论文部分内容阅读
目的:探讨临床体检联合超声补充X射线钼靶检查的乳腺癌筛查模式在普通妇女群体中的应用价值。方法:采用临床体检联合超声补充X射线钼靶检查的乳腺癌筛查模式对35～59岁的广州市郊区农村户籍妇女进行群体性乳腺癌筛查。全部妇女先行临床体检和乳腺超声检查,超声BI-RADS 4c级和5级者活检,BI-RADS 1级和2级者于1年后随访;0、3、4a和4b级补充行X射线钼靶检查,超声和X射线钼靶均为4级以上者行活检,其余由临床医师决定随访或活检。结果:2010-01-01-2011-12-31共完成乳腺癌筛查284 168人,确诊乳腺癌151例。乳腺癌检出率为53.14/10万,检出率与活检率呈正相关,r=0.771;P=0.042。乳腺癌分期构成比0期8.6%,Ⅰ期38.4%,与住院病例相比,Ⅰ期病例明显增多,χ2=13.345,P=0.01。0～Ⅱ期病例检出率为44.7/10万,每检出1例0～Ⅱ期病例需花费13.4万元;其中50～59岁组早期病例检出率为67.0/10万,明显优于35～39岁组(χ2=17.172,P<0.001)和40～49岁组(χ2=4.887,P=0.027),每检出1例0～Ⅱ期病例需花费9.0万元,少于其他年龄组,和2010年广州市人均GDP值(8.8万元)相当。本项目筛查模式的敏感性为97.35%,特异性为99.89%;敏感性显著优于单纯临床体检模式(79.5%),χ2=4.528,P=0.033;与超声检查模式(92.1%)和体检联合超声而不补充X射线钼靶的模式(94.0%)相比较则差异无统计学意义,P>0.05;但其假阳性活检率(110.15/10万)显著低于超声检查模式的129.15/10万,χ2=4.293,P=0.038;也低于体检联合超模式的135.48/10万,χ2=7.436,P=0.006。结论:体检联合超声补充X射线钼靶检查的乳腺癌筛查模式明显提高了Ⅰ期乳腺癌的构成比例,和不含X射线钼靶的筛查模式相比,在得到高敏感性同时又能降低假阳性活检率。成本效益分析显示,50～59岁年龄组具有最优的成本效益。
Objective: To explore the value of clinical screening combined with ultrasonography in screening mammography for breast cancer screening in general women. Methods: Breast cancer screening test with clinical examination combined with sonography and X-ray mammography screening for 359-year-old rural women in Guangzhou suburbs for screening of breast cancer. All women were followed up by clinical examinations and breast ultrasonography, with ultrasound BI-RADS grade 4c and grade 5 biopsies, and those with grade 1 and grade 2 BI-RADS were followed up after one year. X-ray molybdenum Target examination, ultrasound and X-ray molybdenum target are more than 4 biopsy, the rest decided by the clinician follow-up or biopsy. Results: 2010-01-01-2011-12-31 A total of 284 168 breast cancer screening completed, 151 cases of breast cancer confirmed. The detection rate of breast cancer was 53.14 / 100000, the detection rate was positively correlated with the biopsy rate, r = 0.771; P = 0.042. The staging of breast cancer was 8.6% compared with stage 0 and 38.4% of stage I. Compared with inpatient cases, the stageⅠwas significantly increased (χ2 = 13.345, P = 0.01.0 ~ Ⅱ), and the detection rate was 44.7 / The detection rate of one case from stage 0 to stage II was 134,000 yuan, of which the detection rate of early stage cases in 50 to 59 years old group was 67.0 / 100,000, which was significantly better than that in 35-39 group (χ2 = 17.172, P <0.001) In the age group of 40-49 years old (χ2 = 4.887, P = 0.027), one case of stage 0 to stage II was detected with 90,000 yuan per case, less than other age groups and the per capita GDP of Guangzhou in 2010 (88,000 yuan) quite. The sensitivity of this screening program was 97.35% and the specificity was 99.89%. The sensitivity was significantly better than that of simple clinical examination (79.5%), χ2 = 4.528, P = 0.033. However, the false positive rate (110.15 / 100000) was significantly lower than that of the ultrasound examination mode (129.15 / 10), but no significant difference was found between the combined ultrasound and non-X-ray mammography Χ2 = 4.293, P = 0.038; also lower than 135.48 / 100000, χ2 = 7.436, P = 0.006. Conclusion: The combination of physical examination and ultrasound-assisted mammography screening for breast cancer significantly increases the proportion of stage I breast cancer. Compared with screening mode without X-ray molybdenum target, Reduce false-positive biopsy rates. Cost-benefit analysis shows that the 50 to 59 age group has the best cost-effectiveness.