探讨各种临床检查因素对乳腺X射线摄影(mammography, MG)和乳腺彩超(ultrasonography, US)诊断一致性的影响，为适合基层医院执行准确率相对较高、经济方便的乳腺疾病筛查方法，提供依据。

选取北京市海淀区妇幼保健院乳腺病防治中心2008年3月至2008年12月参加乳腺癌筛查，同时行乳腺临床检查、乳腺X射线摄影和乳腺彩超检查的1400例女性受试者资料为研究对象。根据乳腺临床检查结果将其分为①孤立性小结节组(A组，n＝105)；②肿块和不对称增厚组(B组，n＝51)；③双侧乳腺对称性增厚组(C组，n＝168)；④未见异常组(D组，n＝936)(本研究遵循的程序符合北京市海淀区妇幼保健院乳腺病防治中心人体试验委员会所制定的伦理学标准，得到该委员会批准，分组征得受试对象本人的知情同意，并与之签署临床研究知情同意书)。采用美国放射学会(American College of Radiology, ACR)制定的乳腺影像报告和数据系统(breast imaging reporting and data system, BI-RADS)标准，进行影像学判断。采取一致性检验(Kappa)评价各组BI-RADS诊断结论一致性，再通过χ²检验，比较两种方法阳性检出率的差异。

①A组乳腺X射线摄影和乳腺彩超一致性较差(Kappa＝0.338, P＝0.132)，两者阳性检出率比较，差异无显著意义(χ²＝0.702，P＝0.402)；②B组一致性较好(Kappa＝0.648, P＝0.122)，阳性检出率比较，差异无显著意义(χ²＝0.050，P＝0.822)；③C组一致性差(Kappa＝0.177，P＝0.077)，阳性检出率比较，差异有显著意义(χ²＝17.769，P＝0.000)；④D组一致性很好(Kappa＝0.737, P＝0.061)，阳性率比较，差异无显著意义(χ²＝1.873, P＝0.171)。二位放射科医师运用BI-RADS分别判断乳腺病灶影像学特征的一致性较好，差异有显著意义(Kappa＝0.847，P＝0.012)。

根据乳腺临床检查结果，建议对孤立性结节者行乳腺X射线摄影和乳腺彩超相结合进一步检查；对肿块和不对称性增厚者，则行乳腺X射线摄影或乳腺彩超进一步检查；对双侧乳腺对称性增厚者，则行乳腺彩超检出；对未发现异常者，则先行乳腺彩超检出，再结合年龄及乳腺密度选择行乳腺X射线摄影检查。乳腺X射线摄影和乳腺彩超均有其优越性和局限性，在国内乳腺癌普查大量人群中的应用，应根据临床检查结果，有目的地选择适合的检查手段。

To discuss the influence of variable clinical factors on the assessment concordance by mammography (MG) and ultrasonography (US), in order to provide evidences on identifying the more accurate, economical and convenient methodology for breast screening which is more suitable for the primary hospitals.

From March 2008 to December 2008, 1400 women joined breast screening by physical exams, mammography and ultrasonography at the Center for Breast Disease of Beijing Haidian Maternal & Child Health Hospital. These subjects were classified into 4 groups based on their physical exam results. ①Isolated nodus group (group A, n=105). ②Tumour and asymmetry incrassation group (group B, n=51). ③Asymmetry incrassation in both galactophore group (group C, n=168). ④No detectable abnormity group (group D, n=936). In order to do further analysis and get conclusions, the images of mammography and ultrasonography were judged by the breast imaging reporting and data system(BI-RADS)standard of American College of Radiology (ACR) and the assessment concordance was analyzed by Kappa test. Further comparing mammography and ultrasonography by χ2 test positive difference in detection rates, and the results analyzed and summarized.

Comparison of the assessment concordance of mammography, ultrasonography and positive rates: ①Group A was poor(Kappa=0.338, P=0.132)and had no significant difference(χ²=0.702, P=0.402). ②Group B was good(Kappa=0.648, P=0.122)and had no significant difference(χ²=0.050, P=0.822). ③Group C was poor(Kappa=0.177, P=0.077) and had significant difference(χ²=17.769, P=0.000). ④Group D was pretty good(Kappa=0.737, P=0.061)and had no significant difference(χ²=1.873, P=0.171). The overall assessment concordance on the images by two radiologists with BI-RADS guideline was good(Kappa=0.847, P=0.012), and had significant difference(Kappa=0.847, P=0.012).

①When isolated nodus was found in physical exam, further assessments together by mammography and ultrasonography should be recommended. ②When tumour and asymmetry incrassation were found in physical exam, further assessment by mammography or ultrasonography could be recommended. ③When incrassation in both galactophore was recognized in physical exam, ultrasonography should be recommended as the first step. ④If no abnormity was detected by physical exam, ultrasonography should be recommended firstly, followed by mammography appropriately based on the patient's age and breast density. Breast ultrasonography and mammography has its own advantages and limitations of inspection in the country's breast cancer screening of large groups of people. We should select the appropriate destination inspection means based on clinical examination results.