乳腺钼靶X线摄影筛查早期乳腺癌调查

乳腺癌是妇女常见恶性肿瘤之一,发病率逐年上升,并已成为威胁妇女的第一位癌症,病死率较高。目前检查乳腺的方法较多,如B超、CT、MRI等,但乳腺钼靶X线摄影仍是最常用且最有效的方法,对乳腺癌的诊断起着重要作用。本文通过对1034例健康妇女的体检中发现乳腺包块42例的分析,认为乳腺钼靶X线摄影对妇女乳腺癌具有早期的诊断意义。     

心理疏导在乳腺X线摄影中的重要性

目的技师在乳腺钼靶X线摄影前对受检者进行心理疏导,和患者密切配合,对获得符合影像诊断的X线照片的影响。方法对50例参加乳腺普查的女性采用数字化乳腺钼靶X线摄影检查,并对结果分组分析。结果一组对受检者进行良好沟通,预先告知压迫的重要性,受检者能很好地配合检查,减少压迫不适感;另一组与受检者很少沟通,没有预先告知压迫的重要性和必须性,受检者不适感增加,不能很好地配合检查。结论乳腺技师在进行检查前应对受检者做一些心理疏导,告知检查时压迫的必要性,保护受检者的隐私,让受检者更好地配合技师的操作,使我们获得更为满意的乳腺X线影像。     

X线摄影在乳腺普查中的应用

乳腺癌是西方发达国家女性最常见的恶性肿瘤,近年来许多发展中国家受饮食西化及其他因素的影响,乳腺癌的发病率有增高趋势.我国原为乳腺癌低发国家,目前仍不属高发国家,但近年来发病率迅速增高,以大城市为著.为此应唤起人们对此病的注意.     

全数字化乳腺X线摄影联合乳腺超声在中青年乳腺癌诊断中的应用研究

目的观察全数字化乳腺X线摄影联合乳腺超声在中青年乳腺癌诊断中的应用价值。方法选择2016年9月至2018年12月我院收治的158例女性乳腺疾病患者,均行全数字化乳腺X线摄影和乳腺超声检查,以手术病理结果为金标准,计算乳腺超声、全数字化乳腺X线摄影联合乳腺超声的准确度、灵敏度、特异度、阳性预测值、阴性预测值。结果158例患者中,手术病理诊断乳腺癌103例,乳腺超声诊断乳腺癌83例,全数字化乳腺X线摄影联合乳腺超声诊断乳腺癌93例。全数字化乳腺X线摄影联合乳腺超声诊断的准确度、灵敏度、特异度、阳性预测值、阴性预测值均高于乳腺超声诊断(P<0.05)。结论针对中青年乳腺癌患者应用全数字化乳腺X线摄影联合乳腺超声诊断的准确度、灵敏度、特异度更高,对指导临床诊疗意义重大。     

全数字乳腺X线摄影质量控制

目的：通过对乳腺摄影图像质量的分析总结,规范操作方法,优化图像质量.方法：分析1 607例受辁者全数字化乳腺摄影常规和附加体位影像的图像质量,并对投照技术要点进行相关总结分析.结果：1 607例受检者中,甲级片占95.83％,非甲级片占4.17％.非甲级片大部分重拍可改正,32例病变通过胸壁和腋下附加体位得以弥补.结论：优化体位设计,必要时附加体位,可提供高质量的图像,提高乳腺疾病诊断的准确性,降低漏诊率.     

乳腺X线摄影与MRI在乳腺癌保乳术中的应用

目的:探讨乳腺X线摄影与MRI在乳腺癌保乳术中的应用价值。方法:回顾性分析本院2017年2月~2019年1月收治的124例乳腺癌患者临床相关资料,所有患者术前均行乳腺X线及MRI检查,将手术病理结果作为金标准,计算乳腺X线、MRI及联合检查准确度、灵敏度及特异度,明确乳腺X线摄影与MRI在乳腺癌保乳术中的应用价值。结果:乳腺X线、MRI联合检查是否可行保乳术准确度、灵敏度及特异度较单纯MRI及X线,差异有统计学意义(P<0.05)。结论:乳腺X线摄影与MRI均可有效评估乳腺癌保乳术的可行性,联合应用可有效提升准确度、灵敏度及特异度,临床价值应用更高。     

数字乳腺断层摄影和数字乳腺摄影筛查的效果评价

与数字乳腺摄影(DM)相比,使用数字乳腺断层摄影(DBT)进行乳腺癌筛查可降低假阳性、增加乳腺癌检出率。但对于不同类型乳腺癌大小、分期与筛查对象年龄和乳腺密度的关系尚不清楚。为探究使用DBT进行乳腺癌筛查是否可以提高乳腺癌患者预后,比较不同年龄及乳腺密度筛查对象的乳腺癌检出率,本研究基于优化的个体化筛查方案,选择2011年1月1日至2014年9月30日中40~74岁接受过DM或DBT检查的女性进行分析。     

乳腺X线摄影装置的近期进展与新品简介

乳腺Ｘ线摄影装置的近期进展与新品简介ＲｅｃｅｎｔＰｒｏｇｒｅｓｓｏｆＭａｍｍｏｇｒａｇｈｙＳｙｓｔｅｍｓａｎｄＩｔｓＮｅｗＰｒｏｄｕｃｔｓ本刊特约记者古之月ＳｐｅｃｉａｌＣｏｒｒｅｓｐｏｎｄｅｎｔＧｕＺｈｉｙｕｅ目前，乳腺癌的发病率正在上升，我国乳腺...     

X线乳腺摄影质量控制与评价

X线乳腺摄影是乳腺影像学检查的主要手段,《X线乳腺摄影质量控制与评价》一文就影响X线乳腺摄影质量的因素、X线乳腺摄影控制与评价的原则、X线乳腺摄影质量的评估准则和乳腺摄影成像质量的鉴定模型作了介绍。     

乳腺癌钙化钼靶X线分析

目的 分析乳腺癌钙化的特征，评价钼靶。X线摄影对乳腺癌钙化的诊断意义。方法 回顾分析术后病理证实的120例乳腺癌钙化的特征。结果 55％乳腺癌出现钙化，钙化密度偏低且均匀，每平方厘米钙化数目(N／S)大于20个，钙化总数大于30个，混合型钙化对乳腺癌有诊断价值。结论 钙化在乳腺癌的诊断和鉴别诊断中具有重要意义。     

乳腺X线筛查乳腺癌引起过度诊断的研究进展

筛查历来就是一把双刃剑。癌症筛查在给部分人带来收益的同时,也会给另一部分人带来过度诊断。过度诊断是对永远不会导致症状出现或威胁生命的癌症的诊断,由此可能造成被诊断者接受不必要的治疗及终身监测,进而造成不必要的经济负担以及身体和心理上的损害。如何正确评价过度诊断,以及如何根据过度诊断产生的原因,采取有针对性的措施来减少或避免过度诊断,将是乳腺癌筛查中需要深度思考的问题。本文在系统总结既往相关研究的基础上,详细阐述乳腺X线筛查乳腺癌引起过度诊断产生的原因、评价方法,以及避免过度诊断可采取的措施。     

A mobile breast screening project in Scotland: lessons learned for national screening

In 1986, a project was undertaken to determine the feasibility and cost of screening for breast cancer, using single oblique view mammography. Screening was offered to women aged between 40 and 65, on an open access basis, to those living in rural areas near Edinburgh. This article reports on: the logistical difficulties encountered; the costs of mobile screening; a comparison of costs when screening from a static centre; and, identifies factors found to influence attendance rates. The lessons learned from the project were incorporated into the planning of the mobile van operating in the South-East of Scotland Screening Programme, part of the National Breast Screening Programme; comparisons, where possible, have been included.     

钼靶摄影对早期乳腺癌的诊断价值

目的:探讨乳腺钼靶摄影对早期乳腺癌的诊断价值,提高乳腺癌的早期诊断率。方法:总结近3年经乳腺钼靶摄影确诊同时经手术病理证实的早期乳癌33例,分析其钼靶摄影的X线征象对早期乳腺癌的诊断价值。结果:33例乳腺癌中16例有明显肿块影,部分有毛刺样改变或呈分叶状,8例仅有细小点状钙化,5例有导管扩张改变,其中14例伴有间接征象。结论:临床触诊结合乳腺钼靶摄影对乳腺癌的早期诊断具有重要价值,尤其对于触诊阴性者,乳腺钼靶摄影检查更是必不可少的手段。     

乳腺超声和钼靶X线对中国女性乳腺癌筛查的卫生经济学评价

目的:评价中国女性使用乳腺超声、钼靶X线和不筛查三种乳腺癌筛查方式的成本效果和成本效用。方法:采用中国数据,建立Markov决策模型,对每年进行一次乳腺超声筛查、每年进行一次钼靶X线筛查和不筛查的40岁以上女性进行终生队列模拟,以3%贴现率进行贴现。以不筛查组的成本和效用作为基线得到增量成本效用比,并使用单因素敏感度分析和概率敏感度分析验证模型的稳健性,同时对中东西部地区和不同类型城市进行亚组分层分析。结果:与不筛查相比,乳腺超声筛查和钼靶X线筛查的增量成本效用比分别为102 653元/QALY和201 309元/QALY。概率敏感度分析结果显示,乳腺超声和钼靶X线具有成本效用的概率分别为54.5%和26.2%。乳腺超声筛查在不同地区和不同类型城市的亚组分析结果无差异,钼靶X线筛查在东部地区的增量成本效用比与意愿支付阈值接近。结论:乳腺超声筛查可考虑作为我国乳腺癌筛查项目的主要方法,但钼靶X线筛查只适合在东部经济较发达地区使用。     

苏州市40岁以上女性乳腺癌筛查现状及影响因素分析

目的 了解苏州市40岁以上女性乳腺癌筛查现状,分析乳腺筛查行为的影响因素。方法 调查苏州市40岁以上未患过乳腺相关疾病女性的基本情况和乳腺癌筛查情况,结合健康信念模式（感知易感性、感知严重性、感知利益、感知障碍、自我效能）分析乳腺筛查的影响因素。结果 共644名女性完成调查,乳腺自我检查率为63.8%、临床检查率为44.7%、B超检查率为36.6%、X线筛检率为22.4%。健康信念模式中,感知利益得分最高,为（3.83±0.51）分,感知易感性得分最低,为（2.73±0.88）分。多因素Logistic回归分析显示,年龄50～59岁（与40～49岁相比）、家庭收入≥10 000元（与＜5 000元相比）、教育程度较高、感知易感性、自我效能得分较高、亲友曾患乳腺癌的女性更易接受乳腺筛查（P＜0.05）。结论 苏州市40岁以上女性乳腺癌筛查率较低,应加强对乳腺癌早期筛查知识的宣传和教育,提高感知易感性和自我效能。     

Effect of a national population-based breast cancer screening policy on participation in mammography and stage at breast cancer diagnosis in Taiwan

In Taiwan, a Cancer Screening Quality Improvement Program (CAQIP), implemented in 2010, provides financial support to qualified hospitals to improve accessibility. This study examined whether the CAQIP program increased participation in mammography and achieved more early stage diagnosis of breast cancer. We utilised a natural experiment to compare outcomes of interest in women aged 50–69 years with their first mammography date in two different phases, 2005–2009 and 2010–2014. Propensity score matching was used to match comparable cohorts in each phase. In total, 468,259 matched participants in phases 1 and 2 were analyzed. Patient-level logistic regressions were used and adjusted for patient risk factors. Compared with phase 1, our findings indicated women in phase 2 were more likely to have repeat mammography participation (OR, 1.33; 95 % CI, 1.32–1.34), and be diagnosed with early stage breast cancer (OR, 1.15 times; 95 % CI, 1.05–1.26). Women living in rural areas were less likely to repeatedly participate mammography (OR, 0.86; 95 % CI, 0.85–0.86) and experience early diagnosis (OR, 0.90, 95 % CI, 0.81–0.99). Women at low socioeconomic status were less likely to experience early diagnosis, and those with reproductive and hormonal risk factors were less likely to repeatedly participate mammography. Our findings provide evidence of potential benefits of health policy intervention to improve accessibility on participation in mammography and early stage diagnosis of breast cancer.     

Lower adherence to screening mammography guidelines among ethnic minority women in America: a meta-analytic review

OBJECTIVE: This study investigates the association between ethnic minority status and receiving a screening mammogram within the past 2 years among American women over 50. METHOD: The findings from 33 studies identified from interdisciplinary research databases (1980 to 2006) were synthesized. Separate pooled analyses compared white non-Hispanics to African Americans (28 outcomes), Hispanics (18 outcomes), and Asian/Pacific Islanders (10 outcomes). RESULTS: Using the random effects model, results showed that African Americans were screened less than white non-Hispanics at a marginal level (OR 0.87, 95% CI 0.75, 1.00). Larger and significant discrepancies were observed for Hispanics (OR 0.65, 95% CI 0.50, 0.85) and Asian/Pacific Islanders (OR 0.63, 95% CI 0.39, 0.99) compared to white non-Hispanics. However, among studies controlling for socioeconomic status, ethnic differences in mammography screening were no longer significant for African Americans (OR 1.05, 95% CI 0.71, 1.76), Hispanics (OR 1.08, 95% CI 0.64, 1.93), or Asian/Pacific Islanders (OR 1.08, 95% CI 0.64, 1.93). Subgroup analyses further showed that geographical region, sampling method, and data collection strategy significantly impacted results. CONCLUSIONS: This study found evidence that ethnic minority-screening mammography differences exist but were impacted by socioeconomic status. Implications for interpreting existing knowledge and future research needs are discussed.     

The impact of advances in treatment on the efficacy of mammography screening

Objective

The objective of this commentary is to argue that advances in therapy are diminishing the efficacy of mammography screening.

Method

Key studies which demonstrate this effect are briefly reviewed.

Results

The author argues that, for screening to be beneficial, the treatment of screen-detected cancers must be more effective than that of clinically-detected cancers. If there was no effective therapy for breast cancer, then screening would offer no benefit. Furthermore, as breast cancer treatments improve over time, both the absolute and relative benefits of screening will diminish. This is evident in the overview of the nine successive mammography screening trials, which have shown a decrease in the benefit of mammography screening over time, with the three most recent trials showing no benefit at all. Breast cancer adjuvant therapy was widely available in the three most recent mammography screening trials, but not the earlier trials. Additionally, population-based studies seem to suggest that the benefit of mammography screening is diminishing as treatments continue to improve.

Conclusion

Thus, in the years ahead, further declines in breast cancer mortality will likely be fueled by advances in therapy, and not by improvements in screening technology.     

Breast cancer screening in Tel Aviv

Optimal breast cancer screening includes both physical examination and mammography. In anticipation of the addition of routine mammographic screening to Israel's 25-year-old early breast cancer detection program, we examined the demographic characteristics of almost one thousand women attending a breast cancer screening examination in Tel Aviv for the first time. The specific objective of the survey was to see whether women attending screening were those who stood a good chance of benefiting from it. Only half the women were aged 40 or older, and there was a preponderance of women of Western origin. Almost half had a breast-related complaint at the time of the visit. Targeted public education and appropriate administrative measures are necessary to ensure that women who can benefit from screening attend screening clinics and that clinics are not filled to capacity by women needing diagnostic evaluation and followup rather than routine screening. Tel Aviv general practitioners appeared to be aware of the advantages of breast cancer screening.     

变性高效液相色谱分析技术对乳腺癌易感基因突变位点检测的敏感性和特异性

目的:探讨变性高效液相色谱分析技术对乳腺癌易感基因突变位点检测的敏感性和特异性。方法:收集202例诊断为原发性乳腺癌女性患者,同时采用PCR/DNA测序法和变性高效液相色谱分析技术检测BRCA1基因突变,以PCR/DNA测序法作为"金标准",评估变性高效液相色谱分析技术的敏感性和特异性。结果:202例乳腺癌标本中,PCR/DNA测序法发现BRCA1基因突变例数为76例,变性高效液相色谱分析技术结果,阳性73例,敏感性为96.1%;PCR/DNA检测结果为阴性126例,采用变性高效液相色谱分析技术,阴性120例,特异性为95.2%。两种检测方法敏感性和特异性无统计学差异(P=0.265,P=0.226)。结论:采用变性高效液相色谱分析技术检测乳腺癌易感基因BRCA1具有较高的敏感性和特异性,与传统检测方法相比,变性高效液相色谱分析技术具有较多的优点,值得推广。