特异性，阴性和阳性预测值分别为77.6％，98.8％，99.8％，35.8％和98.6％; PE分别为27.6％，99.4％，99.4％，28.9％和98.8％;分别为75.3％，96.8％，99.7％，20.5％和96.6％。筛查美国乳腺疾病使诊断为不可触及的浸润性癌症的妇女人数增加了42％（71名患者中的30名）。随着乳房密度的增加，乳房X光检查的敏感性显着下降（P <.01）（最密集的乳房为48％），而年轻女性的乳房密集（P = .02）;效果是独立的。乳腺X线摄影和US一起的敏感性（97％）明显高于乳腺X线摄影和PE的共同敏感性（74％）（P <.001）。乳腺X线摄影和/或超声检查发现的肿瘤明显小于PE检出的肿瘤（P = .01），而其分期更短（P = .01）。结论：随着乳房密度的增加，对乳房X线照相的敏感性显着下降，并且在乳房密实的老年妇女中，乳房X线照相的敏感性独立地更高。与独立检测极少数癌症的PE相比，增加US筛查显着提高了对小癌的检出率，并显示了明显更多的癌，且病灶更小且分期更低。激素状态对筛查效率的影响与乳房密度无关，没有显着影响。

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