中国乳腺X线筛查项目中联合应用超声检查的价值

目的：评估在乳腺X线摄片基础上联合应用超声检查在乳腺筛查中的价值。方法：选取复旦大学附属肿瘤医院通过乳腺筛查项目筛查出,并在初筛时同时行乳腺X线摄片和超声检查的40岁以上女性乳腺癌病人。分析单用乳腺X线摄片、单用超声和在乳腺X线摄片基础上联合应用超声在检出恶性病例时的诊断灵敏度,并进一步分析单用乳腺X线摄片和在乳腺X线摄片基础上联合应用超声的诊断灵敏度与年龄及腺体致密度间的关系。结果：筛查发现并符合入组标准的乳腺癌病例共42例,单用乳腺X线摄片、单用超声和在乳腺X线摄片基础上联合应用超声的诊断灵敏度分别为81.0%、64.3%、95.2%,单用乳腺X线摄片和在乳腺X线摄片基础上联合应用超声的诊断灵敏度差异有统计学意义（P〈0.05）。多量型和致密型乳腺,在乳腺X线摄片基础上联合应用超声的诊断灵敏度比单用乳腺X线摄片高,其差异有统计学意义（P〈0.05）,但在年轻女性（50岁以下）中,没有发现差异（P〉0.05）。结论：乳腺X线摄片诊断灵敏度高于乳腺超声检查,在乳腺X线摄片基础上联合应用超声可提高乳腺筛查的诊断灵敏度,在乳腺X线摄片基础上联合应用超声推荐用于腺体密度较高的乳腺筛查。

The value of breast ultrasound in a mammography based Chinese breast screening project

Objective The present study is to evaluate the clinical value of a new breast image screening strategy：combination of ultrasound and mammography.Methods Including breast cancers detected by the breast image screening projects in Fudan University,Shanghai Cancer Center（FDSCC）.Females over 40 years old,who took both mammogram and ultrasound at the screening time would be selected.Analyze the diagnostic sensitivity of mammography alone,ultrasound alone and mammography in combination with ultrasound.Furthermore,the sensitivity of mammography in combination with ultrasound and mammography alone were compared in all,and by different age groups and by different breast density.Results 42 breast cancers detected by screening meet the enrolling criteria.Respectively,the screening sensitivity of mammography alone,ultrasound alone and mammography combined with ultrasound was 81.0% 、64.3% 、 95.2%,the difference between mammography in combination with ultrasound and mammography alone was statistically significant（P0.05）.The benefit of adding ultrasound to mammography as a new breast image screening strategy was found statistically significant in patients with dense breast on mammogram,while was not found in younger（50 years old） women（P0.05）.Conclusions Mammography combined with ultrasound could increase the diagnostic sensitivity of breast screening.The combined image screening strategy could be recommended for women with dense breast on mammography.