國民健康局乳癌篩檢追蹤分析研究：台灣中部一所區域醫院的經驗（含數位乳房攝影巡迴車）

Follow-up Analysis of Breast Screening: Experience of a Regional Hospital in Central Taiwan (Including a Mobile Breast Screening Car)

何子龍(Tzu-Lung Ho) ； 劉時佐(Shi-Zuo Liu) ； 詹慧倫(Hui-Lun Zhan) ； 徐守民(Soa-Min Hsu) ； 潘師涵(Shih-Han Pan)

《中華放射線醫學雜誌》 35卷2期 (2010/06) Pp. 89-95

摘要

數位乳房攝影巡迴車的啟用，對我們醫院的乳癌篩檢產生了一些影響。從乳癌篩檢追蹤分析研究中，我們發現數位乳房攝影巡迴車雖然大幅增加我們的乳癌篩檢人數，但是對於我們乳癌治療團隊業務的增加上，卻沒有明顯的幫助。而且，數位乳房攝影巡迴車會排擠到醫院內的乳癌篩檢，使醫院內的乳癌篩檢人數減少，並使醫院內的乳房攝影機產生閒置的情形。因為病人並不是住在我們醫院附近，數位乳房攝影巡迴車的陽性個案回診率，明顯低於醫院內乳癌篩檢的個案。此外，我們也發現本院的陽性個案切片比率過低的問題，可能的原因包括門診醫師做切片決定時過於保守，以及本院並沒有乳房攝影導引切片設備，導致切片比率過低。本院的放射線科醫師在乳房攝影判讀時，診斷的標準並不一致，有些醫師判讀的陽性率有明顯偏高的情形。最後，我們的乳癌篩檢真實陽性率（切片證實為乳癌）偏高，推測可能有樣本污染的情形，換言之，有些有症狀而來就醫的病人，可能也使用了免費的國健局乳癌篩檢，造成數據不正確的情形。

並列摘要

The mobile breast screening project has influences on the breast screening service in our hospital. On the basis of the follow-up analysis, we found the mobile breast screening service has significantly increased the volume of our breast screening, but it has little help to the work of our breast cancer treatment team. In addition, the mobile breast screening service somehow results in a trade-off with our ”in hospital” breast screening practice causing reduction of volume of mammography in the hospital. The OPD recall rate is significantly lower in the positive mobile breast screening group as compared to the ”in hospital” breast screening group. This is probably because they live farther from our hospital. We also find a low biopsy rate in our mammography- positive cases. Possible reasons may include conservative attitude of our doctors and unavailability of mammography-guided biopsy equipment in the hospital. Our radiologists do not follow strict guidelines of mammography interpretation. Some of our radiologist have higher positive rate of breast screening. Our true positive rate of breast screening is relatively high, possibly due to ”sample contamination” because that some symptomatic breast cancer patients may have used the free breast screening service.