24693名查体联合超声选择性补充乳腺X线乳腺癌筛查结果分析

Analysis of breast cancer screening results of 24693 people of physical examination combined with ultrasound and selective complementary mammography

目的探讨查体+超声+选择性补充乳腺X线检查的乳腺癌筛查模式应用价值。方法选择2013年6月—2016年12月北京市海淀区妇幼保健院采用查体+超声+选择性补充乳腺X线检查模式行乳腺癌筛查的适龄妇女24693名为研究对象,分析乳腺X线检查率、乳腺癌及早期乳腺癌检出率、召回活检率、活检率、活检遵从率、活检阳性预测值(PPV)等结果。比较经补充乳腺X线检查前后乳腺癌检出率、早期乳腺癌检出率结果,分析早期乳腺癌检出率与乳腺X线检查率、活检遵从率的相关性。结果共7211名(29.20%)补充乳腺X线检查。补充乳腺X线检查前检出乳腺癌54例(双侧乳腺癌记2例),乳腺癌检出率约为218.69/10万,其中早期乳腺癌33例,检出率约为133.64/10万;补充乳腺X线检查后增加检出乳腺癌10例,其中早期乳腺癌9例,乳腺癌检出率约为259.18/10万,早期乳腺癌检出率约为170.09/10万。补充乳腺X线检查前后乳腺癌检出率、早期乳腺癌检出率比较,差异无统计学意义(P>0.05)。筛查召回活检460名(1.86%),实际接受活检121名(0.49%),活检遵从率约为26.30%,活检PPV约为52.89%。早期乳腺癌检出率与活检遵从率呈显著正相关(r=0.996,P<0.01),与乳腺X线检查率无相关性(P>0.05)。结论采用查体+超声+选择性补充乳腺X线的乳腺癌筛查模式有效可行,但补充乳腺X线检查的标准需优化;筛查后的活检遵从率需提高。

Objective To evaluate the application value of physical examination combined with ultrasound and selective supplemental mammography for breast cancer screening.Methods From June 2013 to December 2016,24693 women of appropriate age who underwent breast cancer screening in Maternal and Child Health Hospital of Haidian District of Beijing were selected as the study subjects.Mammography rate,detection rate of breast cancer and early breast cancer,recall rate of biopsy,rate of biopsy,biopsy compliance rate,biopsy positive predictive value(PPV)were analyzed.The detection rate of breast cancer and early breast cancer before and after supplementary mammography were compared.The correlation between the detection rate of early breast cancer and the rate of mammography examination and biopsy compliance were analyzed.Results A total of 7211(29.20%)people underwent supplementary mammography.Before supplemental mammography,54 cases(bilateral breast cancer were recorded two cases)of breast cancer were detected,and the detection rate of breast cancer was about 218.69/100000.Among them,33 cases of early stage breast cancer and the detection rate of it was about 133.64/100000.Ten cases of breast cancer were detected after supplemental mammography,including nine cases of early breast cancer,the detection rate of breast cancer was about 259.18/100000,and the detection rate of early breast cancer was about 170.09/100000.There were no significant differences between the detection rate of breast cancer and early breast cancer before and after supplemental mammography(P>0.05).A total of 460 people(1.86%)were recalled for biopsy after the screening,and the actual biopsy was 121 people(0.49%),the biopsy compliance rate was about 26.30%,and the biopsy PPV was about 52.89%.The detection rate of early breast cancer was significantly positively correlated with the biopsy compliance rate(r=0.996,P<0.01),but not with the mammography detection rate(P>0.05).Conclusion The screening mode of physical examination combined with ultrasound and selective supplement mammography for breast cancer screening is effective and feasible,but the standards of supplementary mammography should be optimized.The biopsy compliance rate after screening need to be improved.