Ten-year risk of false positive screening mammograms and clinical breast examinations
Ten-year risk of false positive screening mammograms and clinical breast examinations
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DOI：
10.1056/nejm199804163381601
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发表时间：
1998-04-16
影响因子：
158.5
通讯作者：
Fletcher, SW
中科院分区：
文献类型：
--
作者：
Elmore, G;Barton, MB;Fletcher, SW
背景乳腺癌筛查试验假阳性结果的累积风险是unknown.Methods我们进行了一项为期10年的回顾性队列研究，对2400名年龄在40 ~ 69岁的女性进行了乳腺癌筛查和诊断评估。乳腺X线检查或临床乳腺检查被解释为不确定的，引起怀疑的癌症，或提示建议额外的工作，在妇女中没有被诊断为乳腺癌在未来一年内被认为是假阳性tests.Results共9762筛查乳腺X线检查和10,905筛查乳腺检查，在10年期间，每名妇女平均接受4次乳房X光检查和5次临床乳房检查。在接受筛查的妇女中，23.8%的人至少有一次假阳性乳房X光检查，13.4%的人至少有一次假阳性乳房检查，31.7%的人至少有一次假阳性结果。在10次乳房X光检查后，假阳性结果的估计累积风险为49.1%（95%置信区间，40.3%至64.1%），在10次临床乳房检查后为22.3%（95%置信区间，19.2%至27.5%）。假阳性检测导致870次门诊预约，539次诊断性乳房X光检查，186次超声波检查，188次活检和1次住院治疗。我们估计，在未患乳腺癌的女性中，18.6%（95%置信区间，9.8%至41.2%）将在10次乳房X光检查后进行活检，6.2%（95%置信区间，3.7%至11.2%）将在10次临床乳腺检查后进行活检。对于每100美元的筛查花费，额外的33美元花费，以评估假阳性结果。结论超过10年，三分之一的妇女筛选异常的测试结果，需要额外的评估，即使没有乳腺癌。需要技术来减少假阳性结果，同时保持高灵敏度。医生应该教育妇女乳腺癌筛查试验假阳性结果的风险。(C)1998年，马萨诸塞州医学会。
Background The cumulative risk of a false positive result of a breast-cancer screening test is unknown.Methods We performed a 10-year retrospective cohort study of breast-cancer screening and diagnostic evaluations among 2400 women who were 40 to 69 years old at study entry. Mammograms or clinical breast examinations that were interpreted as indeterminate, aroused a suspicion of cancer, or prompted recommendations for additional workup in women in whom breast cancer was not diagnosed within the next year were considered to be false positive tests.Results A total of 9762 screening mammograms and 10,905 screening clinical breast examinations were performed, for a median of 4 mammograms and 5 clinical breast examinations per woman over the 10-year period. Of the women who were screened, 23.8 percent had at least one false positive mammogram, 13.4 percent had at least one false positive breast examination, and 31.7 percent had at least one false positive result for either test. The estimated cumulative risk of a false positive result was 49.1 percent (95 percent confidence interval, 40.3 to 64.1 percent) after 10 mammograms and 22.3 percent (95 percent confidence interval, 19.2 to 27.5 percent) after 10 clinical breast examinations. The false positive tests led to 870 outpatient appointments, 539 diagnostic mammograms, 186 ultrasound examinations, 188 biopsies, and 1 hospitalization. We estimate that among women who do not have breast cancer, 18.6 percent (95 percent confidence interval, 9.8 to 41.2 percent) will undergo a biopsy after 10 mammograms, and 6.2 percent (95 percent confidence interval, 3.7 to 11.2 percent) after 10 clinical breast examinations. For every $100 spent for screening, an additional $33 was spent to evaluate the false positive results.Conclusions Over 10 years, one third of the women screened had abnormal test results requiring additional evaluation, even though no breast cancer was present. Techniques are needed to decrease false positive results while maintaining high sensitivity. Physicians should educate women about the risk of a false positive result of a screening test for breast cancer. (C) 1998, Massachusetts Medical Society.