钼靶X线在亚洲女性乳腺癌筛查中的准确性评价

Accuracy evaluation of mammography in the breast cancer screening in Asian women： a commtmitybased follow-up study and meta analysis

目的评价在亚洲人群乳腺癌筛查中使用钼靶X线诊断乳腺癌的准确性。方法2002年3月至2007年9月，收集8718名常规体检的成都市社区女性的乳腺钼靶X线检查资料，分别以病理组织学结果和随访结果为最终诊断的金标准，计算钼靶X线诊断乳腺癌的敏感度和特异度。检索国内外有关钼靶X线用于亚洲女性一般人群乳腺癌筛查的研究，连同上述队列资料一起纳入Meta分析，计算合并敏感度、特异度及诊断比值比（DOR），并绘制综合受试者工作特征曲线（SROC），评价其诊断效能。结果基于成都社区的随访研究显示，钼靶X线诊断乳腺癌的敏感度为0．889（95％CI为0．741—0．970），特异度为0．991（95％CI为0．987—0．993）。Meta分析共纳入合格研究7个，共计研究对象223619人。纳入的研究具有异质性，按照随机效应模型（REM）计算出的合并敏感度为0．845（95％CI为0．821～0．870），特异度为0．930（95％CI为0．929～0．931），DOR为117．271（95％CI为65．060～211．412），SROC下面积为0．9144。结论钼靶X线在亚洲女性乳腺癌筛查中有较高的准确性。

Objective To evaluate the accuracy of mammography in breast cancer screening in Asian women. Methods 8718 community women in Chengdu were examined by mammography during the routine physical examination from Mar. 2002 to Sep. 2007. Pathological diagnosis and following up results were used as the gold standards for X-ray-positive and -negative findings. The sensitivity, specificity and diagnosis odds ratio were calculated as accuracy indexes. Large scale follow-up studies of breast cancer screening in community in Asian women were collected to evaluate the pooled accuracy of mammography. Diagnosis meta-analysis was conducted with Meta-Disc software to estimate the pooled sensitivity, specificity and DOR, and draw the summary receiver operating characteristic （SROC）. Results The data of seven studies were included with a total of 223 619 women received mammography for screening breast cancer. The sensitivity （95% CI） and specificity （95% CI） of mammography of community-based follow-up study in Chengdu were 0. 889 （0.741-0.970） and 0.991 （0. 987-0.993 ）, respectively. Referring to meta-analysis, random effects models were adopted clue to existed heterogeneity among studies. The pooled sensitivity, specificity, DOR with their 95% confidence intervals were 0.845 （0. 821-0.870）, 0.930 （0.929-0.931） and 117. 271 （65. 060-211. 412）, respectively. The Area Under the Curve （AUC） of SROC was 0. 9144. Conclusion Due to its high accuracy, mammography deserves to be recommend in breast cancer screening in Asian women.