乳癌患者耳廓变化的临床观察之研究
|
摘要
乳癌是女性最常见的恶性肿瘤,其盛行率有升高而且年轻化的趋势。乳癌是现代社会的流行病,占女性所有恶性肿瘤的三分之一,是女性最常见的恶性肿瘤,也是全球女性的主要死因。西方国家平均每八位女性在其一生当中便有一位曾经罹患乳癌。相较于西方国家,亚洲地区尤其在中国与台湾,乳癌的盛行率与死亡率有年轻化而且有不断升高的趋势。
乳癌细胞的病理特性导致早期正确地诊断乳癌并不容易,而临床追踪复检的方法、时间、与成效并不准确。现行乳癌的筛检成效往往与病患的自觉症状并不一致。致使先期诊断困难,容易延误病情,失去治疗先机。
根据Mathis等人研究[141],有43%的乳癌病患是因为触及肿块与其它症状而就医确诊,经由现行筛检工具而就医确诊者仅有57%。正因如此,很多乳癌的病人等到病情发展到比较严重的时候,才会被诊断出来。
国内早在1980年代开始,就有运用耳廓辅助诊断恶性肿瘤等疾病的实证性研究文献论述,惟多见于消化系统的癌症,而在乳癌方面仅有零星的医师临床个案报导,亦未成专论。又,以往耳廓诊断恶性肿瘤的方法较为耗时,必须仰赖特殊仪器,而且该仪器并不普遍,也非垂手可得。
本病例对照研究应用中医对耳廓的望诊与按诊,辅以简易的耳穴探测器,探讨耳廓辅助诊断或筛检乳癌的可行性。
研究目的：
本研究针对乳癌患者的耳廓特性做为主要的观察指标,同时设计耳廓筛检或辅助诊断的临床前驱试验,通过耳廓望诊、触诊、电位检测等方法,辅助检查受试者是否罹患乳癌,或曾经为乳癌患者经手术或化疗后,追踪检查是否复发或发生转移。尝试以耳廓辅助观察诊断的模式,建立初步诊断或筛检乳癌的辅助工具。
研究方法：
本研究自2010年6月至2011年3月进行,应用病例对照研究法,进入合作诊所的所有病人,在患者知情并签属知情同意书后,完成本研究所需的数据收集程序后,经纳入、排除标准,即进入本研究。其中病例组(乳癌阳性)有效病例数99人,对照组(乳癌阴性)有效病例数96人。按耳穴国际标准图为取穴标准,制作耳廓诊断量化表,通过耳穴望诊、耳穴触诊、耳穴电测等,收集各穴区相关资料填入量化表。耳廓数据的测试者,数据的输入者,与资料统计者采三分离法。
本研究以皮尔森氏卡方检定(Pearson's Chi-Square)与费歇尔氏检定(Fisher's Exact)交叉分析统计与乳癌相关的属于非连续性变项之病史与致病因子；以独立样本t检定合并Levene相等变异数分析,计算与乳癌相关的属于连续性变项之病史与致病因子。以Logistic回归(Logistic Regression)多变项统计法,选取在单变项分析中具有统计显着意义的致病因子与耳穴变项,将该变项带入Logistic回归分析,以估计本耳廓辅助诊断乳癌模式的检测效率与辅助诊断的准确性。
研究结果：
本研究具有统计显着性差异的乳癌病史为：经常性晕或眩、经常性口渴、胁肋闷或痛、经常性便秘、便如羊屎状、经常性睡眠障碍、容易疲劳、经期经常改变、月经期间或前后经常乳房胀或痛。
具有统计显着性差异的乳癌危险致病因子为：生活作息不规律、常有负面或消极想法、经常感到不安或恐惧、承受极大的工作或家庭压力而经常自觉无法承担、承受极大的家庭压力而经常自觉无法承担、平日好食大豆制品(豆浆,豆腐,豆皮…)、初经年龄、停经年龄。
在大部分的文献显示具有显着性差异,而在本研究却不具显着性差异的病史与危险致病因子计有：曾经有一段时间经常服用贺尔蒙、乳房囊肿等乳癌以外的乳房疾病、母亲或姊妹是否有人罹患乳癌、怀孕次数、生产胎数、是否亲自哺乳。
具有具有统计显着性差异的耳穴为：肝区、脾区、内分泌区、与肿瘤特异1区的痛觉及肿瘤特异1区的隆起增生。而胃区、肺区、三焦区、与神门区的痛觉指数,经Levene相等变异数法修正后,虽亦具有显着性差异。但因为统计结果显示,对整体回归解释力的改善相当有限,因此应非直接与其它具有统计显着意义的病史、危险致病因子等具有密切相关,而无法独立显示其特殊意义。
将上述具有统计显着差异的变项带入Logistic回归,仅承受极大的工作或家庭压力而经常自觉无法承担(0或1)、月经期间或前后经常乳房胀或痛(0或1)、初经年龄、肿瘤I区是否有隆起增生(0或1)等四项具统计显着差异,其回归的解释力(pseudo R-square)为80.1%,p<0.000.而判别是否为乳癌阳性的机率Pr=ef(x)/l+ef(x)
f(Xn)为乳癌罹病函数,而乳癌罹病函数f(是否罹患乳癌之危险性)=11.60398+2.715262×(承受极大的工作或家庭压力而经常自觉无法承担0+否；1=是)+1.988133×(月经期间或前后经常乳房胀或痛0=否；1=是) -1.169609×初经年龄+8.265418×(肿瘤I区是否有隆起增生0=否；1=是)
将本试验病例组及对照组的耳廓观察数据代入乳癌罹病函数,建立耳廓诊断四格表,计算本研究耳廓诊断的特异度(Specificity)达97.92%、灵敏度(Sensitivity)达92.93%、假阳性率(False Positive Rate)为2.08%、假阴性率(False Negative Rate)为7.07%、阳性预测值(Positive Predictive Value)达97.87%、阴性预测值达(Negative Predictive Value)达93.07%、符合率(Agreement Rate)为95.38%、ROe曲线以下面积为98.34%。与现行西医乳癌的相关检查与诊断方式具有可比较性,说明了耳廓辅助诊断乳癌具有相当程度的可行性。
结论：
本病历对照研究发现,乳癌患者耳穴肝区和脾区的疼痛,与耳廓肿瘤特异I区的疼痛和增生隆起,相较于对照组,具有统计显着性的高比例。而耳廓肿瘤特异Ⅰ区的增生隆起、工作或家庭压力、月经期间或前后经常乳房胀或痛、与初经年龄四者,对于辅助判别罹患乳癌与否,扮演关键性因素。
通过临床试验数据的统计分析处理,本研究初步建立是否患有乳癌的耳廓筛检或辅助诊断的判别函数,经验证此辅助模式具有较高的特异度和灵敏度。可以尝试作为是否患有乳癌的耳廓辅助检查的方法。本研究使用的耳廓辅助检查方法,具有无创伤、无辐射暴露、成本低、快速、操作简单、容易普及化的优点。可以适用于可能患有乳癌的筛检或初步辅助诊断,或适用于曾经为乳癌患者,经化疗或手术切除后,追踪是否复发的辅助检查方法。
Breast cancer is the predominant malignancy over female, with trend towards higher prevalence in younger population. Breast cancer is the epidemic of modern society, taking one-third of all malignant tumors in female. Not only the most prevailing malignant tumor, but also breast cancer is the world's leading cause of death for women. On average, every eight women in Western countries ever had or will have breast cancer in their life. Compared to Western countries, Breast cancer in Asia, especially China and Taiwan, exists higher incidence and mortality rate in younger group. This tendency is still rising.
Pathological characteristics of breast cancer hinder its early and accurate diagnosis. The process, time interval, and effectiveness of current clinical follow-up schemes are still unable to promptly mirror its deteriorating pathological status. Results of current screening tools on breast cancer are often inconsistent with patients'symptoms. Difficulty on early diagnosis makes breast cancer easy to be delayed and to lose opportunities of early treatment.
Auricular diagnosis on malignant tumors began its empirical exposition as early as 1980, but only seen in cancers of the digestive system. As for breast cancer, there were only few and sporadic case reports of clinical observations on its corresponding auricular characteristics, leaving spaces to systemically extend and construct an auricular diagnostic model on breast cancer. Besides, current methods of auricular diagnosis of malignant tumor are time consuming and need to rely on special instruments fabricated by researchers. These instruments are also not accessible to general physicians.
This clinical research applies knowledge and techniques of auricular inspection of traditional Chinese medicine, complemented by simple tools of electrical ear probe to explore the feasibility of constructing an auricular aided diagnostic method on primary and secondary breast cancer.
Objectives:This clinical trial employs the auricular characteristics of patients with breast cancer as primary diagnostic indicators. Through aural observation, palpation, and potential detection by electrical ear probe to study auricular model of breast cancer and to develop an ear-aided method for preliminary diagnosis and screening for breast cancer.
Methods:From June 2010 to march 2011, implementing the rules of case-control study, every patient stepped into the collaboration clinics, after signing consent forms and completing data collection procedure, were assigned into case group (breast cancer positive) or control group (breast cancer negative) by criteria of inclusion and exclusion. The study collected 99 valid cases for case group (breast cancer positive with evidence of biopsy), and 96 valid cases for control group (breast cancer negative with evidence of ultrasonography or mammography). According to the international standard figure for auricular points, the study collected data of aural inspection, palpation, and potential detection into visualized quantification tables. Data collecting, data recording, and data mining were independently prepared by three different teams.
This study applied Pearson's Chi Square Test and Fisher's Exact Test for discrete variables, independent Student's t Test with Levene's Equity Statistics for continuous variables. Further exploration of those statistical significances drawn from the above procedures into Logistic regression to filtrate critical past histories, risk factors, and indications reflected from ears, including pain sensation and color as well as morphology changes, in order to establish a diagnostic model for breast cancer. According the model, Logistic regression re-assessed the original case and control groups and re-assigned them into predicted groups so as to calculate efficiency and accuracy of the ear-aided diagnostic model for breast cancer.
Results:The study concluded statistical significant past histories and risk factor for breast cancer as recurrent dizzy, frequent thirst, recurrent constipation with or without bullet-shaped stool, stagnation or pain sensation at hypochondriac areas, regular sleep disorder, keeping irregular biological clock, chronic fatigue, negativism or passivism, work or family stress, favorite for soybean food, frequent menstrual changes, breast distension or pain during menstruation, and age of menarche and menopause.
Certain risk factors showed their significance with breast cancer in major lituratures but lack of significance in our study were intake of contraceptive pills or other hormone regulating substances, past history of breast cysts, family aggregation on mother side or female siblings, number of gravid, parity, and breast feeding.
Auricular points with primary statistical significance were liver (C012), spleen (C013), endocrine (C018), and tumor specific area I (M1). Otopoints with statistical significance after adjustment by Levene's statistics were stomach (C04), lung (C014), triple burner (C017), and ear-shenmen(TF4).
Logistic regression processed those variables with primary statistical significance and included four variables into its final equation, including overloaded work stress (0 for none,1 for yes), breast distension or pain during menstruation (o for none,1 for yes), age of menarche, and uplift hyperplasia (0 for none,1 for yes) at tumor-specific areaⅠ. Power of explanation for overall variation to breast cancer, in term of pseudo R-square, is 80.1% with significant level of p<0.000. According assumption of logistic regression, probability of breast cancer positive is {ef(x)/(l+ef(x))}, where f (xn) is odds ratio of breast cancer. F(xn)= 11.60398+2.715262×overloaded work or family stress+1.988133 x breast distension or pain during menstruation-1.169609×age of menarche+8.265418×uplift hyperplasia at tumor-specific areaⅠ.
Post-estimation calculated from logistic probability equation of breast cancer positive showed diagnostic specificity is 97.92%, sensitivity 92.93%, false positive rate 2.08%, false negative rate 7.07%, positive predictive value 97.87%, negative predictive value 93.07%, agreement rate 95.38%, and area under ROC curve is 98.34%. In comparison with concurrent examination tools for breast cancer, auricular aided examination model is comprehensive and feasible.
Conclusion:The findings of the significant past histories, risk factors, and key otopoints for breast cancer were not only concordance with modern endocrine medicine on physiological changes and pathological aspects of mammary gland, but also concordance with the pathological progress described in TCM meridian bible literatures and breast disorders related ancient books.
Through case control study design and statistical data processing, the study proposed a simple way of palpitation at the auricular tumor-specific area 1 along with a predictive equation targeted on risk factors of stress, breast distention or pain during menstruation, and age of menarche, in order to calculate the probability breast cancer positive. Diagnosis evaluation indicators showed the underlining auricular examination method for breast cancer that the study suggested has high sensitivity, high specificity, and acceptable agreement rate in comparison with those of the modern medicine's tools.
Auricular aided examination for breast cancer is an efficient tool of non-invasive, non-radiation exposure, low cost, fast, simple to operate, and easy to adapt. It is suggested to apply to screening, and to long-term following-up scheme in order to track recurrence of breast cancer patients with chemotherapy, radiotherapy, or surgical treatment.
乳癌细胞的病理特性导致早期正确地诊断乳癌并不容易,而临床追踪复检的方法、时间、与成效并不准确。现行乳癌的筛检成效往往与病患的自觉症状并不一致。致使先期诊断困难,容易延误病情,失去治疗先机。
根据Mathis等人研究[141],有43%的乳癌病患是因为触及肿块与其它症状而就医确诊,经由现行筛检工具而就医确诊者仅有57%。正因如此,很多乳癌的病人等到病情发展到比较严重的时候,才会被诊断出来。
国内早在1980年代开始,就有运用耳廓辅助诊断恶性肿瘤等疾病的实证性研究文献论述,惟多见于消化系统的癌症,而在乳癌方面仅有零星的医师临床个案报导,亦未成专论。又,以往耳廓诊断恶性肿瘤的方法较为耗时,必须仰赖特殊仪器,而且该仪器并不普遍,也非垂手可得。
本病例对照研究应用中医对耳廓的望诊与按诊,辅以简易的耳穴探测器,探讨耳廓辅助诊断或筛检乳癌的可行性。
研究目的：
本研究针对乳癌患者的耳廓特性做为主要的观察指标,同时设计耳廓筛检或辅助诊断的临床前驱试验,通过耳廓望诊、触诊、电位检测等方法,辅助检查受试者是否罹患乳癌,或曾经为乳癌患者经手术或化疗后,追踪检查是否复发或发生转移。尝试以耳廓辅助观察诊断的模式,建立初步诊断或筛检乳癌的辅助工具。
研究方法：
本研究自2010年6月至2011年3月进行,应用病例对照研究法,进入合作诊所的所有病人,在患者知情并签属知情同意书后,完成本研究所需的数据收集程序后,经纳入、排除标准,即进入本研究。其中病例组(乳癌阳性)有效病例数99人,对照组(乳癌阴性)有效病例数96人。按耳穴国际标准图为取穴标准,制作耳廓诊断量化表,通过耳穴望诊、耳穴触诊、耳穴电测等,收集各穴区相关资料填入量化表。耳廓数据的测试者,数据的输入者,与资料统计者采三分离法。
本研究以皮尔森氏卡方检定(Pearson's Chi-Square)与费歇尔氏检定(Fisher's Exact)交叉分析统计与乳癌相关的属于非连续性变项之病史与致病因子；以独立样本t检定合并Levene相等变异数分析,计算与乳癌相关的属于连续性变项之病史与致病因子。以Logistic回归(Logistic Regression)多变项统计法,选取在单变项分析中具有统计显着意义的致病因子与耳穴变项,将该变项带入Logistic回归分析,以估计本耳廓辅助诊断乳癌模式的检测效率与辅助诊断的准确性。
研究结果：
本研究具有统计显着性差异的乳癌病史为：经常性晕或眩、经常性口渴、胁肋闷或痛、经常性便秘、便如羊屎状、经常性睡眠障碍、容易疲劳、经期经常改变、月经期间或前后经常乳房胀或痛。
具有统计显着性差异的乳癌危险致病因子为：生活作息不规律、常有负面或消极想法、经常感到不安或恐惧、承受极大的工作或家庭压力而经常自觉无法承担、承受极大的家庭压力而经常自觉无法承担、平日好食大豆制品(豆浆,豆腐,豆皮…)、初经年龄、停经年龄。
在大部分的文献显示具有显着性差异,而在本研究却不具显着性差异的病史与危险致病因子计有：曾经有一段时间经常服用贺尔蒙、乳房囊肿等乳癌以外的乳房疾病、母亲或姊妹是否有人罹患乳癌、怀孕次数、生产胎数、是否亲自哺乳。
具有具有统计显着性差异的耳穴为：肝区、脾区、内分泌区、与肿瘤特异1区的痛觉及肿瘤特异1区的隆起增生。而胃区、肺区、三焦区、与神门区的痛觉指数,经Levene相等变异数法修正后,虽亦具有显着性差异。但因为统计结果显示,对整体回归解释力的改善相当有限,因此应非直接与其它具有统计显着意义的病史、危险致病因子等具有密切相关,而无法独立显示其特殊意义。
将上述具有统计显着差异的变项带入Logistic回归,仅承受极大的工作或家庭压力而经常自觉无法承担(0或1)、月经期间或前后经常乳房胀或痛(0或1)、初经年龄、肿瘤I区是否有隆起增生(0或1)等四项具统计显着差异,其回归的解释力(pseudo R-square)为80.1%,p<0.000.而判别是否为乳癌阳性的机率Pr=ef(x)/l+ef(x)
f(Xn)为乳癌罹病函数,而乳癌罹病函数f(是否罹患乳癌之危险性)=11.60398+2.715262×(承受极大的工作或家庭压力而经常自觉无法承担0+否；1=是)+1.988133×(月经期间或前后经常乳房胀或痛0=否；1=是) -1.169609×初经年龄+8.265418×(肿瘤I区是否有隆起增生0=否；1=是)
将本试验病例组及对照组的耳廓观察数据代入乳癌罹病函数,建立耳廓诊断四格表,计算本研究耳廓诊断的特异度(Specificity)达97.92%、灵敏度(Sensitivity)达92.93%、假阳性率(False Positive Rate)为2.08%、假阴性率(False Negative Rate)为7.07%、阳性预测值(Positive Predictive Value)达97.87%、阴性预测值达(Negative Predictive Value)达93.07%、符合率(Agreement Rate)为95.38%、ROe曲线以下面积为98.34%。与现行西医乳癌的相关检查与诊断方式具有可比较性,说明了耳廓辅助诊断乳癌具有相当程度的可行性。
结论：
本病历对照研究发现,乳癌患者耳穴肝区和脾区的疼痛,与耳廓肿瘤特异I区的疼痛和增生隆起,相较于对照组,具有统计显着性的高比例。而耳廓肿瘤特异Ⅰ区的增生隆起、工作或家庭压力、月经期间或前后经常乳房胀或痛、与初经年龄四者,对于辅助判别罹患乳癌与否,扮演关键性因素。
通过临床试验数据的统计分析处理,本研究初步建立是否患有乳癌的耳廓筛检或辅助诊断的判别函数,经验证此辅助模式具有较高的特异度和灵敏度。可以尝试作为是否患有乳癌的耳廓辅助检查的方法。本研究使用的耳廓辅助检查方法,具有无创伤、无辐射暴露、成本低、快速、操作简单、容易普及化的优点。可以适用于可能患有乳癌的筛检或初步辅助诊断,或适用于曾经为乳癌患者,经化疗或手术切除后,追踪是否复发的辅助检查方法。
Breast cancer is the predominant malignancy over female, with trend towards higher prevalence in younger population. Breast cancer is the epidemic of modern society, taking one-third of all malignant tumors in female. Not only the most prevailing malignant tumor, but also breast cancer is the world's leading cause of death for women. On average, every eight women in Western countries ever had or will have breast cancer in their life. Compared to Western countries, Breast cancer in Asia, especially China and Taiwan, exists higher incidence and mortality rate in younger group. This tendency is still rising.
Pathological characteristics of breast cancer hinder its early and accurate diagnosis. The process, time interval, and effectiveness of current clinical follow-up schemes are still unable to promptly mirror its deteriorating pathological status. Results of current screening tools on breast cancer are often inconsistent with patients'symptoms. Difficulty on early diagnosis makes breast cancer easy to be delayed and to lose opportunities of early treatment.
Auricular diagnosis on malignant tumors began its empirical exposition as early as 1980, but only seen in cancers of the digestive system. As for breast cancer, there were only few and sporadic case reports of clinical observations on its corresponding auricular characteristics, leaving spaces to systemically extend and construct an auricular diagnostic model on breast cancer. Besides, current methods of auricular diagnosis of malignant tumor are time consuming and need to rely on special instruments fabricated by researchers. These instruments are also not accessible to general physicians.
This clinical research applies knowledge and techniques of auricular inspection of traditional Chinese medicine, complemented by simple tools of electrical ear probe to explore the feasibility of constructing an auricular aided diagnostic method on primary and secondary breast cancer.
Objectives:This clinical trial employs the auricular characteristics of patients with breast cancer as primary diagnostic indicators. Through aural observation, palpation, and potential detection by electrical ear probe to study auricular model of breast cancer and to develop an ear-aided method for preliminary diagnosis and screening for breast cancer.
Methods:From June 2010 to march 2011, implementing the rules of case-control study, every patient stepped into the collaboration clinics, after signing consent forms and completing data collection procedure, were assigned into case group (breast cancer positive) or control group (breast cancer negative) by criteria of inclusion and exclusion. The study collected 99 valid cases for case group (breast cancer positive with evidence of biopsy), and 96 valid cases for control group (breast cancer negative with evidence of ultrasonography or mammography). According to the international standard figure for auricular points, the study collected data of aural inspection, palpation, and potential detection into visualized quantification tables. Data collecting, data recording, and data mining were independently prepared by three different teams.
This study applied Pearson's Chi Square Test and Fisher's Exact Test for discrete variables, independent Student's t Test with Levene's Equity Statistics for continuous variables. Further exploration of those statistical significances drawn from the above procedures into Logistic regression to filtrate critical past histories, risk factors, and indications reflected from ears, including pain sensation and color as well as morphology changes, in order to establish a diagnostic model for breast cancer. According the model, Logistic regression re-assessed the original case and control groups and re-assigned them into predicted groups so as to calculate efficiency and accuracy of the ear-aided diagnostic model for breast cancer.
Results:The study concluded statistical significant past histories and risk factor for breast cancer as recurrent dizzy, frequent thirst, recurrent constipation with or without bullet-shaped stool, stagnation or pain sensation at hypochondriac areas, regular sleep disorder, keeping irregular biological clock, chronic fatigue, negativism or passivism, work or family stress, favorite for soybean food, frequent menstrual changes, breast distension or pain during menstruation, and age of menarche and menopause.
Certain risk factors showed their significance with breast cancer in major lituratures but lack of significance in our study were intake of contraceptive pills or other hormone regulating substances, past history of breast cysts, family aggregation on mother side or female siblings, number of gravid, parity, and breast feeding.
Auricular points with primary statistical significance were liver (C012), spleen (C013), endocrine (C018), and tumor specific area I (M1). Otopoints with statistical significance after adjustment by Levene's statistics were stomach (C04), lung (C014), triple burner (C017), and ear-shenmen(TF4).
Logistic regression processed those variables with primary statistical significance and included four variables into its final equation, including overloaded work stress (0 for none,1 for yes), breast distension or pain during menstruation (o for none,1 for yes), age of menarche, and uplift hyperplasia (0 for none,1 for yes) at tumor-specific areaⅠ. Power of explanation for overall variation to breast cancer, in term of pseudo R-square, is 80.1% with significant level of p<0.000. According assumption of logistic regression, probability of breast cancer positive is {ef(x)/(l+ef(x))}, where f (xn) is odds ratio of breast cancer. F(xn)= 11.60398+2.715262×overloaded work or family stress+1.988133 x breast distension or pain during menstruation-1.169609×age of menarche+8.265418×uplift hyperplasia at tumor-specific areaⅠ.
Post-estimation calculated from logistic probability equation of breast cancer positive showed diagnostic specificity is 97.92%, sensitivity 92.93%, false positive rate 2.08%, false negative rate 7.07%, positive predictive value 97.87%, negative predictive value 93.07%, agreement rate 95.38%, and area under ROC curve is 98.34%. In comparison with concurrent examination tools for breast cancer, auricular aided examination model is comprehensive and feasible.
Conclusion:The findings of the significant past histories, risk factors, and key otopoints for breast cancer were not only concordance with modern endocrine medicine on physiological changes and pathological aspects of mammary gland, but also concordance with the pathological progress described in TCM meridian bible literatures and breast disorders related ancient books.
Through case control study design and statistical data processing, the study proposed a simple way of palpitation at the auricular tumor-specific area 1 along with a predictive equation targeted on risk factors of stress, breast distention or pain during menstruation, and age of menarche, in order to calculate the probability breast cancer positive. Diagnosis evaluation indicators showed the underlining auricular examination method for breast cancer that the study suggested has high sensitivity, high specificity, and acceptable agreement rate in comparison with those of the modern medicine's tools.
Auricular aided examination for breast cancer is an efficient tool of non-invasive, non-radiation exposure, low cost, fast, simple to operate, and easy to adapt. It is suggested to apply to screening, and to long-term following-up scheme in order to track recurrence of breast cancer patients with chemotherapy, radiotherapy, or surgical treatment.
引文
[1]王翠平,王炳高,齐春华.乳癌诊断进展[J].青岛大学医学院学报,2007,43(4)：374.
[2]Ahmedin J, Rebecca S, Elizabeth W, et al. Cancer statistics,2008 CA [J]. Cancer J Clin,2008,58 (2):71-96.
[3]Carol S, Ahmedin J, Elizabeth W, et al. Trends in Breast Cancer by Race and Ethnicity:Update 2006 [J]. CA Cancer J Clin,2006,56 (3):168-183.
[4]Lei F, Ying Zh, KeDa Y, et al. Breast cancer in a transitional society over 18 years:trends and present status in Shanghai, China [J]. Breast Cancer Res Treat,2009.
[5]Ferlay J, Bray F, Pisani P, Parkin D M. GLOBOCAN 2002:cancer incidence, mortality and prevalence worldwide. IARC Cancer Base No 5. version 2.0. Lyon: IARC Press,2004.
[6]林永望.乳癌的诊治[J].中国普通外科杂志,2002,11(6)：321-323.
[7]Tilanus-Linthorst MMA, Kriege M, Boetes C, et al. Hereditary breast cancer growth rates and its impact on screening policy [J]. European Journal of Cancer, 2005,41:1610-1617.
[8]Cox CL, Oeff inger KC, Montgomery M, et al. Determinants of Mammography Screening Participation in Adult Childhood Cancer Survivors:Results From the Childhood Cancer Survivor Study [J]. Oncology Nursing Forum,2009, 36(3); 335-344.
[9]Aksnes LH, Bruland OS. Some musculo-skeletal sequelae in cancer survivors [J]. Acta Oncologica,2007,46; 490-496.
[1 O]张颖清.全息生物学[M].北京,高等教育出版社.1989.
[11]曹宁芳.生物全息律与中医望诊[J].陕西中医,2001,22(11)：676-677.
[12]蔡彦,揭西娜.刍议《内经》与《周易》同源性[J].中华中医药学刊,2008,26(2)：350-351.
[13]邱幸凡,张六通,王海燕.“内经》全息论思想及临床应用.[J].湖北中医杂志,2004.26(5)：1-4.
[14]华兴邦.耳穴诊治发展的思考[J].上海针灸杂志,1998,17(6)；1.
[15]张诗兴,姜文方.耳穴定位与神经、血管分布的研究[J].南京中医药大学学报,1998.14(4)：228-229.
[16]张诗兴,周坤福,姜文方,等.耳穴的脑、脊神经节投射[J].上海针灸杂志,2002,21(3)：35-36.
[17]张诗兴,徐恒泽,姜文.耳廓神经支配及其与耳穴定位的关系[J].南京铁道医学院学报,1998,17(4)：235-237.
[18]张启兵,张诗兴.耳针调节内脏功能的作用机制研究[J].广东药学院学报,2005,21(3)： 330-33.
[19]朱兵,陈巩荪,许瑞征.耳郭穴位电学特性的研究[J].中国针灸,1999,6：355-358.
[20]朱兵,张骏,李宁,等.耳穴电位反应病变的特异性[J].南京大学学报,1999,35(2)：236-239.
[21]高洁,石晓东,王嘉赋,等.线性模型识别多元耳穴电信息[J].生物医学工程学杂志,2000,17(3)：316-319.
[22]胡智慧,沈友轩,蔡念,等.耳穴特异性与生物分子活性的关系[J].南京中医药大学学报,2001,17(1)：39-42.
[23]刘维洲,许冠荪,张群群,等.耳廓神经支配与耳针对胃肠电活动影响的察[J].针刺研究,1990,8：187-188.
[24]陆新华.耳廓电测定临床诊断观察[J].上海针灸杂志,1997,16(5)；27.
[25]叶本法,徐耀初,周玲,等.耳诊食管、胃部疾患的筛选试验及其对粘膜病变特征的流行病学研究[J].江苏预防医学,1995,4；3-5.
[26]张建斌,冯向先.乳腺癌危险因素的Meta分析[J].中国卫生统计,2002,19(3)：168-170.
[27]Mayberry RM, Branch PT.Breast Cancer risk factors among hispannic women [J]. Ethn Dis,1994,4, (1):41.
[28]袁剑敏,高玉堂.乳腺癌的危险因素与绝经状态的关系[J].肿瘤杂志,1991,11(5)：199-202.
[29]武光林,齐秀英.生育及有关因素与乳腺癌的病例对照研究[J].天津医药,1993,21(13)：673-677
[30]American Cancer Society. Probability of developing invasive cancer over selected age intervals, by sex, US,1999 2001.www.cancer.org,2005
[31]钟颖,孙强,徐雅莉.30年收治乳腺癌的发病趋势[J].中国普通外科杂志,2009,18(11)：1111-1115.
[32]Ries LAG, Eisner MP, Kosary CL, et al. SEER Cancer Statistics Review,1975-2002. Bethesda, MD:National Cancer Institute,2005. (Accessed September 15, 2006, at http://seer.cancer.gov/csr/1975_2002/).
[33]Fremgen AM, Bland KI, McGinnis LS, et al. Clinical high lights from the National Cancer Data Base[J]. CA Cancer J Clin,1999,49 (1):145-158.
[34]Colleoni M, Rotmensz N, Robertson C, et al. Very young women (<
35 years) with operable breast cancer:features of disease at presentation [J]. Ann Oncol,2002,13(2):273-279.
[35]Ries LAG, Eisner MP, Kosary CL, et al. SEER Cancer Statistics Review, 1973-1999 Bethesda, MD [R]. National Cancer Institute,2002:14-15.
[36]Holli K, Isola J. Effect of age on the survival of breast cancer patients [J]. Eur J Cancer,1997,33 (3):425-428.
[37]Korea Central Cancer Registry, Ministry of Health and Welfare, Republic of Korea 2002 Annual Report of the Korea Central Cancer Registry Seoul, Korea [R]. Korea Central Cancer Registry,2003:4-5.
[38]孟洁,郎荣刚,范宇,等.年轻乳腺癌患者的病理学和生物学特征及其与预后的关系[J].中华肿瘤杂志,2007,29(4)：284-288.
[39]高标,余建军,梁国良,等.青年乳腺癌71例的临床分析[J].中华普通外科杂志,2002,17(11)：684-685.
[40]杨桦,王思愚,区伟.华南地区年轻乳腺癌患者预后因素分析[J].癌症,2009,28(12)：1310-1316.
[41]张俊清,吴艳乔,张敏.月经生育因素与乳腺癌关系的Meta分析[J].现代预防医学.2010,37(7)：1262-1264.
[42]王启俊,李玲,祝伟星,等.北京市乳腺癌危险因素病例对照研究[J].中国慢性病预防与控制,2000,8(4)：165-167.
[43]李泓澜,高立峰,杨工,等.月经生育因素与女性乳腺癌关系的病例对照研究[J].肿瘤,2000,20(2)：88-92.
[44]史习舜,吴彬,胡志坚,等.福州市妇女乳腺癌危险因素的病例对照研究[J].海峡预防医学杂志,2000,6(5)：12-14.
[45]曹卡加,吴一龙,马国胜,等.广州市乳腺癌危险因素的病例对照研究[J].中国肿瘤,2001,10(12)：702-704.
[46]蔺新英,徐贵发,徐虹,等.济南市女性乳腺癌危险因素的病例对照研究[J]山东医科大学学报,2001,39(6)：552-553.
[47]闸远萍.女性乳腺癌患病危险因素的病例对照研究[J].实用医学杂志,2001,17(7)： 646.
[48]林毅,唐汉钧.现代中医乳房病学[M].人民卫生出版社,2008,3-12.
[49]张秀娟,王雪梅,戴红梅.乳腺癌与人工流产相关关系的调查[J].中国初级卫生保健,2001,15(4)：59.
[50]邹练,田建荣.青山地区女性乳腺癌危险因素的病例对照研究[J].全国肿瘤护理学术交流暨专题讲座会议论文汇编,2003,8：56-59
[51]袁宝君,戴月,史祖民,等.妇女乳腺癌危险因素病例对照研究[J].中国公共卫 生,2004,20(9)：1036.
[52]韩定芬,马骏,周新.武汉地区女性乳腺癌危险因素的病例对照研究[J].中华流行病学杂志,2004,25(3)：256-260.
[53]李雪莲,何苗,许志远.女性乳腺癌危险因素的病例对照研究[J].疾病控制杂志,2006,2(10)：8-11.
[54]李双飞,李佳圆,雷放鸣.乳腺癌危险因素的病例对照研究[J].现代预防医学,2006,33(12)：2233-2235.
[55]黄向明,王春霞,周永生.深圳市宝安区女性乳腺癌发病危险因素的初步调查[J].中原医刊,2006,33(22)：37-39.
[56]翟祥军,王水,秦建伟,等.月经、生殖因素与乳腺癌关系的病例对照研究[J]疾病控制杂志,2006,10(2)：109-113.
[57]朱留华,李秀芒.郑州市女性乳腺癌危险因素的病例对照研究[J].中国基层医药,2006,13(4)：679-680.
[58]荣素英,李君,牛风玲,等.唐山地区女性乳腺癌环境危险因素的病例对照研究[J].环境与职业医学,2007,24(1)：5-8.
[59]聂建云,金丛国,唐一吟,等.云南省妇女乳腺癌危险因子初步研究[J].实用癌症杂志,2008,23(3)：269-272.
[60]刘继永,沈洪兵,靳光付,等.江苏地区乳腺癌危险因素的病例对照研究[J].南京医科大学学报,2008,28(5)：689-692.
[61]林杰,虞建锋.慈溪市女性乳腺癌危险因素病例对照研究[J].浙江预防医学,2008,20(6)：3-5.
[62]周亮,贺天锋,靳雅丽,等.女性乳腺癌危险因素的病例对照研究[J].中国肿瘤,2009,18(1)：27-30.
[63]陶旻枫,丁辉,刘丽,等.北京地区乳腺癌危险因素分析[J].解放军医学杂志2009,34(5)：605-607.
[64]Dumitrescu RG, Cotarla I. Understanding breast cancer risk-where do we stand in 2005 [J]. J Cell Mol Med,2005,9(1):208-221.
[65]Henderson BE, Pike MC, Bernstern L, et al. Breast cancer(C). IN:Schottenfeld D, Fraumeni JF, eds. Cancer Epidemiology and Prevention [M].2nd ed. New York: Oxford University Press,1996,1022.
[66]Nagata C. Hu YH. Shimizu H. Effects of menstrual and reproductive factors on the risk of breast cancer:meta-analysis of the case-control studies in Japan [J]. Japanese Journal of Cancer Research,1995,86 (10):910-915.
[67]Eisen A. Rebbeck TR. Prophylactic surgery in women with a hereditary predisposition to breast and ovarian cancer [J]. Journal of Clinical Oncology, 2000,18 (9):1980-1995.
[68]Nagata C. Hu YH. Shimizu H. Effects of menstrual and reproductive factors on the risk of breast cancer:meta-analysis of the case-control studies in Japan [J]. Japanese Journal of Cancer Research,1995,86 (10):910-915.
[69]Chavez Mac Gregor M. Elias SG. Postmenopausal breast cancer risk and cumulative number of menstrual cycles[J].Cancer Epidemiology, Biomarkers &Prevention,2005,14 (4):799-804.
[70]Collaborative Group on Hormonal Factors in breast cancer. Breast cancer and hormonal contraceptive:collaborative reanalysis of individual date on 53297 women with breast cancer and 100239 women without breast cancer from 54 epidemiological studies [J]. Lancet,1996,347:1713-1727.
[71]Carmichael A, Sami AS, Dixon JM. Breast cancer risk among the survivors of atomic bomb and patients exposed to therapeutic ionising radiation[J]. European Journal of Surgical Oncology,2003,29(5):475-479.
[72]Miller A, Howe G, Sherman G. Mortality from breast cancer after irradiation of the thymus in infancy[J]. N Engl J Med 1989,321:146.
[73]Hoffman DA, Lonstein JE, Morin MM, et al. Breast cancer in women with scoliosis exposed to multiple diagnostic X-rays[J]. J Nat1 Cancer Inst,1989, 81(17):1307-1312.
[74]Morin DM, Lonstein JE, Stovall M, et al. Breast cancer mortality after diagnostic radiography:findings from the U.S. Scoliosis Cohort Study [J]. Spine,2000,25(16):2052 2063.
[75]Clemons M, Loijens L, Goss P. Breast cancer risk following irradiation for Hodgkin's Disease [J]. Cancer Treat Rev,2000,26(4):291 302.
[76]Sankaranarayanan R, Swaminathan R, Brenner H, et al. Cancer survival in Africa, Asia, and Central America:a population-based study [J]. Lancet Oncology. Feb 2010,11 (2); 165-1723.
[77]Huang CS, Lin CH, Lu YS, Shen CY. Unique features of breast cancer in Asian women—Breast cancer in Taiwan as an example [J]. Journal of Steroid Biochemistry & Molecular Biology,2010,118 (4/5); 300-303.
[78]饶南燕.中国汉族乳腺癌人群BRCA基因的研究.复旦大学博士论文,2008.
[79]千新来,孟勇,常海敏.HPV16E6蛋白阳性和阴性乳癌组织中p53基因检测[J].郑州大学学报(医学版),2009,44(4)：720-723.
[80]ChakrabartiO, Krishna S. Molecular interactions of/high risk human papillomaviruses E6 and E7 oncoproteins:implications for tumour progression [J]. J Biosci,2003,28(3):337.
[81]Zur Hausen H. Papillomaviruses and cancer from basic studies to clinical application[J]. Nat Rev Cancer,2002,7222(5):342.
[82]Tungteakkhun SS, Duerksen-Hughes PJ. Cellular binding partners of the human papillomavirus E6 protein[J]. Arch Virol,2008,153(3):397.
[83]Narisawa-SaitoM, Kiyono T. Basic mechanisms of high-risk human papillomavirus induced carcinogenesis:roles of E6 and E7 proteins [J]. Cancer Sci,2007,98(10):1505.
[84]千新来,赵杰,张钢,等.HPV16 DNA阳性乳腺良、恶性病变组织中E6和E7蛋白的表达[J].郑州大学学报：医学版,2009,44(4)：717.
[85]Soussi T. p53 alterations in human cancer:more questions than answers [J]. Oncogene,2007,26(15):2145.
[86]Fuster JJ, Sanz-Gonzalez SM, MollUM, et al. Classic and novel roles of p53:prospects for anticancer therapy [J]. Trends Mol Med,2007,13(5):192.
[87]BouletG, Horvath C, Vanden Broeck D, et al. Human papillomavirus:E6 and E7 oncogenes [J]. Int J Biochem CellBio,2007,39(11):2-6.
[88]HillerT, Stubenrauch F, IftnerT. Isolation and functional analysis of five HPVE6 Variants with respect to p53 degradation[J]. J Med Viro,12008,80(3): 478.
[89]WiestT, Schwarz E, Enders C, et al. Involvement of intact HPV16 E6/E7 gene expression in head and neck cancers with unaltered p53 status and perturbed pRb cell cyclecontrol[J]. Oncogene,2002,21(10):1510.
[90]李向阳,张伟宏.乳癌组织中PTEN的表达[J].郑州大学学报(医学版).2005,40(6)：1112-1114
[91]Steck PA, Pershouse MA, Jasser SA, et al. Identification of a candidatate tumor suppressor gene, MMAC1, at chromosome 10q23.3 that is mutated inmultiple advanced cancer[J]. Nat Genet,1997,15(4):356.
[92]王玉岳.PTEN研究的新进展.国外医学分子生物学分册,2003,25(3)：150.
[93]Li J,Yen C, Liaw D, et al. PTEN, a putative protein tyrosine phosphatase gene mutated in human brain, breast and prostate cancer[J]. Science,1997, 275(5308):19-43.
[94]Li Y, Podsvpanina K, Liu X, et al. Deficiency of PTEN accelerate mammary oncogenesis in MMTV-Wnt-1 transgenicmice[J]. BMC Mol Biol,2001,2(1):2.
[95]Perren A, Weng LP, Boag AH, et al. Immuohistochemical evidence of loss of PTEN expression in primary ductualadenocarcinoma of the breast [J]. Am J Pathol,1999,155(4):12-53.
[96]Starnbolic V, Tsao MS, Macpherson D, et al. High incidence of breast and endometrial neoplasia resembling human cowdlen syndrome in PTEN+/-mice [J]. CancerRes,2000,60(13):3 605
[97]Sano T, Lin H, Chen X, et al. Differential expression of MMAC1/PTEN in glioblastoma multiforme; relationship to localization and prognosis [J]. Cancer Res,1999,59(8):18-20.
[98.1王知力,郭双平,王文亮.PTEN基因的研究进展.临床与实验病理学杂志[J]2001,17(4)： 339.
[99]甄乐锋,叶长生,刘民锋等.青年乳腺癌中ER、PR、HER-2及VEGF表达及其临床病理学意义[J].广东医学,2010,31(4)：490-492.
[100]韩晶,王培军,汤如勇,等.雌激素受体亚型在不同乳腺组织中的表达及其与乳腺癌关系的研究[J].同济大学学报：医学版,2005,26(5)：21-24.
[101]VRBANEC D, PETRICEVIC B. Estrogen and progesterone receptor status in Primary breast cancer-a study ofll 273 patients from the year1990 to 2002[J]. Coll Antropol,2007,31(2):535-540.
[102]薄爱华,芦广萍,闫爱春,等.EGFR和VEGF在乳腺癌中表达的临床意义[J].中国肿瘤临床,2007,34(23)：1324-1326.
[1 O 3]李宝江,朱志华,王军业,等.Ki 67、P53、VEGF和CerbB-2在乳腺癌组织中表达的相关性研究及其临床意义[J].癌症,2004,23(10)：1176-1179.
[104]GONG S J, RHA SY, JEUNGH C, et al. Bilateral breast cancer:differential diagnosis using histological and biological parameters [J]. Jpn J Clin Oncol, 2007,37(7):487-492.
[105]KROGER N, MILDE LANGOSCH K. Prognostic and predictive effects of Immune histochemical factors in high-risk primary breast Cancer patients[J]. Clin Cancer Res,2006,12(1):159-168.
[106]ALAHWALM S. HER-2 positivity and correlations with other histopathologic features in breast cancer patients-hospital based study [J]. J Pak Med Assoc, 2006,56 (2):65-68.
[107]FOLKMAN J. Angiogenesis [J]. Annu Rev Med,2006,57:1-18.
[108]Kruk J, Aboul-Enein HY. Psychological stress and the risk of breast cancer:a case control study[J]. Cancer Detection and Prevention,2004, 28 (6):399-408.
[109]Sanna V, Fancellu A, Sotgiu MI, Contu M, et al.84 Psychological distress in breast cancer patients:depression, anxiety and post-traumatic stress disorder in different phases of the disease[J]. European Journal of Cancer Supplements,2010,8 (3):83.
[110]Larsen BS, Vogel U, Christensen J, Hansen RD, et al. Interaction between ADH1C Arg272Gln and alcohol intake in relation to breast cancer risk suggests that ethanol is the causal factor in alcohol related breast cancer[J]. Cancer Letters, In Press, Corrected Proof, Available online 29 March 2010.
[111]Stark A, Schultz D, Kapke A, Nadkarni P, et al. The Journal of Cancer Surgery,2009,35:928-935.
[112]Taioli E, Barone J, Wynder EL. A case-control study on breast cancer and body mass[J]. European Journal of Cancer,1995,31(5):723-728.
[113]Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve[J]. Radiology,1982,143:29-36.
[114]张丽萍,许良中.应用聚合酶链反应技术检测乳腺肿瘤中EB病毒整合[J].中国癌症杂志,1997,7(2)：79-81.
[115]Fina F, Romain S, Ouaf ik L, et al. Frequency and genome load of Epstein-Barr virus in 509 breast cancers from different geographical areas [J]. Br J Cancer, 2001,84 (6):783-790.
[116]Chu PG, Chang KL, Chen YY, et al. No significant association of Epstein-Barr virus infection with invasive breast carcinoma [J]. Am J Pathol,2001,159 (2):571-578.
[117]李淑英,李冀,胡金华,等.乳腺癌患者癌组织中EB病毒感染基因产物的研究[J].中国妇幼保健,2008,23(1)：87-88.
[118]Bonnet M, Guinebretiere JM, Kremmer E, et al. Detection of Epstein-Barr virus in invas ive breast cancers[J]. J Natl Cancer Inst,1999,91(16):1376-1381.
[119]Preciado MV, Chabay PA, De Matteo EN, et al. Epstein-Barr virus in breast carcinoma in Argentina [J]. Arch Pathol Lab Med,2005,129 (3):377-381.
[120]Z 杨文涛,许良中.102例乳腺癌中的EB病毒感染[J].上海医科大学学报,1998,25(3)：175-178.
[121]Trabelsi A, Rammeh S, Stita W, et al. Detection of Epstein-Barr virus in breast cancers with lymphoid stroma [J]. Ann Biol Clin (Paris),2008,66 (1):59-62.
[122]Thorne LB, Ryan JL, Elmore SH, et al. Real-time PCR measures Epstein-Barr virus DNA in archival breast adenocarcinomas [J]. Diagn Mol Pathol,2005, 14 (1):29-33.
[123]胡维维,宗永生,李凤萍,等.六种抗EB病毒抗体检测在鼻咽癌血清学诊断中 的比较[J].中国肿瘤临床,2006,33(14)：795-798.
[124]Hines SL, Jorn HKS, Thompson KM, et al. Breast cancer survivors and vitamin D [J]:A review. Nutrition,2010,26 (3):255-262
[125]Kruk J. Lifetime physical activity and the risk of breast cancer:A case control study [J]. Cancer Detection and Prevention 2007,31(1); 18-28.
[126]Alcohol, tobacco and breast cancer:collaborative reanalysis of individual data from 53 epidemiological studies, including 58,515 women with breast cancer and 95,067 women without the disease [J]. British Journal of Cancer,2002; 87:1234 45.
[127]Gammon MD, Eng SM, Teitelbaum SL, et al. Environmental tobacco smoke and breast cancer incidence [J]. Environmental Research,2004,96 (2):176-185.
[128]Ambrosone CB, Abrams SM, Roberts KG, et al. Hair dye use, meat intake, and tobacco exposure and presence of carcinogen-DNA adducts in exfoliated breast ductal epithelial cells [J]. Archives of Biochemistry and Biophysics, 2007,464(2):169-175.
[129]Darbre PD. Environmental oestrogens, cosmetics and breast cancer [J]. Best Practice & Research Clinical Endocrinology & Metabolism,2006,20 (1); 121-143.
[130]Fernandez MF, Santa-Marina L, Ibarluzea JM, et al. Analysis of population characteristics related to the total effective xenoestrogen burden:A biomarker of xenoestrogen exposure in breast cancer [J]. European Journal of Cancer,2007,43 (8); 1290-1299.
[131]Landau-Ossondo M, Rabia N, Jos-Pelage J, et al. Why pesticides could be a common cause of prostate and breast cancers in the French Caribbean Island, Martinique. An overview on key mechanisms of pesticide-induced cancer [J] Biomedicine & Pharmacotherapy,2009,63 (6); 383-395.
[132]常永丽,杨秋霞,李君.有机氯农药及谷胱甘肽转移酶M1基因多态性与乳腺癌关系的研究[J].环境与健康杂志,2009,26(12)：1104-1107.
[133]荣素英,李君,牛风玲,等.唐山地区女性乳腺癌环境危险因素的病例对照研究[J].环境与职业医学,2007,24(1)：5-8.
[134]邹其嘉,王子平,陈非比,等.唐山地震灾区社会恢复与社会问题研究(M]北京：地震出版社,1997：398-401.
[135]Minh TB, Watanabe M, Tanabe S, et al. Specific accumulation and elimination kinetics of tris (4-chlorophenyl)metnane, tris (4-chlorophenyl) methnol, and other persistent organochlor ines in humans from Japan [J]. Environ Health Perspect,2001,109:927-935.
[136]Demers A, Ayotte P,Brisson J, et al. Risk and aggressiveness of breast cancer in relation to plasma organochlorine concentrations[J]. Cancer Epidemiol Biomarkers Prev,2000,9:161-166.
[137]Isabelle R, Mauricio HA, Eduardo LP, et al. Breast cancer, lactation history, and serum organochlorines [J].American Journal of Epidemiology,2000,152: 363-370.
[138]Charlier C, Albert A, Herman P, et al. Breast cancer and serumorganochlorine residues [J]. OccupEnvironMed,2003,60:348-351.
[139]华小梅,单正军.我国农药生产、使用状况及影响因子分析[J].环境科学进展,1996,4(2)：33-45.
[140]Halpin, SFS. Medico-legal claims against English radiologists: 1995-2006[J]. British Journal of Radiology,2009,82 (984);982-988.
[141]Mathis KL, Hoskin TL, Boughey JC, et al. Palpable Presentation of Breast Cancer Persists in the Era of Screening Mammography [J]. Journal of the American College of Surgeons,2010,210 (3); 314-318.
[142]Bruening W, Fontanarosa J, Tipton K, et al. Systematic Review: Comparative Effectiveness of Core-Needle and Open Surgical Biopsy to Diagnose Breast Lesions[J]. Ann Intern Med,2010,152; 238-246.
[143]李素侠,任萍.细针抽吸细胞学检查早期诊断乳癌的价值.现代肿瘤医学,2008,16(6)；963-964.
[144]Dominguez FJ, GolshanM, Black DM, et al. Sentinel node biopsy is important In mastectomy for ductal carcinoma in situ[J]. Ann Surg Oncol,2008,15(1): 268-273.
[145]Goyal A, Newcombe RG, Chhabra A, et al. Factors affecting failed localization and False negative rates of sentinel node biopsy in breast cancer results of the ALMANAC validation phase [J]. Breast Cancer Res Treat,2006, 99(2):203-208.
[146]吕大鹏,郭怡晖,段志军等.Isosulfan示踪乳腺癌前哨淋巴结活检术[J].山东医药,2010,50(10)：12-14.
[147]Krag DN, Anderson SJ, Julian TB, et al. Technical outcomes of sentinel lymph node resection and conventional auxiliary lymph node dissection in patients with clinically node-negative breast cancer:results from the NSABP B232 randomized phase III trial [J]. Lancet Oncol,2007,8(10):881-888.
[148]张静,王培军,袁小东,等.钼靶、磁共振及核素显像诊断乳腺癌准确性的Meta 分析[J].第二军医大学学报,2007,28(10)；1098-1103.
[149]翟景花,高丹凝,庞达,等.乳头抽吸液中癌胚抗原与乳腺癌的关系[J].疾病控制杂志,2007,11(2)；164-167.
[150]邬玉辉,陈飞宇,欧阳慧英,等.不可触及肿物乳腺癌的临床诊断[J]中南大学学报,2008,33(9)；861-864.
[151]杜燕萍,陆建平.高频超声和钼靶x线摄片对小乳癌的诊断价值[J].中国医师杂志,2009,11(8)；1118一1119.
[152]李兴慧,陈赛华,杨爱建,等.早期乳腺癌诊断的临床分析[J].现代肿瘤医学,2009,17(12)；2333-2334.
[153]谢丽珍,杨建勇,陈晓兰,等.超声诊断早期乳腺癌的价值分析[J].中国妇幼保健,2010,25(1)：119-120.
[154]杨光华.病理学第5版,北京：人民卫生出版社,2004：306.
[155]丛新丽,李树祝.乳腺癌的影像诊断现状与进展[J].医学影像学杂志,2003,13(8)： 602.
[156]赵汉学.乳腺导管内原位癌和内癌微小浸润的声像图表现及其病理基础[J].中国超声医学杂志,2007,23(4)：301.
[157]吴秀花1乳腺浸润性导管癌的高频彩色多普勒超声诊断分析[J].中国超声医学杂志,2006,7(12)：910.
[158]何萍霞,张玉花,杨立国,等.胸部CT扫描诊断乳腺疾病的应用价值.中国医疗器械信息,2009,15(5)；40-43.
[159]陈建伟,王杰,刘标,等.PETCT与胸部诊断CT在乳腺癌术后随访中的比较[J].南京医科大学学报(自然科学版),2010,30(2)：195-198.
[160]S Eubank WB, Mankoff DA. Evolving role of positron emission tomography in breast cancer imaging [J]. Semin Nucl Med,2005,35 (2):84-99.
[161]李雪娜,尹雅芙,李亚明,等.18F-FDG PET/CT不同诊断方法对乳腺癌及其淋巴结转移的应用价值[J].中华核医学杂志,2008,28(4)：244-249.
[162]Lavayssiere R, Cab e e AE, Filmont JE. Positron emission tomography (PET) and breast cancer in clinical practice [J]. Eur J Radiol,2009,69 (1):50-58.
[163]Kuru B, Camlibel M, Dine S, et al. Prognostic factors for survival in breast cancer patients who developed distant metastasis subsequent to definitive surgery [J]. Singapore Med J,2008,49 (11):904-911.
[164]Eubank WB, Mankoff DA, Takasugi J, et al.18F-fluo-rodeoxyglucose positron emission tomography to detect mediastinal or internal mammary metastases in breast cancer [J]. J Clin Oncol,2001,19 (15):3516-3523.
[165]Groheux D, Moretti JL, Baillet G, et al. Effect of 18F-FDG PET/CT imaging in patients with clinical stage Ⅱ and Ⅲ breast cancer [J]. Int J Radiat Oncol Biol Phys,2008,71 (3):695-704.
[166]Weir L, Worsley D, Bernstein V. The value of FDG positron emission tomography in the management of patients with breast cancer [J]. Breast J, 2005,11 (3):204-209.
[167]Fuster D, Duch J, Paredes P, et al. Preoperative staging of large primary breast cancer with 18F-fluorodeoxyglucose positron emission tomography/ computed tomography compared with conventional imaging procedures [J]. J Clin Oncol,2008,26 (29):4746-4751.
[168]Heusner TA, Kuemmel S, Umutlu L, et al. Breast cancer staging in a single session:whole-body PET/CT mammog-raphy[J]. J Nucl Med,2008,49(8):1215-1222.
[169]Lim HS,Yoon W, Chung TW, et al. FDG PET/CT for the detection and evaluation of breast diseases:usefulness and limitations [J].Radiographics,2007,27 (Suppl 1):S197-213.
[170]Nakai T, OkuyamaC, Kubota T, et al. Pitfalls of FDG-PET for the diagnosis of osteoblastic bone metastases in patients with breast cancer [J]. Eur J Nucl Med Mol Imaging,2005,32(11):1253-1258.
[171]Du Y, Cullum 1, Illidge TM, et al. Fusion of metabolic function and morphology:sequential 18F-fluorodeoxyglucose positron-emission tomography /computed tomography studies yield new insights into the natural history of bone metastases in breast cancer [J]. J Clin Oncol,2007,25(23):3440-3447.
[172]McCall SA, Lichy JH, Bijwaard KE, et al. Epstein-Barr virus detection in ductal carcinoma of the breast [J]. J Natl Cancer Inst,2001,93(2):148-150.
[173]陈智周,范振符,杨剑,等.肿瘤标志物CAl53的免疫放射分析及其临床应用[J].中华肿瘤杂志,1998,20(2)：125-127.
[174]Wojtacki J, Kruszewski WJ, Sliwiska M, et al. Elevation of serum Ca15-3 antigen:an early indicator of distant metastasis from breast cancer. Retrospective analysis of 733 cases [J].Przegl Lek,2001.58 (6):4981.
[175]赵惠柳,黄玲莎,朱波.CYFRA21-1、CA153联合检测对乳腺癌的诊断意义.海南医学,2005,16(12)：143-144.
[176]陆云飞,向俾庭,曾健,等.血清TSGF、CA153、CA125及CEA联合检测对乳腺癌的诊断价值[J].广西医科大学学报,2006,23(2)：173-175.
[177]陶冀,游廉,王锡山.乳腺癌肿瘤标志物CEA、CA153表达水平的临床意义[J].中国肿瘤临床,2005,32(13)：751-754.
[178]Bodenmuller H. Technical evaluation of a new automated tumor marker assay: the enzymum-test CYFRA21-1. In Hapdor R.Tumor associated antigens, oncogene receptors cytokines in tumor diagnosis and therapy at the beginning of the 90ths [M]. Zuckschwenlt:Verlag,1992.137-147.
[179]DohmotoK, Hojo S, Fujita J, et al. Mechanisms of the release of CYFRA21-1 in the human lung cancer cell lines [J].Lung Cancer,2000,30 (1):55.
[180]Sheard MA, Vojtesek B, Simickova M, et al. Release of cytokeratin-18 and 19 fragments (TPS and CYFRA21-1) into the extra-cellular space during apoptosis [J]. J Cell Biochem,2002,85 (4):670.
[181]顾怡生,肖必文,蔡菊芬.恶性肿瘤病人血清细胞角蛋白19片段等四联检结果分析[J].放射免疫学杂志,2002,15(5)：272-275.
[182]赵惠柳,黄文成,黄昭东,等.肿瘤标志物CYFRA21-1诊断鼻咽癌的临床价值研究[J].现代肿瘤医学,2004,12(4)：225-226.
[183]孟冬娅,胡晓芳,高洪福,等.检测血清VEGF, CEA, TSGF在肿瘤中的临床意义[J].中国现代医学杂志,2004,14(1)：117-118.
[184]王英,黄文成,朱波,等.CYFRA21-1、CA153和TSGF联合检测对乳腺癌诊断的临床意义[J].中国现代医学杂志,2006,16(20)：3104-3106.
[185]周剑波,纪成斌,唐琳,等.化学发光免疫分析联合检测四项肿瘤标记物及其临床应用[J].右江医学,1999,27(3)：151-152.
[186]Singletary SE, Connolly JL. Breast Cancer Staging:Working With the Sixth Edition of the AJCC Cancer Staging Manual [J]. Cancer Journal for Clinicians, 2006,56:37-47.
[187]季兴.中医治疗乳腺增生病的进展[J].河北中医.2004,26(7)；549-551
[188]徐英纳,张福忠.乳腺增生病中医治疗进展.中医药临床杂志2004,16(6)：605-607.
[189]李静惠,韩国晖,午巧焕.乳腺癌手术177例的困惑与思考[J].中外医学研究.2009,10(7)：48.
[190]张全霞,杜卫萍,殷丽红,等.中医疗法治疗乳腺增生119例临床观察[J].山东医药,2007,47(22)：97.
[191]鲁平.乳康宁方治疗乳癌化疗骨髓抑制56例[J].光明中医.2003,6；41-42.
[192]王进才.针刺乳根穴治疗乳腺增生120例[J].中医杂志.2001,42(8)；505-506.
[193]刘永霞.也谈幽门螺杆菌与胃外疾病[J].中华内科杂志,2001,40(1)：53-54.
[194]曾慧玲,唐汉钧.唐汉钧.运用健脾益气法经验[J].中医文献杂,2008,6：37-39.
[195]贾喜花,唐汉钧.唐汉钧.调治乳腺癌术后的经验[J].中西医结合报,2005,3(3).
[196]李琳,宋爱莉.乳癌根治术后对侧乳房肿块的中西医结合诊治[J].山东中医药 大学学报,2002,26(3)：177-178.
[197]朱兵,李宁生,余正,李和生,等.耳穴电信息反应早期癌病变的特异性[J].南京大学学报,1995,31(1)：39-44.
[198]朱兵,陈巩荪,许瑞征,等.耳穴的电学特性及其特异性[J].中国针灸,2001,21(12)：731-734.
[199]仲远明,俞明,胡智慧,等.耳穴电特性反应胃癌病变的特异性研究[J].江苏中医,2001,22(12)：43.
[200]邢剑秋,胡智慧,俞明,等.耳穴电特性反应肝癌病变特异性的实验研究[J].江苏中医,2000,21(12)：52-53.
[201]俞明,徐定,朱兵,等.耳穴电特性反应食道癌病变的特异性[J].南京中医药大学学报,2002,11(18)：357-359.
[202]刘世佩,石翠英.耳穴诊断食管癌146例临床观察[J].安徽中医学院学报,1990,9(3)：43-44.
[203]李海斌,保燕,奎宏,余庆鹤.耳廓结节在肺肿瘤诊断中的应用[J].云南中医学院学报,2000,12(4)：51-52.
[204]彭正顺,陈昱宇.肝恶性肿瘤患者体表信息临床分析[J].现代诊断与医疗,1992,3(2)：141-143.
[205]时景璞.临床研究中样本量的估计方法[J].中国临床康复,2003,7(10))：1569-1571.
[206]张学中,谭学瑞,潘红星.临床试验所需样本量之管见[J].世界华人消化杂志,2006,14(14)：1339-1340.
[207]NSCHULZ K. THE LANCET临床研究导论[M].台湾爱思唯尔有限公司出版,2008,55-67.
[208]齐元富.肿瘤的几个中医新体征[J].山东中医药大学学报,2002,26(4)：262-264.
[209]彭清华.耳诊研究进展(一) [J].山东中医学院学报,1989,13(2)：53-54.
[210]巴元明,高清平.耳诊在肿瘤诊断中的应用进展[J].湖北中医杂志,1995,2：71-73.
[211]彭正顺,陈昱宇.肝恶性肿瘤患者体表信息临床分析[J].现代诊断与医疗,1992,3(2)：141-143.
[212]陈树楷.感染幽门螺旋杆菌患者耳廓辅助诊断的研究.北京中医药大学博士论文,2010年.
[213]Beam CA, Sullian DC, Layde PM. Effect of human variability on independent double reading in screening mammography[J]. Acad Radial,1996,3:891-897.
[214]Madeleine MA Tilanus-Linthorst, Mieke Kriege, Carla Boetes, et al. Hereditary breast cancer growth rates and its impact onscreening policy [J]. European Journal of Cancer,2005,41:1610-1617.
[215]Nickerson, RS. Null hypothesis significance testing:A review of an old and continuing controversy. Psychological Methods [J],2000,5:241-301.
[2]Ahmedin J, Rebecca S, Elizabeth W, et al. Cancer statistics,2008 CA [J]. Cancer J Clin,2008,58 (2):71-96.
[3]Carol S, Ahmedin J, Elizabeth W, et al. Trends in Breast Cancer by Race and Ethnicity:Update 2006 [J]. CA Cancer J Clin,2006,56 (3):168-183.
[4]Lei F, Ying Zh, KeDa Y, et al. Breast cancer in a transitional society over 18 years:trends and present status in Shanghai, China [J]. Breast Cancer Res Treat,2009.
[5]Ferlay J, Bray F, Pisani P, Parkin D M. GLOBOCAN 2002:cancer incidence, mortality and prevalence worldwide. IARC Cancer Base No 5. version 2.0. Lyon: IARC Press,2004.
[6]林永望.乳癌的诊治[J].中国普通外科杂志,2002,11(6)：321-323.
[7]Tilanus-Linthorst MMA, Kriege M, Boetes C, et al. Hereditary breast cancer growth rates and its impact on screening policy [J]. European Journal of Cancer, 2005,41:1610-1617.
[8]Cox CL, Oeff inger KC, Montgomery M, et al. Determinants of Mammography Screening Participation in Adult Childhood Cancer Survivors:Results From the Childhood Cancer Survivor Study [J]. Oncology Nursing Forum,2009, 36(3); 335-344.
[9]Aksnes LH, Bruland OS. Some musculo-skeletal sequelae in cancer survivors [J]. Acta Oncologica,2007,46; 490-496.
[1 O]张颖清.全息生物学[M].北京,高等教育出版社.1989.
[11]曹宁芳.生物全息律与中医望诊[J].陕西中医,2001,22(11)：676-677.
[12]蔡彦,揭西娜.刍议《内经》与《周易》同源性[J].中华中医药学刊,2008,26(2)：350-351.
[13]邱幸凡,张六通,王海燕.“内经》全息论思想及临床应用.[J].湖北中医杂志,2004.26(5)：1-4.
[14]华兴邦.耳穴诊治发展的思考[J].上海针灸杂志,1998,17(6)；1.
[15]张诗兴,姜文方.耳穴定位与神经、血管分布的研究[J].南京中医药大学学报,1998.14(4)：228-229.
[16]张诗兴,周坤福,姜文方,等.耳穴的脑、脊神经节投射[J].上海针灸杂志,2002,21(3)：35-36.
[17]张诗兴,徐恒泽,姜文.耳廓神经支配及其与耳穴定位的关系[J].南京铁道医学院学报,1998,17(4)：235-237.
[18]张启兵,张诗兴.耳针调节内脏功能的作用机制研究[J].广东药学院学报,2005,21(3)： 330-33.
[19]朱兵,陈巩荪,许瑞征.耳郭穴位电学特性的研究[J].中国针灸,1999,6：355-358.
[20]朱兵,张骏,李宁,等.耳穴电位反应病变的特异性[J].南京大学学报,1999,35(2)：236-239.
[21]高洁,石晓东,王嘉赋,等.线性模型识别多元耳穴电信息[J].生物医学工程学杂志,2000,17(3)：316-319.
[22]胡智慧,沈友轩,蔡念,等.耳穴特异性与生物分子活性的关系[J].南京中医药大学学报,2001,17(1)：39-42.
[23]刘维洲,许冠荪,张群群,等.耳廓神经支配与耳针对胃肠电活动影响的察[J].针刺研究,1990,8：187-188.
[24]陆新华.耳廓电测定临床诊断观察[J].上海针灸杂志,1997,16(5)；27.
[25]叶本法,徐耀初,周玲,等.耳诊食管、胃部疾患的筛选试验及其对粘膜病变特征的流行病学研究[J].江苏预防医学,1995,4；3-5.
[26]张建斌,冯向先.乳腺癌危险因素的Meta分析[J].中国卫生统计,2002,19(3)：168-170.
[27]Mayberry RM, Branch PT.Breast Cancer risk factors among hispannic women [J]. Ethn Dis,1994,4, (1):41.
[28]袁剑敏,高玉堂.乳腺癌的危险因素与绝经状态的关系[J].肿瘤杂志,1991,11(5)：199-202.
[29]武光林,齐秀英.生育及有关因素与乳腺癌的病例对照研究[J].天津医药,1993,21(13)：673-677
[30]American Cancer Society. Probability of developing invasive cancer over selected age intervals, by sex, US,1999 2001.www.cancer.org,2005
[31]钟颖,孙强,徐雅莉.30年收治乳腺癌的发病趋势[J].中国普通外科杂志,2009,18(11)：1111-1115.
[32]Ries LAG, Eisner MP, Kosary CL, et al. SEER Cancer Statistics Review,1975-2002. Bethesda, MD:National Cancer Institute,2005. (Accessed September 15, 2006, at http://seer.cancer.gov/csr/1975_2002/).
[33]Fremgen AM, Bland KI, McGinnis LS, et al. Clinical high lights from the National Cancer Data Base[J]. CA Cancer J Clin,1999,49 (1):145-158.
[34]Colleoni M, Rotmensz N, Robertson C, et al. Very young women (<
35 years) with operable breast cancer:features of disease at presentation [J]. Ann Oncol,2002,13(2):273-279.
[35]Ries LAG, Eisner MP, Kosary CL, et al. SEER Cancer Statistics Review, 1973-1999 Bethesda, MD [R]. National Cancer Institute,2002:14-15.
[36]Holli K, Isola J. Effect of age on the survival of breast cancer patients [J]. Eur J Cancer,1997,33 (3):425-428.
[37]Korea Central Cancer Registry, Ministry of Health and Welfare, Republic of Korea 2002 Annual Report of the Korea Central Cancer Registry Seoul, Korea [R]. Korea Central Cancer Registry,2003:4-5.
[38]孟洁,郎荣刚,范宇,等.年轻乳腺癌患者的病理学和生物学特征及其与预后的关系[J].中华肿瘤杂志,2007,29(4)：284-288.
[39]高标,余建军,梁国良,等.青年乳腺癌71例的临床分析[J].中华普通外科杂志,2002,17(11)：684-685.
[40]杨桦,王思愚,区伟.华南地区年轻乳腺癌患者预后因素分析[J].癌症,2009,28(12)：1310-1316.
[41]张俊清,吴艳乔,张敏.月经生育因素与乳腺癌关系的Meta分析[J].现代预防医学.2010,37(7)：1262-1264.
[42]王启俊,李玲,祝伟星,等.北京市乳腺癌危险因素病例对照研究[J].中国慢性病预防与控制,2000,8(4)：165-167.
[43]李泓澜,高立峰,杨工,等.月经生育因素与女性乳腺癌关系的病例对照研究[J].肿瘤,2000,20(2)：88-92.
[44]史习舜,吴彬,胡志坚,等.福州市妇女乳腺癌危险因素的病例对照研究[J].海峡预防医学杂志,2000,6(5)：12-14.
[45]曹卡加,吴一龙,马国胜,等.广州市乳腺癌危险因素的病例对照研究[J].中国肿瘤,2001,10(12)：702-704.
[46]蔺新英,徐贵发,徐虹,等.济南市女性乳腺癌危险因素的病例对照研究[J]山东医科大学学报,2001,39(6)：552-553.
[47]闸远萍.女性乳腺癌患病危险因素的病例对照研究[J].实用医学杂志,2001,17(7)： 646.
[48]林毅,唐汉钧.现代中医乳房病学[M].人民卫生出版社,2008,3-12.
[49]张秀娟,王雪梅,戴红梅.乳腺癌与人工流产相关关系的调查[J].中国初级卫生保健,2001,15(4)：59.
[50]邹练,田建荣.青山地区女性乳腺癌危险因素的病例对照研究[J].全国肿瘤护理学术交流暨专题讲座会议论文汇编,2003,8：56-59
[51]袁宝君,戴月,史祖民,等.妇女乳腺癌危险因素病例对照研究[J].中国公共卫 生,2004,20(9)：1036.
[52]韩定芬,马骏,周新.武汉地区女性乳腺癌危险因素的病例对照研究[J].中华流行病学杂志,2004,25(3)：256-260.
[53]李雪莲,何苗,许志远.女性乳腺癌危险因素的病例对照研究[J].疾病控制杂志,2006,2(10)：8-11.
[54]李双飞,李佳圆,雷放鸣.乳腺癌危险因素的病例对照研究[J].现代预防医学,2006,33(12)：2233-2235.
[55]黄向明,王春霞,周永生.深圳市宝安区女性乳腺癌发病危险因素的初步调查[J].中原医刊,2006,33(22)：37-39.
[56]翟祥军,王水,秦建伟,等.月经、生殖因素与乳腺癌关系的病例对照研究[J]疾病控制杂志,2006,10(2)：109-113.
[57]朱留华,李秀芒.郑州市女性乳腺癌危险因素的病例对照研究[J].中国基层医药,2006,13(4)：679-680.
[58]荣素英,李君,牛风玲,等.唐山地区女性乳腺癌环境危险因素的病例对照研究[J].环境与职业医学,2007,24(1)：5-8.
[59]聂建云,金丛国,唐一吟,等.云南省妇女乳腺癌危险因子初步研究[J].实用癌症杂志,2008,23(3)：269-272.
[60]刘继永,沈洪兵,靳光付,等.江苏地区乳腺癌危险因素的病例对照研究[J].南京医科大学学报,2008,28(5)：689-692.
[61]林杰,虞建锋.慈溪市女性乳腺癌危险因素病例对照研究[J].浙江预防医学,2008,20(6)：3-5.
[62]周亮,贺天锋,靳雅丽,等.女性乳腺癌危险因素的病例对照研究[J].中国肿瘤,2009,18(1)：27-30.
[63]陶旻枫,丁辉,刘丽,等.北京地区乳腺癌危险因素分析[J].解放军医学杂志2009,34(5)：605-607.
[64]Dumitrescu RG, Cotarla I. Understanding breast cancer risk-where do we stand in 2005 [J]. J Cell Mol Med,2005,9(1):208-221.
[65]Henderson BE, Pike MC, Bernstern L, et al. Breast cancer(C). IN:Schottenfeld D, Fraumeni JF, eds. Cancer Epidemiology and Prevention [M].2nd ed. New York: Oxford University Press,1996,1022.
[66]Nagata C. Hu YH. Shimizu H. Effects of menstrual and reproductive factors on the risk of breast cancer:meta-analysis of the case-control studies in Japan [J]. Japanese Journal of Cancer Research,1995,86 (10):910-915.
[67]Eisen A. Rebbeck TR. Prophylactic surgery in women with a hereditary predisposition to breast and ovarian cancer [J]. Journal of Clinical Oncology, 2000,18 (9):1980-1995.
[68]Nagata C. Hu YH. Shimizu H. Effects of menstrual and reproductive factors on the risk of breast cancer:meta-analysis of the case-control studies in Japan [J]. Japanese Journal of Cancer Research,1995,86 (10):910-915.
[69]Chavez Mac Gregor M. Elias SG. Postmenopausal breast cancer risk and cumulative number of menstrual cycles[J].Cancer Epidemiology, Biomarkers &Prevention,2005,14 (4):799-804.
[70]Collaborative Group on Hormonal Factors in breast cancer. Breast cancer and hormonal contraceptive:collaborative reanalysis of individual date on 53297 women with breast cancer and 100239 women without breast cancer from 54 epidemiological studies [J]. Lancet,1996,347:1713-1727.
[71]Carmichael A, Sami AS, Dixon JM. Breast cancer risk among the survivors of atomic bomb and patients exposed to therapeutic ionising radiation[J]. European Journal of Surgical Oncology,2003,29(5):475-479.
[72]Miller A, Howe G, Sherman G. Mortality from breast cancer after irradiation of the thymus in infancy[J]. N Engl J Med 1989,321:146.
[73]Hoffman DA, Lonstein JE, Morin MM, et al. Breast cancer in women with scoliosis exposed to multiple diagnostic X-rays[J]. J Nat1 Cancer Inst,1989, 81(17):1307-1312.
[74]Morin DM, Lonstein JE, Stovall M, et al. Breast cancer mortality after diagnostic radiography:findings from the U.S. Scoliosis Cohort Study [J]. Spine,2000,25(16):2052 2063.
[75]Clemons M, Loijens L, Goss P. Breast cancer risk following irradiation for Hodgkin's Disease [J]. Cancer Treat Rev,2000,26(4):291 302.
[76]Sankaranarayanan R, Swaminathan R, Brenner H, et al. Cancer survival in Africa, Asia, and Central America:a population-based study [J]. Lancet Oncology. Feb 2010,11 (2); 165-1723.
[77]Huang CS, Lin CH, Lu YS, Shen CY. Unique features of breast cancer in Asian women—Breast cancer in Taiwan as an example [J]. Journal of Steroid Biochemistry & Molecular Biology,2010,118 (4/5); 300-303.
[78]饶南燕.中国汉族乳腺癌人群BRCA基因的研究.复旦大学博士论文,2008.
[79]千新来,孟勇,常海敏.HPV16E6蛋白阳性和阴性乳癌组织中p53基因检测[J].郑州大学学报(医学版),2009,44(4)：720-723.
[80]ChakrabartiO, Krishna S. Molecular interactions of/high risk human papillomaviruses E6 and E7 oncoproteins:implications for tumour progression [J]. J Biosci,2003,28(3):337.
[81]Zur Hausen H. Papillomaviruses and cancer from basic studies to clinical application[J]. Nat Rev Cancer,2002,7222(5):342.
[82]Tungteakkhun SS, Duerksen-Hughes PJ. Cellular binding partners of the human papillomavirus E6 protein[J]. Arch Virol,2008,153(3):397.
[83]Narisawa-SaitoM, Kiyono T. Basic mechanisms of high-risk human papillomavirus induced carcinogenesis:roles of E6 and E7 proteins [J]. Cancer Sci,2007,98(10):1505.
[84]千新来,赵杰,张钢,等.HPV16 DNA阳性乳腺良、恶性病变组织中E6和E7蛋白的表达[J].郑州大学学报：医学版,2009,44(4)：717.
[85]Soussi T. p53 alterations in human cancer:more questions than answers [J]. Oncogene,2007,26(15):2145.
[86]Fuster JJ, Sanz-Gonzalez SM, MollUM, et al. Classic and novel roles of p53:prospects for anticancer therapy [J]. Trends Mol Med,2007,13(5):192.
[87]BouletG, Horvath C, Vanden Broeck D, et al. Human papillomavirus:E6 and E7 oncogenes [J]. Int J Biochem CellBio,2007,39(11):2-6.
[88]HillerT, Stubenrauch F, IftnerT. Isolation and functional analysis of five HPVE6 Variants with respect to p53 degradation[J]. J Med Viro,12008,80(3): 478.
[89]WiestT, Schwarz E, Enders C, et al. Involvement of intact HPV16 E6/E7 gene expression in head and neck cancers with unaltered p53 status and perturbed pRb cell cyclecontrol[J]. Oncogene,2002,21(10):1510.
[90]李向阳,张伟宏.乳癌组织中PTEN的表达[J].郑州大学学报(医学版).2005,40(6)：1112-1114
[91]Steck PA, Pershouse MA, Jasser SA, et al. Identification of a candidatate tumor suppressor gene, MMAC1, at chromosome 10q23.3 that is mutated inmultiple advanced cancer[J]. Nat Genet,1997,15(4):356.
[92]王玉岳.PTEN研究的新进展.国外医学分子生物学分册,2003,25(3)：150.
[93]Li J,Yen C, Liaw D, et al. PTEN, a putative protein tyrosine phosphatase gene mutated in human brain, breast and prostate cancer[J]. Science,1997, 275(5308):19-43.
[94]Li Y, Podsvpanina K, Liu X, et al. Deficiency of PTEN accelerate mammary oncogenesis in MMTV-Wnt-1 transgenicmice[J]. BMC Mol Biol,2001,2(1):2.
[95]Perren A, Weng LP, Boag AH, et al. Immuohistochemical evidence of loss of PTEN expression in primary ductualadenocarcinoma of the breast [J]. Am J Pathol,1999,155(4):12-53.
[96]Starnbolic V, Tsao MS, Macpherson D, et al. High incidence of breast and endometrial neoplasia resembling human cowdlen syndrome in PTEN+/-mice [J]. CancerRes,2000,60(13):3 605
[97]Sano T, Lin H, Chen X, et al. Differential expression of MMAC1/PTEN in glioblastoma multiforme; relationship to localization and prognosis [J]. Cancer Res,1999,59(8):18-20.
[98.1王知力,郭双平,王文亮.PTEN基因的研究进展.临床与实验病理学杂志[J]2001,17(4)： 339.
[99]甄乐锋,叶长生,刘民锋等.青年乳腺癌中ER、PR、HER-2及VEGF表达及其临床病理学意义[J].广东医学,2010,31(4)：490-492.
[100]韩晶,王培军,汤如勇,等.雌激素受体亚型在不同乳腺组织中的表达及其与乳腺癌关系的研究[J].同济大学学报：医学版,2005,26(5)：21-24.
[101]VRBANEC D, PETRICEVIC B. Estrogen and progesterone receptor status in Primary breast cancer-a study ofll 273 patients from the year1990 to 2002[J]. Coll Antropol,2007,31(2):535-540.
[102]薄爱华,芦广萍,闫爱春,等.EGFR和VEGF在乳腺癌中表达的临床意义[J].中国肿瘤临床,2007,34(23)：1324-1326.
[1 O 3]李宝江,朱志华,王军业,等.Ki 67、P53、VEGF和CerbB-2在乳腺癌组织中表达的相关性研究及其临床意义[J].癌症,2004,23(10)：1176-1179.
[104]GONG S J, RHA SY, JEUNGH C, et al. Bilateral breast cancer:differential diagnosis using histological and biological parameters [J]. Jpn J Clin Oncol, 2007,37(7):487-492.
[105]KROGER N, MILDE LANGOSCH K. Prognostic and predictive effects of Immune histochemical factors in high-risk primary breast Cancer patients[J]. Clin Cancer Res,2006,12(1):159-168.
[106]ALAHWALM S. HER-2 positivity and correlations with other histopathologic features in breast cancer patients-hospital based study [J]. J Pak Med Assoc, 2006,56 (2):65-68.
[107]FOLKMAN J. Angiogenesis [J]. Annu Rev Med,2006,57:1-18.
[108]Kruk J, Aboul-Enein HY. Psychological stress and the risk of breast cancer:a case control study[J]. Cancer Detection and Prevention,2004, 28 (6):399-408.
[109]Sanna V, Fancellu A, Sotgiu MI, Contu M, et al.84 Psychological distress in breast cancer patients:depression, anxiety and post-traumatic stress disorder in different phases of the disease[J]. European Journal of Cancer Supplements,2010,8 (3):83.
[110]Larsen BS, Vogel U, Christensen J, Hansen RD, et al. Interaction between ADH1C Arg272Gln and alcohol intake in relation to breast cancer risk suggests that ethanol is the causal factor in alcohol related breast cancer[J]. Cancer Letters, In Press, Corrected Proof, Available online 29 March 2010.
[111]Stark A, Schultz D, Kapke A, Nadkarni P, et al. The Journal of Cancer Surgery,2009,35:928-935.
[112]Taioli E, Barone J, Wynder EL. A case-control study on breast cancer and body mass[J]. European Journal of Cancer,1995,31(5):723-728.
[113]Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve[J]. Radiology,1982,143:29-36.
[114]张丽萍,许良中.应用聚合酶链反应技术检测乳腺肿瘤中EB病毒整合[J].中国癌症杂志,1997,7(2)：79-81.
[115]Fina F, Romain S, Ouaf ik L, et al. Frequency and genome load of Epstein-Barr virus in 509 breast cancers from different geographical areas [J]. Br J Cancer, 2001,84 (6):783-790.
[116]Chu PG, Chang KL, Chen YY, et al. No significant association of Epstein-Barr virus infection with invasive breast carcinoma [J]. Am J Pathol,2001,159 (2):571-578.
[117]李淑英,李冀,胡金华,等.乳腺癌患者癌组织中EB病毒感染基因产物的研究[J].中国妇幼保健,2008,23(1)：87-88.
[118]Bonnet M, Guinebretiere JM, Kremmer E, et al. Detection of Epstein-Barr virus in invas ive breast cancers[J]. J Natl Cancer Inst,1999,91(16):1376-1381.
[119]Preciado MV, Chabay PA, De Matteo EN, et al. Epstein-Barr virus in breast carcinoma in Argentina [J]. Arch Pathol Lab Med,2005,129 (3):377-381.
[120]Z 杨文涛,许良中.102例乳腺癌中的EB病毒感染[J].上海医科大学学报,1998,25(3)：175-178.
[121]Trabelsi A, Rammeh S, Stita W, et al. Detection of Epstein-Barr virus in breast cancers with lymphoid stroma [J]. Ann Biol Clin (Paris),2008,66 (1):59-62.
[122]Thorne LB, Ryan JL, Elmore SH, et al. Real-time PCR measures Epstein-Barr virus DNA in archival breast adenocarcinomas [J]. Diagn Mol Pathol,2005, 14 (1):29-33.
[123]胡维维,宗永生,李凤萍,等.六种抗EB病毒抗体检测在鼻咽癌血清学诊断中 的比较[J].中国肿瘤临床,2006,33(14)：795-798.
[124]Hines SL, Jorn HKS, Thompson KM, et al. Breast cancer survivors and vitamin D [J]:A review. Nutrition,2010,26 (3):255-262
[125]Kruk J. Lifetime physical activity and the risk of breast cancer:A case control study [J]. Cancer Detection and Prevention 2007,31(1); 18-28.
[126]Alcohol, tobacco and breast cancer:collaborative reanalysis of individual data from 53 epidemiological studies, including 58,515 women with breast cancer and 95,067 women without the disease [J]. British Journal of Cancer,2002; 87:1234 45.
[127]Gammon MD, Eng SM, Teitelbaum SL, et al. Environmental tobacco smoke and breast cancer incidence [J]. Environmental Research,2004,96 (2):176-185.
[128]Ambrosone CB, Abrams SM, Roberts KG, et al. Hair dye use, meat intake, and tobacco exposure and presence of carcinogen-DNA adducts in exfoliated breast ductal epithelial cells [J]. Archives of Biochemistry and Biophysics, 2007,464(2):169-175.
[129]Darbre PD. Environmental oestrogens, cosmetics and breast cancer [J]. Best Practice & Research Clinical Endocrinology & Metabolism,2006,20 (1); 121-143.
[130]Fernandez MF, Santa-Marina L, Ibarluzea JM, et al. Analysis of population characteristics related to the total effective xenoestrogen burden:A biomarker of xenoestrogen exposure in breast cancer [J]. European Journal of Cancer,2007,43 (8); 1290-1299.
[131]Landau-Ossondo M, Rabia N, Jos-Pelage J, et al. Why pesticides could be a common cause of prostate and breast cancers in the French Caribbean Island, Martinique. An overview on key mechanisms of pesticide-induced cancer [J] Biomedicine & Pharmacotherapy,2009,63 (6); 383-395.
[132]常永丽,杨秋霞,李君.有机氯农药及谷胱甘肽转移酶M1基因多态性与乳腺癌关系的研究[J].环境与健康杂志,2009,26(12)：1104-1107.
[133]荣素英,李君,牛风玲,等.唐山地区女性乳腺癌环境危险因素的病例对照研究[J].环境与职业医学,2007,24(1)：5-8.
[134]邹其嘉,王子平,陈非比,等.唐山地震灾区社会恢复与社会问题研究(M]北京：地震出版社,1997：398-401.
[135]Minh TB, Watanabe M, Tanabe S, et al. Specific accumulation and elimination kinetics of tris (4-chlorophenyl)metnane, tris (4-chlorophenyl) methnol, and other persistent organochlor ines in humans from Japan [J]. Environ Health Perspect,2001,109:927-935.
[136]Demers A, Ayotte P,Brisson J, et al. Risk and aggressiveness of breast cancer in relation to plasma organochlorine concentrations[J]. Cancer Epidemiol Biomarkers Prev,2000,9:161-166.
[137]Isabelle R, Mauricio HA, Eduardo LP, et al. Breast cancer, lactation history, and serum organochlorines [J].American Journal of Epidemiology,2000,152: 363-370.
[138]Charlier C, Albert A, Herman P, et al. Breast cancer and serumorganochlorine residues [J]. OccupEnvironMed,2003,60:348-351.
[139]华小梅,单正军.我国农药生产、使用状况及影响因子分析[J].环境科学进展,1996,4(2)：33-45.
[140]Halpin, SFS. Medico-legal claims against English radiologists: 1995-2006[J]. British Journal of Radiology,2009,82 (984);982-988.
[141]Mathis KL, Hoskin TL, Boughey JC, et al. Palpable Presentation of Breast Cancer Persists in the Era of Screening Mammography [J]. Journal of the American College of Surgeons,2010,210 (3); 314-318.
[142]Bruening W, Fontanarosa J, Tipton K, et al. Systematic Review: Comparative Effectiveness of Core-Needle and Open Surgical Biopsy to Diagnose Breast Lesions[J]. Ann Intern Med,2010,152; 238-246.
[143]李素侠,任萍.细针抽吸细胞学检查早期诊断乳癌的价值.现代肿瘤医学,2008,16(6)；963-964.
[144]Dominguez FJ, GolshanM, Black DM, et al. Sentinel node biopsy is important In mastectomy for ductal carcinoma in situ[J]. Ann Surg Oncol,2008,15(1): 268-273.
[145]Goyal A, Newcombe RG, Chhabra A, et al. Factors affecting failed localization and False negative rates of sentinel node biopsy in breast cancer results of the ALMANAC validation phase [J]. Breast Cancer Res Treat,2006, 99(2):203-208.
[146]吕大鹏,郭怡晖,段志军等.Isosulfan示踪乳腺癌前哨淋巴结活检术[J].山东医药,2010,50(10)：12-14.
[147]Krag DN, Anderson SJ, Julian TB, et al. Technical outcomes of sentinel lymph node resection and conventional auxiliary lymph node dissection in patients with clinically node-negative breast cancer:results from the NSABP B232 randomized phase III trial [J]. Lancet Oncol,2007,8(10):881-888.
[148]张静,王培军,袁小东,等.钼靶、磁共振及核素显像诊断乳腺癌准确性的Meta 分析[J].第二军医大学学报,2007,28(10)；1098-1103.
[149]翟景花,高丹凝,庞达,等.乳头抽吸液中癌胚抗原与乳腺癌的关系[J].疾病控制杂志,2007,11(2)；164-167.
[150]邬玉辉,陈飞宇,欧阳慧英,等.不可触及肿物乳腺癌的临床诊断[J]中南大学学报,2008,33(9)；861-864.
[151]杜燕萍,陆建平.高频超声和钼靶x线摄片对小乳癌的诊断价值[J].中国医师杂志,2009,11(8)；1118一1119.
[152]李兴慧,陈赛华,杨爱建,等.早期乳腺癌诊断的临床分析[J].现代肿瘤医学,2009,17(12)；2333-2334.
[153]谢丽珍,杨建勇,陈晓兰,等.超声诊断早期乳腺癌的价值分析[J].中国妇幼保健,2010,25(1)：119-120.
[154]杨光华.病理学第5版,北京：人民卫生出版社,2004：306.
[155]丛新丽,李树祝.乳腺癌的影像诊断现状与进展[J].医学影像学杂志,2003,13(8)： 602.
[156]赵汉学.乳腺导管内原位癌和内癌微小浸润的声像图表现及其病理基础[J].中国超声医学杂志,2007,23(4)：301.
[157]吴秀花1乳腺浸润性导管癌的高频彩色多普勒超声诊断分析[J].中国超声医学杂志,2006,7(12)：910.
[158]何萍霞,张玉花,杨立国,等.胸部CT扫描诊断乳腺疾病的应用价值.中国医疗器械信息,2009,15(5)；40-43.
[159]陈建伟,王杰,刘标,等.PETCT与胸部诊断CT在乳腺癌术后随访中的比较[J].南京医科大学学报(自然科学版),2010,30(2)：195-198.
[160]S Eubank WB, Mankoff DA. Evolving role of positron emission tomography in breast cancer imaging [J]. Semin Nucl Med,2005,35 (2):84-99.
[161]李雪娜,尹雅芙,李亚明,等.18F-FDG PET/CT不同诊断方法对乳腺癌及其淋巴结转移的应用价值[J].中华核医学杂志,2008,28(4)：244-249.
[162]Lavayssiere R, Cab e e AE, Filmont JE. Positron emission tomography (PET) and breast cancer in clinical practice [J]. Eur J Radiol,2009,69 (1):50-58.
[163]Kuru B, Camlibel M, Dine S, et al. Prognostic factors for survival in breast cancer patients who developed distant metastasis subsequent to definitive surgery [J]. Singapore Med J,2008,49 (11):904-911.
[164]Eubank WB, Mankoff DA, Takasugi J, et al.18F-fluo-rodeoxyglucose positron emission tomography to detect mediastinal or internal mammary metastases in breast cancer [J]. J Clin Oncol,2001,19 (15):3516-3523.
[165]Groheux D, Moretti JL, Baillet G, et al. Effect of 18F-FDG PET/CT imaging in patients with clinical stage Ⅱ and Ⅲ breast cancer [J]. Int J Radiat Oncol Biol Phys,2008,71 (3):695-704.
[166]Weir L, Worsley D, Bernstein V. The value of FDG positron emission tomography in the management of patients with breast cancer [J]. Breast J, 2005,11 (3):204-209.
[167]Fuster D, Duch J, Paredes P, et al. Preoperative staging of large primary breast cancer with 18F-fluorodeoxyglucose positron emission tomography/ computed tomography compared with conventional imaging procedures [J]. J Clin Oncol,2008,26 (29):4746-4751.
[168]Heusner TA, Kuemmel S, Umutlu L, et al. Breast cancer staging in a single session:whole-body PET/CT mammog-raphy[J]. J Nucl Med,2008,49(8):1215-1222.
[169]Lim HS,Yoon W, Chung TW, et al. FDG PET/CT for the detection and evaluation of breast diseases:usefulness and limitations [J].Radiographics,2007,27 (Suppl 1):S197-213.
[170]Nakai T, OkuyamaC, Kubota T, et al. Pitfalls of FDG-PET for the diagnosis of osteoblastic bone metastases in patients with breast cancer [J]. Eur J Nucl Med Mol Imaging,2005,32(11):1253-1258.
[171]Du Y, Cullum 1, Illidge TM, et al. Fusion of metabolic function and morphology:sequential 18F-fluorodeoxyglucose positron-emission tomography /computed tomography studies yield new insights into the natural history of bone metastases in breast cancer [J]. J Clin Oncol,2007,25(23):3440-3447.
[172]McCall SA, Lichy JH, Bijwaard KE, et al. Epstein-Barr virus detection in ductal carcinoma of the breast [J]. J Natl Cancer Inst,2001,93(2):148-150.
[173]陈智周,范振符,杨剑,等.肿瘤标志物CAl53的免疫放射分析及其临床应用[J].中华肿瘤杂志,1998,20(2)：125-127.
[174]Wojtacki J, Kruszewski WJ, Sliwiska M, et al. Elevation of serum Ca15-3 antigen:an early indicator of distant metastasis from breast cancer. Retrospective analysis of 733 cases [J].Przegl Lek,2001.58 (6):4981.
[175]赵惠柳,黄玲莎,朱波.CYFRA21-1、CA153联合检测对乳腺癌的诊断意义.海南医学,2005,16(12)：143-144.
[176]陆云飞,向俾庭,曾健,等.血清TSGF、CA153、CA125及CEA联合检测对乳腺癌的诊断价值[J].广西医科大学学报,2006,23(2)：173-175.
[177]陶冀,游廉,王锡山.乳腺癌肿瘤标志物CEA、CA153表达水平的临床意义[J].中国肿瘤临床,2005,32(13)：751-754.
[178]Bodenmuller H. Technical evaluation of a new automated tumor marker assay: the enzymum-test CYFRA21-1. In Hapdor R.Tumor associated antigens, oncogene receptors cytokines in tumor diagnosis and therapy at the beginning of the 90ths [M]. Zuckschwenlt:Verlag,1992.137-147.
[179]DohmotoK, Hojo S, Fujita J, et al. Mechanisms of the release of CYFRA21-1 in the human lung cancer cell lines [J].Lung Cancer,2000,30 (1):55.
[180]Sheard MA, Vojtesek B, Simickova M, et al. Release of cytokeratin-18 and 19 fragments (TPS and CYFRA21-1) into the extra-cellular space during apoptosis [J]. J Cell Biochem,2002,85 (4):670.
[181]顾怡生,肖必文,蔡菊芬.恶性肿瘤病人血清细胞角蛋白19片段等四联检结果分析[J].放射免疫学杂志,2002,15(5)：272-275.
[182]赵惠柳,黄文成,黄昭东,等.肿瘤标志物CYFRA21-1诊断鼻咽癌的临床价值研究[J].现代肿瘤医学,2004,12(4)：225-226.
[183]孟冬娅,胡晓芳,高洪福,等.检测血清VEGF, CEA, TSGF在肿瘤中的临床意义[J].中国现代医学杂志,2004,14(1)：117-118.
[184]王英,黄文成,朱波,等.CYFRA21-1、CA153和TSGF联合检测对乳腺癌诊断的临床意义[J].中国现代医学杂志,2006,16(20)：3104-3106.
[185]周剑波,纪成斌,唐琳,等.化学发光免疫分析联合检测四项肿瘤标记物及其临床应用[J].右江医学,1999,27(3)：151-152.
[186]Singletary SE, Connolly JL. Breast Cancer Staging:Working With the Sixth Edition of the AJCC Cancer Staging Manual [J]. Cancer Journal for Clinicians, 2006,56:37-47.
[187]季兴.中医治疗乳腺增生病的进展[J].河北中医.2004,26(7)；549-551
[188]徐英纳,张福忠.乳腺增生病中医治疗进展.中医药临床杂志2004,16(6)：605-607.
[189]李静惠,韩国晖,午巧焕.乳腺癌手术177例的困惑与思考[J].中外医学研究.2009,10(7)：48.
[190]张全霞,杜卫萍,殷丽红,等.中医疗法治疗乳腺增生119例临床观察[J].山东医药,2007,47(22)：97.
[191]鲁平.乳康宁方治疗乳癌化疗骨髓抑制56例[J].光明中医.2003,6；41-42.
[192]王进才.针刺乳根穴治疗乳腺增生120例[J].中医杂志.2001,42(8)；505-506.
[193]刘永霞.也谈幽门螺杆菌与胃外疾病[J].中华内科杂志,2001,40(1)：53-54.
[194]曾慧玲,唐汉钧.唐汉钧.运用健脾益气法经验[J].中医文献杂,2008,6：37-39.
[195]贾喜花,唐汉钧.唐汉钧.调治乳腺癌术后的经验[J].中西医结合报,2005,3(3).
[196]李琳,宋爱莉.乳癌根治术后对侧乳房肿块的中西医结合诊治[J].山东中医药 大学学报,2002,26(3)：177-178.
[197]朱兵,李宁生,余正,李和生,等.耳穴电信息反应早期癌病变的特异性[J].南京大学学报,1995,31(1)：39-44.
[198]朱兵,陈巩荪,许瑞征,等.耳穴的电学特性及其特异性[J].中国针灸,2001,21(12)：731-734.
[199]仲远明,俞明,胡智慧,等.耳穴电特性反应胃癌病变的特异性研究[J].江苏中医,2001,22(12)：43.
[200]邢剑秋,胡智慧,俞明,等.耳穴电特性反应肝癌病变特异性的实验研究[J].江苏中医,2000,21(12)：52-53.
[201]俞明,徐定,朱兵,等.耳穴电特性反应食道癌病变的特异性[J].南京中医药大学学报,2002,11(18)：357-359.
[202]刘世佩,石翠英.耳穴诊断食管癌146例临床观察[J].安徽中医学院学报,1990,9(3)：43-44.
[203]李海斌,保燕,奎宏,余庆鹤.耳廓结节在肺肿瘤诊断中的应用[J].云南中医学院学报,2000,12(4)：51-52.
[204]彭正顺,陈昱宇.肝恶性肿瘤患者体表信息临床分析[J].现代诊断与医疗,1992,3(2)：141-143.
[205]时景璞.临床研究中样本量的估计方法[J].中国临床康复,2003,7(10))：1569-1571.
[206]张学中,谭学瑞,潘红星.临床试验所需样本量之管见[J].世界华人消化杂志,2006,14(14)：1339-1340.
[207]NSCHULZ K. THE LANCET临床研究导论[M].台湾爱思唯尔有限公司出版,2008,55-67.
[208]齐元富.肿瘤的几个中医新体征[J].山东中医药大学学报,2002,26(4)：262-264.
[209]彭清华.耳诊研究进展(一) [J].山东中医学院学报,1989,13(2)：53-54.
[210]巴元明,高清平.耳诊在肿瘤诊断中的应用进展[J].湖北中医杂志,1995,2：71-73.
[211]彭正顺,陈昱宇.肝恶性肿瘤患者体表信息临床分析[J].现代诊断与医疗,1992,3(2)：141-143.
[212]陈树楷.感染幽门螺旋杆菌患者耳廓辅助诊断的研究.北京中医药大学博士论文,2010年.
[213]Beam CA, Sullian DC, Layde PM. Effect of human variability on independent double reading in screening mammography[J]. Acad Radial,1996,3:891-897.
[214]Madeleine MA Tilanus-Linthorst, Mieke Kriege, Carla Boetes, et al. Hereditary breast cancer growth rates and its impact onscreening policy [J]. European Journal of Cancer,2005,41:1610-1617.
[215]Nickerson, RS. Null hypothesis significance testing:A review of an old and continuing controversy. Psychological Methods [J],2000,5:241-301.