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丁松涛马祥君何湘萍[摘要]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133.64/10萬;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。[关键词]乳腺癌;筛查;分析[]R737.9[文献标识码]A[]1673-7210（2020）10（b）-0098-04[Abstract]ObjectiveToevaluatetheapplicationvalueofphysicalexaminationcombinedwithultrasoundandselectivesupplementalmammographyforbreastcancerscreening.MethodsFromJune2013toDecember2016，24693womenofappropriateagewhounderwentbreastcancerscreeninginMaternalandChildHealthHospitalofHaidianDistrictofBei激ngwereselectedasthestudysubjects.Mammographyrate，detectionrateofbreastcancerandearlybreastcancer，recallrateofbiopsy，rateofbiopsy，biopsycompliancerate，biopsypositivepredictivevalue（PPV）wereanalyzed.Thedetectionrateofbreastcancerandearlybreastcancerbeforeandaftersupplementarymammographywerecompared.Thecorrelationbetweenthedetectionrateofearlybreastcancerandtherateofmammographyexaminationandbiopsycompliancewereanalyzed.ResultsAtotalof7211（29.20%）peopleunderwentsupplementarymammography.Beforesupplementalmammography，54cases（bilateralbreastcancerwererecordedtwocases）ofbreastcancerweredetected，andthedetectionrateofbreastcancerwasabout218.69/100000.Amongthem，33casesofearlystagebreastcancerandthedetectionrateofitwasabout133.64/100000.Tencasesofbreastcancerweredetectedaftersupplementalmammography，includingninecasesofearlybreastcancer，thedetectionrateofbreastcancerwasabout259.18/100000，andthedetectionrateofearlybreastcancerwasabout170.09/100000.Therewerenosignificantdifferencesbetweenthedetectionrateofbreastcancerandearlybreastcancerbeforeandaftersupplementalmammography（P>0.05）.Atotalof460people（1.86%）wererecalledforbiopsyafterthescreening，andtheactualbiopsywas121people（0.49%），thebiopsycomplianceratewasabout26.30%，andthebiopsyPPVwasabout52.89%.Thedetectionrateofearlybreastcancerwassignificantlypositivelycorrelatedwiththebiopsycompliancerate（r=0.996，P<0.01），butnotwiththemammographydetectionrate（P>0.05）.ConclusionThescreeningmodeofphysicalexaminationcombinedwithultrasoundandselectivesupplementmammographyforbreastcancerscreeningiseffectiveandfeasible，butthestandardsofsupplementarymammographyshouldbeoptimized.Thebiopsycompliancerateafterscreeningneedtobeimproved.[Keywords]Breastcance;Screening;Analysis乳腺癌是女性最常见的恶性肿瘤之...