常用乳腺癌筛查方法诊断价值的应用评价

目的研究ROC曲线分析法评价乳腺临床检查、乳腺超声检查（US）、钼靶X线检查（MAM）及这3项检查综合分级在乳腺癌筛查中的诊断价值,为农村地区开展乳腺癌筛查选择适宜技术。方法采用问卷调查和乳腺临床检查,对乳腺癌高危人群采用乳腺超声和钼靶X线检查进行乳腺癌筛查,利用ROC曲线分析法评价临床检查、超声、钼靶X线检查及各项联合检查（综合检查）在乳腺癌筛查中的灵敏度和特异性。结果在23 910名接受乳腺癌筛查的农村妇女中,病理确诊乳腺癌31例,乳腺癌检出率为129.65/10万。乳腺综合检查的灵敏度、特异性及ROC曲线下面积分别为90.323、94.605和0.954;超声检查的灵敏度、特异性及ROC曲线下面积分别为70.968、90.288和0.814;钼靶X线检查的灵敏度、特异性及ROC曲线下面积分别为74.194、91.727和0.850;临床检查的灵敏度、特异性及ROC曲线下面积分别为41.935、82.734和0.676。其ROC曲线下面积（AUC）比较经Z检验,综合检查F分级评价诊断优于其他各项检查的准确性（P〈0.05）,超声与钼靶X线检查诊断准确性比较差异无统计学意义（P〉0.05）。结论乳腺超声和钼靶X线检查是乳腺癌筛查的有效方法,而综合检查分级评价方法能明显提高乳腺癌的诊断能力。

An Application Evaluation on Different Screening Methods of Breast Cancer

Objective To evaluate the values of different methods in breast cancer screening using receiver operating characteristic（ ROC） curve analysis,and to suggest a appropriate model for female breast cancer screening in rural areas. Methods After questionnaire investigation and clinical examination,breast ultrasound and X- ray mammography were performed in the high risk group. Sensitivity and specificity of clinical examination, breast ultrasound, X- ray mammography and comprehensive examination were evaluated by ROC curves. Results There were 31 pathologically diagnosed cases among the 23,910 screening women. The detection rate of breast cancer was 129. 65 /100,000. The sensitivity,specificity and the area under the ROC curves was 90. 323,94. 604 and 0. 954 respectively for comprehensive examination,and 70. 968,90. 288 and 0. 814 respectively for ultrasound examination,and 74. 194,91. 727 and 0. 850 respectively for mammography examination,and 41. 935,82. 734 and 0. 676 respectively for clinical examination. After Z test,comprehensive examination was better than other methods（ P 0. 05） and there was no significant difference between breast ultrasound and X- ray mammography（ P 0. 05）. Conclusion Both ultrasound and X- ray mammography are the effective methods in breast cancer screening. The comprehensive examination could significantly improve the diagnostic capabilities of breast cancer.