Frequency and predictive value of a mammographic recommendation for short-interval follow-up.
Frequency and predictive value of a mammographic recommendation for short-interval follow-up.
复制标题
短间隔随访的乳房X光检查建议的频率和预测价值。
DOI：
10.1093/jnci/95.6.429
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发表时间：
2003
期刊：
影响因子：
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通讯作者：
Hendrix,SusanL
中科院分区：
文献类型：
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作者：
Yasmeen,Shagufta;Romano,PatrickS;Pettinger,Mary;Chlebowski,RowanT;Robbins,JohnA;Lane,DorothyS;Hendrix,SusanL
背景：建议对“可能为良性的发现”进行短期随访与高达11%的筛查性乳房X线片相关，但其对乳腺癌的预测价值尚不清楚。我们检查了预测值（即，建议短期随访2年后诊断为乳腺癌的女性百分比）和似然比（来自妇女健康倡议样本中乳腺癌的测试前和测试后的几率）与绝经后妇女中短间隔随访的建议相关的乳腺癌。方法：我们对68126名绝经后妇女的前瞻性队列进行了纵向分析（年龄50-79岁），他们在美国40个中心参加了作为妇女健康倡议一部分的临床试验。合格的参与者在基线时进行了筛查性乳房X线摄影，并进行了至少2年的随访，其中包括重复乳房X线摄影。测量的结果是基线后1年和2年的乳腺癌事件以及随后的乳房X线照片结果。结果：58408名合格妇女中共有2927名（5%）进行了基线乳房X线检查，其中包括短期随访的建议。在基线乳房X线检查后2年，建议进行短期随访的女性乳腺癌发病率为1.0%，而基线乳房X线检查被描述为“良性”和“阴性”的女性乳腺癌发病率分别为0.6%和0.5%。在40个参与中心中，基线乳房X光检查中短间隔随访建议的患病率从1.2%到9.8%不等（P<0.001），即使分析在回归模型中对关键变量进行了调整。报告此类建议频率较高的中心对乳腺癌的阳性预测值并不低于报告频率较低的中心。乳腺癌的似然比为2.20（95%置信区间= 1.65至2.86）。结论：乳腺摄影建议短间隔随访与绝经后妇女在2年随访期间乳腺癌的阳性预测值较低相关。这一结果表明，目前的诊断标准-在6个月内重复乳房X光检查-应该重新考虑。
Background:A recommendation for short-interval follow-up of “probably benign finding” is associated with up to 11% of screening mammograms, but its predictive value for breast cancer is unclear. We examined the predictive values (i.e., the percentage of women with a diagnosis of breast cancer 2 years after a short-interval follow-up recommendation) and likelihood ratios (derived from the pretest and post-test odds of breast cancer in the Women’s Health Initiative sample) for breast cancer that are associated with a recommendation for short-interval follow-up among postmenopausal women.Methods:We performed a longitudinal analysis of a prospective cohort of 68 126 postmenopausal women (aged 50–79 years) who were participating in clinical trials as part of the Women’s Health Initiative at 40 centers across the United States. Eligible participants had screening mammograms at baseline and at least 2 years of follow-up that included a repeat mammography. Outcomes measured were breast cancer events at 1 and 2 years after baseline and the results of subsequent mammograms. AllPvalues were two-sided.Results:A total of 2927 (5%) of the 58 408 eligible women had baseline mammograms that included recommendations for short-interval follow-up. The incidence of breast cancer for women with a short-interval follow-up recommendation was 1.0% at 2 years after the baseline mammogram compared with breast cancer incidences of 0.6% and 0.5% for women whose baseline mammograms were described as “benign” and “negative,” respectively. Across the 40 participating centers, the prevalence of short-interval follow-up recommendations among baseline mammograms varied from 1.2% to 9.8% (P<.001), even when the analysis was adjusted for key variables in regression models. Centers reporting higher frequencies of such recommendations did not have lower positive predictive values for breast cancer than centers reporting lower frequencies. The likelihood ratio for breast cancer after a recommendation for short-interval follow-up on a subsequent mammogram was 2.20 (95% confidence interval = 1.65 to 2.86).Conclusion:Having a mammographic recommendation for short-interval follow-up was associated with a low positive predictive value for breast cancer among postmenopausal women during a 2-year follow-up. This result suggests that the current criteria for this recommendation—repeat mammography within 6 months—should be reconsidered.