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目的在数字乳腺钼靶筛查中被召回并由医生行补充双侧全乳超声检查的人群中,评估与乳腺钼靶密度相关的额外乳腺癌检出的阳性预测值(PPV1)和穿刺活检的阳性预测值(PPV3)。方法研究包括2803例经钼靶筛查被召回(50~69岁)的病人,均接受补充的双乳超声检查并具有完整的前瞻性完整记录文档[乳腺密度分级(ACR1～4),超声和乳腺推荐的穿刺活检]。结果仅由双乳超声检查额外发现乳腺癌的PPV1值为0.21%(6/2803),钼靶为13.8%(386/2803)。对于女性乳腺不同密度ACR1、ACR2、ACR3和ACR4,仅经超声乳腺癌检出的PPV1值分别为0、0.16%(2/1220)、0.22%(3/1374)和1.06%(1/94)。病例中由超声检出的病灶其PPV3为33.3%(9/27),经乳腺钼靶检出的PPV3为38.0%(405/1066)。对于<10mm的乳腺浸润癌,仅经超声检出的占37.5%(3/8),钼靶检出的占38.4%(113/294)。结论对筛查召回的病人行双侧乳腺超声除了能对乳腺钼靶筛查异常进行评估外,对于额外乳腺癌检查的PPV值低,但也不会引起假阳性活检不成比例的增加。要点①双侧乳腺超声检查用于评估女性数字乳腺X线摄影筛查后被召回者。②总体乳腺癌的检出率达到了欧洲指南的预期水平。③额外超声检查检出乳腺癌的阳性预测值较低(0.21%)。④超声检查对于能明确乳腺分级ACR2~4的病人能明确检出额外的乳腺癌。⑤双侧乳腺超声在常规筛查中几乎不起或仅起很小的作用。
Objective To evaluate the positive predictive value (PPV1) for extra breast cancer associated with breast molybdenum target density in patients recalled by digital mammography screening and double-sided ultrasound examination performed by physicians, and the biopsy Positive predictive value (PPV3). METHODS: A total of 2,803 patients who were recalled (50-69 years) by mammographic screening were enrolled in this study. All patients underwent double-sonography and had complete prospective complete documentation of the disease (breast density grading (ACR1-4), sonography Breast biopsy recommended]. Results The additional PPV1 value of breast cancer was 0.21% (6/2803) and 13.8% (386/2803) for mammography. The PPV1 values detected by ultrasound-only breast cancer were 0,0.16% (2/1220), 0.22% (3/1374) and 1.06% (1/94) respectively for ACR1, ACR2, ACR3 and ACR4 at different breast densities . PPV3 was found in 33.3% (9/27) of the cases diagnosed by ultrasound and in 38.0% (405/1066) of PPV3 detected by mammography. For breast cancer <10 mm, only 37.5% (3/8) were detected by ultrasound and 38.4% (113/294) by mammography. Conclusions Bilateral mammography in screening patients with recurrent findings In addition to assessing mammographic screening abnormalities, PPV values for extra breast cancer tests are low but do not cause a disproportionate increase in false-positive biopsies. Key points ① Bilateral sonography was used to assess the number of women who were recalled after digital mammography screening. ② The overall detection rate of breast cancer has reached the expected level of European guidelines. ③ additional ultrasound examination detected a lower positive predictive value of breast cancer (0.21%). ④ ultrasonography can clearly breast cancer grade ACR2 ~ 4 patients can be clearly detected. ⑤ bilateral breast ultrasound in the routine screening almost can not afford or play only a small role.