目的

对2021 至2023 年陕西省渭北农村地区基于超声的乳腺癌筛查结果进行分析，探讨基于超声的乳腺癌筛查模式的筛查效果及相关影响因素。

方法

选取2021 年1 月至2023 年12月参与陕西省渭北农村地区乳腺癌免费筛查项目的139 622 名女性，年龄35 ～64 岁。数据来源于该地区参与筛查项目的各县上报的乳腺癌筛查结果统计表。研究收集的所有女性均进行了临床检查及乳腺超声检查，超声报告结果为乳腺影像报告和数据系统（BI-RADS ）1、2 类被认为是阴性筛查结果，BI-RADS 0、3、4、5 类被认为是阳性筛查结果。对BI-RADS 0 类和3 类的补充乳腺X 线摄影检查，4 类和5 类进行活检。统计分析参与者的调查问卷结果以及筛查结果数据，计算筛查相关指标，包括召回率、活检率、超声筛查的阳性预测值、乳腺癌检出率、乳腺癌早诊率等；采用多因素二元Logistic 回归分析超声筛查阳性和乳腺癌检出的影响因素。

结果

超声初筛结果显示，召回率为4.18%（5832/139 622），超声筛查的阳性预测值为1.06%（62/5832）。该研究样本的活检率为0.25%（356/139 622），共检出乳腺癌63 例，乳腺癌检出率为0.45‰（45.12/10 万），早诊率为80.95%（51/63）。其中，超声检出62 例，未检出1 例。超声筛查阳性影响因素的分析结果显示，45 ～54岁［OR 值（95%CI）：1.16（1.08 ～1.25）］、高中文化程度［OR 值（95%CI）：1.46（1.37 ～1.56）］、大专及以上文化程度［OR 值（95%CI）：1.30（1.16 ～1.45）］ 和未绝经［OR 值（95%CI）：1.68（1.56 ～1.81）］是超声筛查阳性的独立危险因素（P 均＜0.05）。乳腺癌检出影响因素的分析结果显示，大专及以上文化程度［OR 值（95%CI）：4.77（1.34 ～16.95），P＜0.05］是乳腺癌检出的独立危险因素。

结论

陕西省渭北农村地区乳腺癌筛查项目乳腺癌的检出和早诊情况符合相关质控要求，表明基于超声的乳腺癌筛查模式在该地区是可行且有效的。

Objective

To analyze the breast cancer screening results based on ultrasound in the rural areas of Weibei， Shaanxi Province from 2021 to 2023， and to explore the screening effectiveness and related influencing factors of the ultrasound-based breast cancer screening model.

Methods

A total of 139 622 women aged 35-64 years who participated in the free breast cancer screening program in the rural areas of Weibei， Shaanxi Province from January 2021 to December 2023 were selected.The data were derived from the breast cancer screening result reports submitted by the counties participating in the screening program in this region.All the women included in the study underwent clinical examination and breast ultrasound.Ultrasound reports with BI-RADS categories 1 and 2 were considered negative screening results，while those with BI-RADS categories 0， 3， 4， and 5 were considered positive screening results.Women with BI-RADS category 0 or 3 underwent supplemental breast mammography， while those with BI-RADS category 4 or 5 underwent biopsy.The survey questionnaires returned by the participants and the screening results were statistically analyzed to calculate screening-related indicators， including recall rate， biopsy rate， positive predictive value of ultrasound screening， breast cancer detection rate， and early diagnosis rate of breast cancer.Multivariate binary logistic regression analysis was used to identify the factors influencing positive ultrasound screening results and breast cancer detection.

Results

The initial ultrasound screening results showed a recall rate of 4.18% （5832/139 622） and a positive predictive value of ultrasound screening of 1.06% （62/5832）.The biopsy rate in the study sample was 0.25% （356/139 622）， with a total of 63 breast cancer cases detected.The breast cancer detection rate was 0.45‰ （45.12 per 100 000）， and the early diagnosis rate was 80.95%（51/63）.Among these， 62 cases were detected by ultrasound， while 1 case was not detected by ultrasound.The analysis of factors influencing positive ultrasound screening results showed that age 45-54 years ［OR （95%CI）：1.16 （1.08-1.25）］， high school education ［OR （95%CI）：1.46 （1.37-1.56）］， college or higher education ［OR（95%CI）：1.30 （1.16-1.45）］， and premenopausal status ［OR （95%CI）：1.68 （1.56-1.81）］ were independent risk factors for positive ultrasound screening results （all P＜0.05）.The analysis of the influencing factors for breast cancer detection revealed that having an educational level of college degree or above ［OR （95%CI）：4.77 （1.34-16.95）， P＜0.05］ was an independent risk factor for breast cancer detection.

Conclusion

The detection and early diagnosis of breast cancer in the breast cancer screening program in the rural areas of Weinan， Shaanxi Province meet the relevant quality control requirements， indicating that the ultrasound-based breast cancer screening model is feasible and effective in this region.