Likelihood ratios for modern screening mammography - Risk of breast cancer based on age and mammographic interpretation
Likelihood ratios for modern screening mammography - Risk of breast cancer based on age and mammographic interpretation
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DOI：
10.1001/jama.276.1.39
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发表时间：
1996-07-03
影响因子：
120.7
通讯作者：
Ernster, V
中科院分区：
文献类型：
--
作者：
Kerlikowske, K;Grady, D;Ernster, V
目标。确定现代乳房x线摄影筛查的敏感性、特异性和似然比（LRs）（按年龄和乳房x线摄影解释）。-北加州的9个县。从1985年4月到1991年9月，共有26057名年龄在30岁及以上的女性在加州大学旧金山分校的移动乳房x线摄影筛查项目中接受了41447次首次和随后的筛查性乳房x线摄影检查。-乳腺癌风险概况，每个乳房2次标准乳房x光检查，通过联系女性医生和与区域监测、流行病学和最终结果肿瘤登记处的联系，对异常和正常乳房x光检查进行随访。假阴性检查是指在诊断为浸润性乳腺癌或原位导管癌后13个月内发生的正常检查。首次筛查乳房x光检查的敏感性随年龄增加而增加：30 ~ 39岁77.3%，40 ~ 49岁86.7%，50 ~ 59岁93.6%，60 ~ 69岁94.1%，91岁94.1%。70岁及以上（P= 0.04）。所有年龄段的特异性相似，范围为92.6%至95.2%。在所有异常的首次筛查检查中，92.9%报告为“需要额外评估”。这一类人的最低风险指数从5.2到8.8不等，不随年龄变化。根据乳房x光检查前乳腺癌风险随年龄增长而增加，与LRs相关的乳房x光检查后乳腺癌风险30 - 39岁为0.01,40 - 49岁为0.02,50 - 59岁为0.05,60 - 69岁为0.07,70岁及以上为0.07。乳房x光检查报告为“可疑恶性肿瘤”的LRs从88到144不等，在不同年龄组之间没有变化。这些LRs与乳腺癌的风险相关，大约是乳房x光检查报告为“需要额外评估”时的10倍。大多数异常的首次筛查乳房x光检查被解释为“需要额外的评估”，并与LRs约为7相关。鉴于这种低LR，乳房x光检查后乳腺癌的风险主要受乳房x光检查前女性年龄特异性乳腺癌风险的影响。筛查乳房x光检查被解释为“可疑恶性肿瘤”的LRs很高（约为124），并且与乳腺癌风险的大幅增加有关，而与年龄无关，但这些解释仅占异常乳房x光检查的一小部分。
Objective.-To determine the sensitivity, specificity, and likelihood ratios (LRs) for modern screening mammography by decade of age and mammographic interpretation.Design.-Cross-sectional.Setting.-Nine counties in northern California.Participants.-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.Measurements.-Breast cancer risk profile, 2 standard mammographic views per breast, and follow-up of abnormal and normal mammograms by 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.Results.-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.?% 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.''Conclusions.-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 mammagraphy.