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
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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DOI：
10.1148/radiol.2251011667
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发表时间：
2002-10-01
期刊：
影响因子：
19.7
通讯作者：
Newhouse, JH
中科院分区：
文献类型：
--
作者：
Kolb, TM;Lichy, J;Newhouse, JH
目得：（a）确定筛查性乳腺X线摄影、超声检查（US）和体格检查（PE）的性能;（B）分析年龄、激素状态和乳腺密度的影响;（c）比较每种方式检测的肿瘤大小和分期;（d）确定哪种方式或方式组合优化癌症检测。材料和方法：共有11，130名无症状女性接受了27，825次筛查（乳房X线摄影和随后的PE）。乳腺致密的女性随后接受了超声筛查。结果：在221例妇女中，共发现246例乳腺癌，乳腺X线检查的敏感性、特异性、阴性和阳性预测值及准确性分别为77.6%、98.8%、99.8%、35.8%和98.6%; PE组分别为27.6%、99.4%、99.4%、28.9%、98.8%，US组分别为75.3%、96.8%、99.7%、20.5%、96.6%。乳腺超声筛查使诊断为不可触及浸润性癌症的女性人数增加了42%（71人中有30人）。乳腺摄影的敏感性随着乳腺密度的增加而显著下降（P <0.01）（致密乳腺为48%），而在致密乳腺的年轻女性中（P = 0.02）;这些影响是独立的。钼靶X线摄影和超声联合检查的敏感性（97%）明显高于钼靶X线摄影和PE联合检查的敏感性（74%）（P <0.001）。在乳房X线摄影和/或US检测到的肿瘤显着较小（P = .01）和较低的阶段（P =.01）比在PE检测到的。结论：乳腺癌的Marnmography灵敏度显着下降，随着乳腺密度的增加，是独立的高密度乳腺的老年妇女。与PE相比，增加筛查US显著增加了对更多的小癌症以及更小尺寸和更低阶段的癌症的检测，并且显著降低，PE独立地检测极少数癌症。激素状态对筛查的有效性没有显著影响，与乳腺密度无关。(C)RSNA，2002年。
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: Marnmographic 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 ficantly more cancers and at smaller size and lower stage cancers and depitts signi i than does PE, which detects, independently extremely few cancers. Hormonal status has no significant effect on effectiveness of screening independent of breast density. (C) RSNA, 2002.