CAJ | 학술논문

目的评价临床扪诊、钼靶X线或高频超声不同筛查方案在中国女性乳腺癌筛查中的准确性及直接医疗成本.方法采用以体检人群为基础的平行盲法比较试验设计,对≥35岁女性进行第一轮乳腺癌筛查,以及首轮筛查阴性者的1年随访和第二轮复查.以活组织检查和1年随访结果为金标准,分别计算不同乳腺癌筛查方案的准确性指标和直接医疗成本,比较不同乳腺癌筛查方案的准确性差异和直接医疗成本差异.结果共入组研究对象2 471例,检出14例乳腺癌,其中单纯使用钼靶X线检查检出11例,高频超声检查检出9例,临床扪诊检出8例.在3项独立筛查模式中,钼靶X线检查检出了最少的可疑癌(52例)和最多的乳腺癌(11例).超声→钼靶筛查模式的特异度(99.7％)和阳性预测值(11.4％)最高,灵敏度为78.6％,每确诊1例乳腺癌病例的平均筛查费用在城市和农村地区分别为29.121万元和88.605万元.结论超声→钼靶筛查模式可能是更适合我国国情的乳腺癌筛查方案,但在发病率较低、卫生资源有限的地区开展全人群的乳腺癌筛查成本仍显过高.
목적 평개림상문진、목파X선혹고빈초성불동사사방안재중국녀성유선암사사중적준학성급직접의료성본.방법 채용이체검인군위기출적평행맹법비교시험설계,대≥35세녀성진행제일륜유선암사사,이급수륜사사음성자적1년수방화제이륜복사.이활조직검사화1년수방결과위금표준,분별계산불동유선암사사방안적준학성지표화직접의료성본,비교불동유선암사사방안적준학성차이화직접의료성본차이.결과 공입조연구대상2 471례,검출14례유선암,기중단순사용목파X선검사검출11례,고빈초성검사검출9례,림상문진검출8례.재3항독립사사모식중,목파X선검사검출료최소적가의암(52례)화최다적유선암(11례).초성→목파사사모식적특이도(99.7％)화양성예측치(11.4％)최고,령민도위78.6％,매학진1례유선암병례적평균사사비용재성시화농촌지구분별위29.121만원화88.605만원.결론 초성→목파사사모식가능시경괄합아국국정적유선암사사방안,단재발병솔교저、위생자원유한적지구개전전인군적유선암사사성본잉현과고.
Objective To evaluate the accuracy and direct medical cost of different screening modalities of physical examination (PE),mammography (MAM),and high-frequency ultrasonography (US) for breast cancer among Chinese women.Methods This study was designed as a blindly carried outcom parative parallel screening trial for breast cancer among Chinese women aged 35 years or older.Physical examination was conducted with the subjects in the first round of breast cancer screening.The negative cases were followed up approximately 1 year later and moved into the second round of screening.Using the results of biopsies and 1-year follow-up as the gold standards,the accuracy and cost indexes of different screening modalities were calculated.Data were analyzed by McNemar test.Results A total of 2 471 eligible women were included in this trial,and 14 breast cancers were identified among them.Mammography enabled to detect 11 cancers,high-frequency ultrasonography detected 9 cancers and physical examination detected 8 cancers.Considering the three modalities separately,MAM identified the fewest suspicious cases (52 cases) and detected the most cancers (11 cases).Using US alone at the first stage,followed by MAM when indicated,offered the highest specificity (99.7％) and correct positive predictive value (11.4％),meanwhile the sensitivity was 78.6％,and the mean costs of the screening modality in urban and rural areas were 291,210 yuan and 886,050 yuan per cancer case detected.Conclusions The strategy of screening with US alone at the first stage,followed by MAM when indicated,may be the most suitable modality of breast cancer detection in most regions of China,but the cost is still too high to develop the breast cancer screening in some low incidence regions with limited health resources.