CAJ | 학술논문

目的比较分析乳腺癌高危因素(病史采集)、乳腺查体、乳腺彩色多普勒超声(即彩超)和乳腺钼靶X线摄影术(即乳腺钼靶)等常用的早期乳腺癌诊断方法对乳腺癌早期诊断的准确性.方法采用前瞻性方法,对2010年4月至2011年9月进行手术活检的初治患者,通过病史采集以及前期“十一五”课题建立的中国乳腺癌发病风险预测模型确定乳腺癌的发病风险,并独立进行乳腺查体、乳腺彩超和钼靶评估,并与最终病理结果进行比较,分析其灵敏度、特异度、阳性预测值、阴性预测值和准确性.结果共入组患者1468例,年龄13 ～92岁,中位年龄44岁.其中乳腺癌患者551例,发病高峰年龄为40 ～ 60岁.乳腺癌发病风险预测模型、乳腺查体、乳腺彩超和乳腺钼靶的灵敏度分别为47.5％、86.2％、89.8％和79.3％,特异度分别为68.8％、83.3％、81.0％和88.7％,阳性预测值分别为47.6％、75.5％、73.8％和80.8％,阴性预测值分别为68.8％、91.0％、93.0％和87.8％,准确性分别为60.9％、84.4％、84.3％和85.2％.年龄是影响乳腺查体、乳腺彩超和乳腺钼靶灵敏度和特异度的重要因素.结论在乳腺癌早期诊断中,乳腺彩超对中国女性灵敏度优于钼靶,应该作为初诊患者首选的常规检查；任何单一的检查方法还不能获得很高的准确性,对于高危的乳腺癌人群需要采用多种检查方法联合进行诊断.
목적 비교분석유선암고위인소(병사채집)、유선사체、유선채색다보륵초성(즉채초)화유선목파X선섭영술(즉유선목파)등상용적조기유선암진단방법대유선암조기진단적준학성.방법 채용전첨성방법,대2010년4월지2011년9월진행수술활검적초치환자,통과병사채집이급전기“십일오”과제건립적중국유선암발병풍험예측모형학정유선암적발병풍험,병독립진행유선사체、유선채초화목파평고,병여최종병리결과진행비교,분석기령민도、특이도、양성예측치、음성예측치화준학성.결과 공입조환자1468례,년령13 ～92세,중위년령44세.기중유선암환자551례,발병고봉년령위40 ～ 60세.유선암발병풍험예측모형、유선사체、유선채초화유선목파적령민도분별위47.5％、86.2％、89.8％화79.3％,특이도분별위68.8％、83.3％、81.0％화88.7％,양성예측치분별위47.6％、75.5％、73.8％화80.8％,음성예측치분별위68.8％、91.0％、93.0％화87.8％,준학성분별위60.9％、84.4％、84.3％화85.2％.년령시영향유선사체、유선채초화유선목파령민도화특이도적중요인소.결론 재유선암조기진단중,유선채초대중국녀성령민도우우목파,응해작위초진환자수선적상규검사；임하단일적검사방법환불능획득흔고적준학성,대우고위적유선암인군수요채용다충검사방법연합진행진단.
Objective Mammography is the principle imaging modality used for early diagnosis of breast cancer in Western countries.It has not been well-established whether this Western diagnostic modality is adoptable for Chinese women.The aim of this study was to evaluate the respective accuracy of the common diagnostic tools for breast cancer including history-taking,physical examination,ultrasound and mammography.Methods Clinical presentation and investigations for consecutive patients undergoing history-taking,physical examination,ultrasound,mammography and pathological assessment at Peking Union Medical College Hospital were prospectively recorded between April 2010 and September 2011.Breast cancer high-risk factors acquired by history-taking were input into the risk assessment model established previously by Eleventh Five Year Key Programs for Science and Technology Development of China (Grant No.2006BAI02A09) and classified into low-,medium-,high-and extremely high-risk groups.The low-and medium-risk groups were defined as test negative,while the high-and extremely high-risk groups were defined as test positive.Each mammogram and ultrasound was reported prospectively using a five-point reporting scale of the American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS).Clinical data were compared with pathological findings.Sensitivity,specificity,positive predictive value (PRV),negative predictive value (NPV) and accuracy of respective diagnostic methods were calculated and compared.The patients were divided into two groups,above and below 50 years of age for subgroup analysis.Results A total of 1468 patients (1475 breast lesions) constituted the study population.The median age was 44 (range 13-92) years.Five hundred and fifty-one patients were diagnosed as breast cancer.The median age at diagnosis was 51 years and breast cancer peaked in the age group of 40-60 years.The sensitivity of risk assessment model,physical examination,ultrasound and mammogram was 47.5％,86.2％,89.8％ and 79.3％,respectively ; specificity was 68.8％,83.3％,81.0％ and 88.7％,respectively ; PRV was 47.6％,75.5％,73.8％ and 80.8％,respectively; NPV was 68.8％,91.0％,93.0％ and 87.8％,respectively; and accuracy was 60.9％,84.4％,84.3％ and 85.2％,respectively.Further subgroup analysis demonstrated that age is an important factor influencing the sensitivity and specificity of physical examination,ultrasound and mammography.Conclusions Ultrasound is more sensitive than mammography for early diagnosis of breast cancer in Chinese women and should be routinely used as a first-line diagnostic tool.Only a single diagnostic method is not enough sometimes and combined examination is needed for some high-risk populations.