上海市田林社区4070例妇女乳腺普查结果分析

[目的]为了配合全国范围内开展的妇女乳腺癌早诊早治项目,了解上海市徐汇区田林社区35～69岁妇女的乳腺癌发病情况。[方法]先临床乳房触诊,可疑的做乳房钼靶,阳性做病理,钼靶可疑做B超。[结果]共筛查了田林社区35～69岁妇女4070例,筛查出乳腺癌6例,筛查率0.15%。[结论]随着生活水平的提高,生活压力增大,饮食结构的改变及生育次数的减少。乳腺癌的发病率会越来越高,尤其是高危人群。在社区中应大力宣传母乳喂养及乳腺癌的自我检测方法,提倡高危人群应每年做一次钼靶检查。     

农村妇女乳腺癌筛查方法的探讨

目的探讨临床检查、超声检查和钼靶X线摄影检查以及多种方法联合运用在农村妇女乳腺癌筛查中的应用效果,以及农村地区乳腺癌普查方法。方法以2012-2013年参加珠海市金湾区红旗镇乳腺癌筛查项目的 3 054名20~59岁的健康妇女为研究对象,采用乳腺临床检查和乳腺B超检查相结合,阳性和可疑者进一步作乳腺钼靶X线检查及组织病理检查的筛查方法。分析临床检查和超声检查,钼靶X线检查和三种方法联合运用的敏感性、特异度、阳性预测值和阴性预测值。结果临床触诊、超声检查和钼靶X线检查在筛查中的敏感性分别为25%、50%和75%;临床检查和超声检查联合运用时的敏感性为75%;临床检查、超声检查和钼靶X线检查三者联合运用时的敏感性为100%,特异度、阳性预测值和阴性预测值分别为97.8%、80%、100%,均高于单项检查。结论联合检查可以显著提高乳腺癌筛查的敏感性、特异度,具有较高的临床应用价值。临床体检与超声检查两种方法相结合→阳性和可疑者进一步作钼靶X线检查→组织病理诊断并追踪结果的模式比较适宜于农村开展乳腺癌普查工作。     

2016—2019年乌鲁木齐市城市高危人群乳腺癌筛查结果分析

目的 探讨乌鲁木齐地区城市高危人群乳腺疾病检出情况及分布特征,为乌鲁木齐地区乳腺癌的预防与控制提供科学依据。 方法 选取2016—2019年在新疆医科大学附属肿瘤医院进行常规体检的女性作为目标人群,采用防癌风险问卷筛选乳腺高危人群,40~44岁乳腺癌高危女性采用彩色超声检查,45岁及以上的乳腺癌高危女性采用超声检查结合钼靶检查进行联合诊断。采用乳腺影像报告及数据系统(Breast Imaging Reporting and Data System, BI-RADS)分级标准报告筛查结果。本研究中以BI-RADS 1~2级为乳腺癌阴性患者,BI-RADS 3级为乳腺癌可疑阳性患者,BI-RADS 4~5级为乳腺癌阳性患者,经活检证实为癌症病变为乳腺癌患者。 结果 2016—2019年间,共6 618名被评为乳腺癌高危人群,检出可疑乳腺癌阳性1 326例(20.04%),阳性122例(1.84%),乳腺癌22例(0.33%)。2019年乳腺癌可疑阳性、阳性和乳腺癌检出率最高,分别为20.41%、2.90%、0.42%,趋势性检验结果显示,2016—2019年乳腺癌阳性检出率逐渐增加(Z=27.599,P<0.001)。不同民族乳腺癌可疑阳性、阳性以及乳腺癌检出率差异均无统计学意义(P>0.05);不同年龄段乳腺癌可疑阳性和阳性检出率差异均有统计学意义(P<0.05),45~<50岁组乳腺癌可疑阳性检出率最高(24.23%),50~<55岁组乳腺癌阳性和乳腺癌检出率最高,分别为2.31%和0.44%;不同初潮年龄、生育次数、是否哺乳、是否具有良性乳腺疾病史和是否具有乳腺癌家族史组间乳腺癌可疑阳性和阳性检出率差异均有统计学意义(P<0.05)。45岁及以上的高风险人群进行乳腺超声联合钼靶检查结果显示,钼靶单一检查以及联合检查可疑阳性检出率均明显高于超声单一检查,经两两比较差异均有统计学意义(P<0.05)。 结论 对高危人群进行乳腺癌筛查可有效提高乳腺癌阳性检出率。对于45~60岁年龄段,具有良性乳腺疾病史以及乳腺癌家族史的人群应作为重点筛查对象,并采用超声和钼靶联合方式提高准确率,降低漏诊率。     

选择性斜位单相法钼靶X线在临床早期乳腺癌筛查中的价值

目的:①探讨选择性斜位钼靶单相法X线检查在临床早期乳腺癌筛查中的价值;②分析筛查中乳腺触诊+高频B超及/或斜位单相法钼靶X线检查对乳腺癌诊断的敏感度。方法:采用复合式乳腺健康调查问卷,对触诊异常者加做乳腺高频B超;对B超异常及40岁以上高危人群加做斜位单相法钼靶X线检查;对在2006~2008年妇女乳腺癌筛查中确诊的56例乳腺癌及46例临床早期乳腺癌患者的数据进行统计分析。结果:临床早期乳腺癌的诊断率为82.14%;对临床早期乳腺癌诊断的敏感度①触诊+斜位单相法钼靶X线检查为87.50%;②触诊+斜位单相法钼靶X线+乳腺高频B超为92.56%;③触诊+乳腺高频B超为72.72%。触诊+斜位单相法钼靶X线与触诊+斜位单相法钼靶X线+乳腺高频B超比较,P>0.05,差异无统计学意义;⑤触诊+乳腺高频B超与触诊+斜位单相法钼靶X线比较,P<0.05,差异有统计学意义。结论:①选择性斜位单相法钼靶X线检查是提高群体乳腺癌临床早期诊断率的关键。②触诊+斜位单相法钼靶X线+乳腺高频B超对临床早期乳腺癌诊断的敏感度明显高于触诊+乳腺高频B超,适用于临床早期乳腺癌的筛查。     

临床体检与超声检查在乳腺疾病筛查中的应用

目的了解不同乳腺疾病的患病现状,探讨乳腺癌发生的可能的高危因素以及乳腺临床检查与超声诊断技术在乳腺病筛查中的意义。方法采用临床体检及乳腺超声对兰州市16223名妇女进行乳腺疾病筛查,同时进行问卷调查,体检女性年龄／〉35岁及乳腺触诊异常或乳腺超声提示3级或以上则行乳腺钼靶检查,非哺乳期乳头溢液患者行乳导管镜检查,乳腺超声或乳腺钼靶提示可疑恶性病灶行空芯针穿刺病理检查以确诊。结果筛查对象中乳腺增生检出率为52．7％,乳腺纤维腺瘤检出率为1．0％,乳腺癌12例（74．0／10万）;40—59岁为乳腺癌发病高峰年龄段;乳腺癌的发生可能与患者年龄、有乳腺癌家族史、月经初潮年龄c：12岁、未哺乳、使用雌激素类药物、高脂饮食、既往乳腺疾病史等因素有关,乳腺超声的筛查阳性率较手诊阳性率i写。结论乳腺普查中应用临床体检结合影像学检查是发现乳腺疾病及早期乳腺癌的有效手段。     

钼靶及核芯针微创活检诊断触诊阴性的乳腺癌

目的:探讨触诊阴性的乳腺癌钼靶表现,评价核芯针微创活检的临床运用价值。方法:31例触诊阴性的乳腺癌均行常规钼靶摄片,21例采用X线立体定位系统装置、配套的自动弹射活检枪及核芯针进行微创活检。所有病例均经手术病理证实。结果:钼靶片表现为簇状钙化21例,孤立结节2例,局限性致密或结构紊乱4例,放射状毛刺影4例,21例活检病理结果导管原位癌6例,小叶原位癌1例,浸润性导管癌14例,21例行核芯针微创活检病例术后病理结果导管原位癌5例,小叶原位癌1例,浸润性导管癌15例。结论:钼靶对检出触诊阴性的乳腺癌具有重要价值,核芯针微创活检可获得准确的病理组织学结果。     

社区乳腺普查模式的探讨

目的探讨社区妇女乳腺常见病的普查模式。方法 2010年4月—2011年12月对本市各社区35～65岁的妇女采用临床触诊+彩超+X线钼靶的模式进行乳腺普查,并对相关普查结果进行分析。结果经临床触诊并彩超检查后转诊钼靶检查共3 720例。钼靶检出2 668例乳腺常见病,其中乳腺增生2 182例,钙化296例,纤维瘤或囊肿461例,乳腺癌25例。结论 35～65周岁健康女性适宜开展乳腺钼靶普查,因此在加强健康教育的同时,推广临床触诊+彩超+X线钼靶的社区乳腺筛查模式对乳腺相关疾病的早期发现、早期诊断、早期治疗具有重要意义。     

MRI对乳腺癌的诊断效能及其征象和分子生物学标记物的相关性

目的分析磁共振成像(MRI)对乳腺癌的诊断效能及其征象与分子生物学标记物的相关性。方法选取2019年1月-2020年10月浙江省荣军医院和丽水市中心医院收治的115例乳腺肿块患者为研究对象,入院后7 d内完成乳腺钼靶、MRI检查。以病理检查结果为金标准,计算乳腺钼靶、MRI诊断乳腺癌的灵敏度、特异度、准确度、阳性预测值及阴性预测值,采用Kappa检验分析各检查方法和病理检查结果的一致性。比较MRI和乳腺钼靶对乳腺癌病理分型的符合率。采用Pearson检验分析乳腺癌MRI形态学、病灶早期增强率(EPER)、峰值时间(TTP)及表观扩散系数(ADC)值与分子生物学标记物的相关性。结果 115例患者中,病理检查共检出74例乳腺癌患者,检出率为64.35%。以病理检查结果为金标准,MRI诊断乳腺癌的灵敏度、准确度及阴性预测值分别为90.28%、87.83%及80.00%,均显著高于乳腺钼靶的70.27%、71.30%及57.69%,差异均有统计学意义(χ~2=6.896,P=0.009;χ~2=9.654,P=0.002;χ~2=5.521,P=0.019)。一致性分析显示:乳腺钼靶、MRI与病理检查结果的Kappa值分别为0.410、0.740。病理检查显示:74例乳腺癌患者中,29例为浸润性导管癌,21例为导管原位癌,17例为浸润性小叶癌,7例为黏液腺癌。MRI对导管原位癌、浸润性小叶癌病理分型的符合率分别为90.47%、88.24%,均高于乳腺钼靶的61.90%、52.94%,差异均有统计学意义(χ~2=4.725,P=0.030;χ~2=5.100,P=0.024)。Pearson相关性分析结果显示:乳腺癌边缘毛刺征和ER癌细胞阳性表达呈正相关(r=0.631,P0.05);强化不均匀和p53、CerbB-2癌细胞阳性表达呈正相关(r=0.307,P0.05;r=0.465,P0.05);TTP和CerbB-2癌细胞阳性表达呈负相关(r=-0.433,P0.05);ADC和p53癌细胞阳性表达呈负相关(r=-0.397,P0.05)。结论 MRI对乳腺癌和病理分型的诊断效能显著优于乳腺钼靶,可作为临床早期筛查乳腺癌的重要手段。乳腺癌MRI征象和分子生物学标记物有一定相关性,观察乳腺癌影像学图像对评估患者预后有一定指导意义。     

基于人群的乳腺癌筛查效果评估的研究进展

基于人群的乳腺癌筛查是已经获得公认的乳腺癌的二级预防措施。目前国外常用的筛查模式包括基于钼靶的筛查方式、基于钼靶和超声的筛查方式,以及基于钼靶和乳腺临床触诊检查的筛查方式。本文试图对这三种筛查模式的有效性、适宜性和卫生经济学评估的研究进展作一综述报道。     

彩色多普勒超声 超声弹性成像及X线钼靶检查在健康体检妇女乳腺癌筛查中的方案优化

目的对比分析彩色多普勒超声(CDUs)、超声弹性成像(UE)及X线钼靶检查不同组合方案在健康体检妇女乳腺癌筛查中的优劣,为健康体检妇女乳腺癌筛查方案优化提供参考依据。方法选择2016年1月-2018年1月在该院行健康体检符合纳入条件的100例成年女性受试者作为研究对象。所有受试者均行乳腺彩色多普勒超声检查、超声弹性成像检查及X线钼靶检查。彩色多普勒超声检查与X线钼靶检查结果均行规范的乳腺影像报告和数据系统(BI-RADS)术语报告,由两位资深超声医师分别阅片并作出诊断结果,超声弹性成像检查结果,由上述两位医师采用改良超声弹性成像5分法进行阅片并出具诊断报告。以病理诊断结果及三项均为良性诊断结果为金标准,采用并联方法对CDUs、UE及X线钼靶不同组合筛查方案的灵敏度、特异度、准确性、阳性预测值、阴性预测值及误诊率进行计算并比较。结果 X线钼靶检查、CDUs及UE检查良性、需行病理活检、需行手术探查或者治疗构成情况比较,X线钼靶需行病理活检率明显高于CDUs、UE (P0.05); 100例受试者病理诊断为乳腺癌者计37例,CDUs、UE及X线钼靶分别判断为乳腺癌41例、39例及48例,并联组合后,CDUs+UE+X线钼靶与CDUs+UE诊断乳腺癌均为36例,其他两两联合诊断乳腺癌例数低于36例; CDUs+UE诊断乳腺癌的灵敏度、特异度、准确度、阳性预测值及阴性预测值均较其他方案高或持平,且误诊率为所有方案中最低,CDUs+UE+X线钼靶方案虽然各检验统计值误诊率为次低,单纯X线钼靶误诊率最高。结论 CDUs检查和X线钼靶检查均存在一定的缺陷,而UE检查则可弥补CDUs检查对部分受检者血流不敏感的不足,CDUs+UE筛查方案对行健康体检的女性乳腺癌筛查临床价值更高。     

灰阶中位数分析用于乳腺癌超声筛查的初步研究

目的:评估灰阶中位数分析(gray-scale median,GSM)用于乳腺癌超声筛查的临床价值.方法:基于计算机辅助程序获得二维超声良性和恶性乳腺结节灰阶中位数,以乳腺结节病理检查结果为金标准,统计灰阶中位数分析用于筛查乳腺癌的敏感性、特异性、阳性预测值、阴性预测值、Youden指数和AUC曲线下面积.结果:乳腺良...     

Breast cancer screening -- an update

The incidence of breast cancer tends to be lower in developing countries than in developed countries. Breast cancer makes up about 14% of new cancers in women in developing countries. Most breast cancer cases are not diagnosed or detected early enough to effectively treat. Current screening methods for breast cancer include mammography combined with or without ultrasound and/or physical examination and self-breast examination. Fine needle aspiration biopsy has virtually replaced surgical biopsy as a method to analyze breast tumors for malignancy. The sensitivity rate for mammography is as high as 80%. If it is combined with ultrasound, sensitivity may jump as high as 93%. Its specificity rate is still low (15-25%). Even though the positive predictive value of fine needle aspiration biopsy is almost 100%, the false negative rate is 5-25%. Surgical biopsy may be the only certain method of detecting malignancy or benignancy. Mammography has reduced breast cancer mortality by at least 30%. If breast cancer screening were universal, global breast cancer related-mortality rates would fall 25-30%. Breast cancer that is detected between mammographic screenings is more likely to result in death than that detected at a screening. Some reasons for missed diagnoses include minimal sign present at mammography, radiographically concealed, and radiographically concealed at diagnosis. Reducing the mammography screening interval from two years to one year may decrease interval cancers. It is not yet clear whether mammography saves lives for women 40-49 years old and those older than 70. Clinicians must consider cytologic information on nonpalpable breast tumors with clinical risk factors (e.g., positive maternal history of breast cancer or previous breast biopsy). Few radiologists in Sweden are interested in breast cancer, while, in the US, many radiologists are interested but US women tend not to understand the significance of screening. Breast cancer screening, prevention, and treatment should be promoted more vigorously in developing countries.     

B超引导下活检针穿刺对可疑甲状腺癌结节的诊断意义

目的：探讨超声引导下活检针穿刺对可疑甲状腺癌结节的诊断价值。方法：在512例患有可疑甲状腺癌结节的患者中,按完全随机设计的原则抽取120例作为研究对象,在术前均行超声引导下活检针穿刺术。计算kappa值、准确率、灵敏度、特异度、漏诊率、误诊率、阳性预测值、阴性预测值、约登指数、阳性似然比、阴性似然比。结果：经术后病理证实84例为甲状腺癌,活检针穿刺正确79例,漏诊5例,不能确定5例。kappa值0.844、一致率0.933、灵敏度0.94、特异度0.917、漏诊率0.06、误诊率0.083、阳性预测值0.963、阴性预测值0.868、阳性似然比11.286、阴性似然比0.065、约登指数0.857。结论：超声引导下活检针穿刺对可疑甲状腺癌结节有较高的诊断价值,可作为判断良恶性结节的首选。     

Determining sensitivity of mammography from screening data, cancer incidence, and receiver-operating characteristic curve parameters.

OBJECTIVES: A mathematical model is presented that allows the computation of the sensitivity and specificity of breast screening based on receiver-operating characteristic (ROC) curve shape, the positive predictive value (PPV) of screening mammography, and the cancer incidence, f. METHODS: The normal and cancer populations are modeled as normal distributions with independent means and standard deviations. The distributions are scaled such that the area of the normal population is equal to 1-f and that of the cancer population is f. The PPV for screening mammography is used to determine the operating point on the ROC curve. Knowing this leads directly to the computation of sensitivity and specificity. The derivation is general and is applicable to both symmetrical and asymmetrical ROC curves. RESULTS: For symmetric ROC curves and typical values for the PPV of mammography (about 8%) and cancer incidence (f= 0.003), an A(z) value of 0.95 was required to achieve 63% sensitivity and an A. value of 0.98 led to 86% sensitivity. CONCLUSION: A model was developed that should allow researchers to deduce sensitivity and specificity for screening mammography based on ROC curve measurements and using realistic values of PPV and f. This model allows A. values to be related to the probability of breast cancer detection.     

数字钼靶、超声、MRI对乳腺导管原位癌的诊断价值比较

目的 探讨数字化钼靶、超声、磁共振成像(MRI)对乳腺导管原位癌的诊断价值.方法 选取2013年1月至2016年8月东莞市妇幼保健院收治的18例乳腺疾病患者共20个病理乳房的临床资料进行回顾性分析,其中18例患者进行数字化钼靶检查,18例进行超声检查,8例进行MRI检查,以病理结果为诊断的金标准,比较三种检查方法的诊断符合率及敏感性指标.结果 数字化钼靶、超声、MRI的诊断符合率分别为60.00%、60.00%、100.00%.与数字化钼靶、超声相比,MRI的灵敏度(χ2=13.26,P=0.01)、特异度(χ2=54.39,P<0.01)、诊断符合率(χ2=54.54,P<0.01)、阴性预测值(χ2=12.26,P=0.02)、阳性预测值(χ2=8.01,P=0.02)均较高,差异均有统计学意义.结论 对于初步诊断乳腺导管原位癌,可首选数字化钼靶和超声检查,结合MRI则可提高临床诊断符合率.     

Mammographic breast density and risk of breast cancer: Masking bias or causality?

Masking bias is hypothesized to explain associations between breast density and breast cancer risk. Tumours in dense breasts may be concealed at the initial examination, but manifest themselves in later years, suggesting an increase in breast cancer incidence. We studied the association between breast density and breast cancer risk in 0, 1–2, 3–4 and 5–6 year periods between initial examination and diagnosis. We studied 359 cases and 922 referents, identified in a breast cancer screening programme in Nijmegen, the Netherlands. Breast density was assessed at the initial examination and classified as 'dense' (if > 25% of the breast was composed of density) or 'lucent' ( 25% density). In women examined with mid-1970s film screen mammography, we found that at time 0 the odds ratio (OR) for women with dense breasts compared to those with lucent breasts was 1.4 (95% confidence interval (CI): 0.7–6.2). After a 3–4 year period the risk was increased to 3.3 (95% CI: 1.5–7.1). Then, the risk decreased again (OR: 1.2, 95% CI: 0.6–2.7). This rise and decline in risk are in accordance with the masking hypothesis. The observation, however, that the risk at time 0 does not appear to be lower for women with dense breasts than for those with lucent breasts, seems to be inconsistent with the masking hypothesis and may be indicative of causality. The same analysis were performed in women whose initial screening examination was done with current high-quality mammography. Due to the small size of this study group no firm conclusions could be drawn, but it seems as if masking bias could still play a role with high-quality mammography.     

Physician recommendations for screening mammography: results of a survey using clinical vignettes

BACKGROUND. Although experts estimate that 30% of breast cancer deaths could be prevented if women were screened according to published guidelines, fewer than 50% of physicians follow screening mammography guidelines, and fewer than 30% of women are screened with mammography. METHODS. Physician recommendations for screening mammography were examined in a questionnaire mailed to 300 randomly selected physicians of the Ohio Academy of Family Physicians. Physicians responded with their likelihood of recommending screening mammography to 24 clinical vignettes that high-lighted patient, mammographic, and encounter characteristics. RESULTS. Seventy-one percent responded. Ninety-one percent reported almost always recommending screening mammography to a 55-year-old woman at her yearly examination. They were significantly less likely to recommend mammography to women who were young (40 years old), were old (70 years old), were poor, had small breasts, had painful mammograms, did not want the doctor to look for cancer, lived in a nursing home, or were retarded. Physicians recommended mammography less often when the mammography unit was far away or produced poor quality films or ambiguous interpretations. When physicians ran behind schedule, perceived a more urgent medical problem during the encounter, or saw a woman for an acute visit, they recommended mammography significantly less often. CONCLUSIONS. Patient, mammographic, and encounter characteristics significantly limit physician recommendations for screening mammography as assessed by clinical vignettes. These characteristics must be addressed if breast cancer mortality is to be reduced with early screening.     

Mammography: a critical evaluation of its role in breast cancer screening, especially in developing countries

Screening for breast cancer using mammography alone, or mammography plus physical examination of the breasts, reduces mortality from breast cancer in women age 50-69. The evidence for effectiveness in older women is less clear. If effective in younger women, benefit is delayed compared to that seen in women age 50 or more. The increasing incidence of breast cancer in developing countries, and the late stage at diagnosis of most disease, supports efforts to introduce screening for breast cancer. However, the requirements of mammography in terms of technology and skilled personnel make it difficult to apply in most developing countries at present. There is a need to evaluate simpler screening tests, such as physical examination of the breasts and breast self-examination, as they can be applied by existing health personnel, and more readily integrated into medical care.     

高危型人乳头瘤病毒DNA检测在宫颈癌筛查中的应用

目的:评价高危型人乳头瘤病毒(HPV)DNA检测在宫颈癌筛查中的应用价值。方法:2004～2006年期间,在连云港市第一人民医院健康体检、无妇科临床症状的已婚妇女1628例进行宫颈癌前病变筛查,采用PCR荧光定量检测高危型HPV(HR-HPV)DNA,以病理组织学诊断结果为金标准,应用约登指数比较HPVDNA和薄层液基细胞学(TCT)筛查效果。结果:受检者平均年龄(35±10.2)岁,经病理学诊断HPV感染51例(3.24%),宫颈上皮内瘤变(CIN)Ⅰ级18例、CINⅡ12例,CINⅢ6例,浸润癌3例,内膜癌1例,湿疣15例;以病理学确诊为金标准,HR-HPVDNA检测CINⅡ、Ⅲ的敏感度94.44%、特异度96.76%,阳性预测值25.0%,阴性预测值99.93%,约登指数0.91;HR-HPVDNA检测+TCT检测敏感度100.0%,特异度96.82%,阳性预测值26.47%,阴性预测值100.0%,约登指数0.97。HR-HPVDNA在健康妇女和不同宫颈病变中的阳性率分别是正常/炎症3.24%(51/1572)、CINⅠ84.21%(16/19)、CINⅡ91.67%(11/12)、CINⅢ100.0%(6/6)、浸润癌100.0%(3/3)、湿疣80%(12/15)、内膜癌1例未检出。结论:HR-HPVDNA检测在宫颈癌的筛查中具有敏感度高、阴性预测值高的特点,TCT与HR-HPVDNA联合检测可提高筛查的敏感度和阴性预测值。