超声检查、乳房X线摄影术在乳腺癌筛查和早期诊断中作用的Meta分析

The effect of ultrasonic inspection and mammography in the screening and early diagnosis of breast cancer: a Meta-analysis

目的评价超声检查（US）、乳房X线摄影术（MAM）及两种方法联合应用对乳腺癌的诊断效能，探讨US在乳腺癌筛沓和早期诊断中的作用。方法应用Meta分析方法对有关US、MAM及两种方法联合应用诊断乳腺癌的文献进行定量综合分析，按诊断策略不同分为3组，计算不同诊断方法的合并诊断比值比（DOR），然后绘制出3条综合接受者工作特征（SROC）曲线。结果共纳入8篇文献。超声诊断的合并DOR值为19．10（95％CI为12．62～28，91）；MAM诊断的合并DOR值为33.07（95％CI为1647～66．40）；苘种方法联合诊断的合并DOR值为78．13（95％CI为27.68～220．59）。SROC曲线分析表明，MAM比US的诊断效能高；MAM与US联合应用，可明显提高乳腺癌诊断的灵敏度，诊断效能最好。结论US对MAM早期诊断乳腺癌起重要的辅助作用。结合我国的实际情况，US可作为定期筛查乳腺癌的首选方法。

Objective To evaluate the diagnostic efficiency of ultrasonic inspection, mammography and a combined diagnosis using the two methods together and to discuss the diagnostic performance of ultrasonography in the screening and early detection of breast cancer. Methods The Meta-analysis was used to analyze the results which the subjects were all diagnosed using ultrasonography, mammography and a combined diagnosis using the two methods together. According to the different diagnostic strategies, three groups were defined, and calculated the diagnostic odds ratios （DOR） of different diagnostic methods, then plotted three SROCs. Results Eight studies were included in the present analysis. The incorporate DOR value of ultrasonography was 19.10, and the 95 % CI was 12.62 - 28.90 ; the ineoporate DOR value of mammography was 33.07, and the 95% CI was 16.47-66.40; the incorporate DOR value of the combined diagnosis was 78.13, and the 95% CI was 27. 68 - 220. 59 ; all the resuhs were statistically significant. Analysis of the SROC showed that there was no significant difference between MAM and US, and that the combined diagnosis was the most efficient and can improve sensitivity significantly. Conclusions It suggested that ultrasonography was an important adjunct to mammography in early detection of breast cancer. Ultrasonography represented the best method for .screening breast cancer regularly in China.