超声在无症状女性乳腺癌筛查中的有效性评估

The effectiveness of ultrasound for breast cancer screening in asymptomatic Chinese women

目的评估超声(ultrasound,US)对无症状女性乳腺癌筛查的有效性。方法分析2001-2017年中国医学科学院北京协和医学院北京协和医院检测到的996例单侧不可触及乳腺癌(non-palpable breast cancer,NPBC)患者,其中812例为US检出的NPBC患者(US-NPBC组),184例为乳腺X射线摄影(mammography,MG)检出的NPBC患者(MG-NPBC组)。比较两组患者的临床病理特征、10年无复发生存(recurrence-free survival,RFS)率、无远处复发生存(distant recurrencefree survival,DRFS)率和总生存(overall survival,OS)率。结果与MG相比,US可检出更多的浸润性NPBC和T1b+T1c分期NPBC。US和MG检测出的浸润性NPBC患者的淋巴结状态、N分期、TNM分期、人表皮生长因子受体2状态及分子亚型比较均无统计学意义(均P>0.05);两组患者接受类似的辅助治疗;US-NPBC组患者保乳手术比率更高(P<0.05)。US和MG分别检出的所有NPBC、导管内癌和浸润性癌患者的10年RFS率、DRFS率和OS率比较均无统计学意义(均P>0.05)。淋巴结状态、淋巴管侵犯、雌激素受体状态和手术方式均是所有NPBC患者10年RFS率的影响因素(均P<0.05);T分期、N分期和分子亚型均是所有NPBC患者10年OS率的影响因素(均P<0.05)。结论在真实世界的临床实践中,US可合理应用于无症状女性乳腺癌筛查,无需过多担心过度诊断、延迟诊断或漏诊等风险。

Objective To evaluate the effectiveness of ultrasound(US)for breast cancer screening in asymptomatic women.Method We analyzed 996 consecutive unilateral non-palpable breast cancer(NPBC)detected in Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College between 2001 and 2017,including 812 USdetected NPBC and 184 mammography(MG)-detected NPBC.The clinicopathological characteristics,10-year recurrence-free survival(RFS),distant recurrence-free survival(DRFS),and overall survival(OS)were compared between US-and MG-detected NPBC cases.Result US could detect more invasive and T1b+T1c NPBC cases than MG.No significant difference between US-and MG-detected invasive NPBC was noted in lymph node(LN)status;N and TNM stages;human epidermal growth factor receptor 2 status and molecular subtype(all P>0.05).US-and MG-detected NPBC patients required similar adjuvant treatments;women with US-NPBC underwent more breast-conserving surgery(P<0.05).There was no significant difference in the 10-year RFS,DRFS,or OS between:US-and MG-detected NPBC,US-and MG-detected ductal carcinoma in situ,or US-and MG-detected invasive NPBC(all P>0.05).Lymph node status,lymphatic vessel invasion,estrogen receptor status,and surgical approach were all factors influencing the 10-year RFS rate in all NPBC patients(all P<0.05);T stage,N stage and molecular subtype were all influencing factors for the 10-year OS rate of all NPBC patients(all P<0.05).Conclusion Ultrasound is justified for breast cancer screening among asymptomatic women in the real-world practice,with limited concerns of over-diagnosis,delayed diagnosis,or missed diagnosis.