Sensitivity Of Clinical Breast Examination Research Articles

Role of Triple Test in Evaluating Breast Lumps

Breast tissue undergoes constant physiological changes in a woman’s life because of influence of endocrine hormones during and after reproductive life. These changes may present as pain, lumpiness or both in the breast. Breast lumps are feared for cancer. Thus, it is important for women with a breast lump to receive appropriate evaluation. Clinical breast examination is first step in evaluation of breast lump. The diagnostic sensitivity of clinical breast examination is high (98%) whereas its specificity is low, averaging 48%. Ultrasound is preferred in evaluation of radiologically dense breasts and in the study of breasts with augmentation mammoplasties. Micro-calcifications on mammography are considered to be important signs of breast cancer. X-ray mammography detects microcalcifications in 30–50% of breast cancers. FNAC is a cheap, cost effective and readily available routine diagnostic with a sensitivity ranging between 89% to 98% and specificity between 98% to 100% for palpable breast lumps.
 When combined together triple test achieves a higher sensitivity, specificity and diagnostic accuracy than any of the investigations taken alone. We conducted a prospective study to evaluate breast masses by clinical assessment, imaging and pathological examination. Results were compared with histopathology. We concluded that triple assessment in breast lumps gives superior results than any of its modalities taken alone.

Hereditary breast cancer: screening and risk reducing surgery.

The screening modalities for women at high risk for breast cancer has received an increasing role during the last years. The aim of this study was to evaluate the performance of our screening program comparing the diagnostic sensitivity of clinical breast examination, mammography, ultrasonography (US) and magnetic resonance imaging (MRI). Clinical Breast examination, mammography, US and MRI for each patient with BRCA1 and BRCA2 mutation who underwent breast surgery in our Institution from October 2008 to April 2016 were retrospectively evaluated. The diagnostic accuracy for MRI and for the other surveillance tests in identifying early breast cancer were assessed. Twenty-six female patients with genetic mutation underwent breast surgery. Twenty-two out of 26 (85%) developed cancer during the dedicated screening protocol whereas 4 women who underwent surgery did not have cancer. Imaging was able to detect cancer in all 22 patients (per patient sensibility of 100%), identifying all 35 neoplastic lesions (per lesion sensibility of 100%). The combination of Clinical Breast Examination, US and mammography aided the cancer diagnosis in 14 (64%) of patients with a sensitivity of 64% and specificity of 100%. MRI identified all the cancers, with sensibility and specificity of 100%. Moreover, in 8 (36%) of the 22 patients who developed breast cancers, the cancers were detected only by MRI, revealing a significant superiority respect to the other surveillance modalities (P<0.05). MRI demonstrated to be the best imaging modality in detection of breast cancer even for lesion <1 cm. Prophylactic mastectomy is the most effective risk reduction strategy in women at high risk, contributing to the reduction of anxiety related to the condition of a carrier.

Accuracy of clinical breast examination’s abnormalities for breast cancer screening: cross-sectional study

ObjectivesThe guidelines for breast cancer screening with clinical breast examination (CBE) are diverging CBE is recommended in France, whereas it is not recommended in the United States and Canada, given the lack of clear benefit and the risk of overmedication. To assess the accuracy of abnormalities found during CBE for in breast cancer screening. Study designA cross-sectional study included women over 18 years with no history of breast cancer coming for a mammography at 3 ambulatory radiology practices in Paris. A questionnaire collected the risk of breast cancer on mammography according to the Breast Imaging-Reporting And Data System (Bi-RADS) (high risk: Bi-RADS 4 or 5 versus lower risk: other Bi-RADS categories), the risk factors for breast cancer and the breast clinical abnormalities (none, mass, skin abnormality, oedema, pain, nipple discharge, lymph nodes…) For each abnormality, sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were calculated. ResultAmong the 3218 included patients (mean age 55.1 +/-10 years), 713 (22.2%) had an abnormal CBE and 133 (4.1%) had high-risk mammography. The sensitivity of CBE was 36%[28%;45%] and the specificity was 78%[77%;80%]. The PPV and NPV for each clinical abnormality were low, except for nipple discharge, retraction and lymph nodes, for which the PPV were 10.5[3.7;29.9], 6.6[1.4;31.6], and 5.0[1.5;17.1], respectively, but these abnormalities were rare (0.5%, 0.2% and 0.5% respectively). These values were similar across all age groups. ConclusionThe accuracy of CBE for breast cancer screening appeared to be low which did not support recommending regular CBE in France.

Accuracy of mammography and clinical breast examination in the implementation of breast cancer screening programs in Colombia

Most evidence on breast cancer screening accuracy derives from high income countries. We evaluated screening accuracy and factors related to program implementation in Bogota, Colombia. Between 2008 and 2012 participants underwent clinical breast examination (CBE) and mammography. Positive results underwent histological verification. Adherence to screening protocols was analyzed. Sensitivity, specificity, and predictive values were estimated and adjusted by overdiagnosis. Impact of alternative screening algorithms on follow-up was explored, including combined screening tests and modified coding systems for mammography. In total, 7436 women aged 50–69 were enrolled; 400 discontinued and 1003 non-compliant with screening protocols. 23 cancer cases were diagnosed. Mammography sensitivity and specificity were 78.3% (95%CI 77.3–99.3) and 99.4% (95%CI 99.2–99.6). CBE sensitivity was 39.1% (95%CI 37.9–40.3) and specificity 83.4% (95%CI 82.6–84.3). Parallel mammography and CBE showed the highest sensitivity (95.6%) and combined as serial tests the lowest (positive CBE followed by mammography 13.0%). A simplified coding system for mammography (recall/no-recall) had 6.3% of positive results and a minor reduction in specificity compared with standard mammography, but reported the best balance between recall rates and screening protocol compliance. Call-backs had high rates of loss-to-follow-up; thus, alternative screening algorithms might help increase screening compliance and follow-up in low and middle income countries, particularly in populations with poor screening history and low access to health services.

Hybrid Simulation in Teaching Clinical Breast Examination to Medical Students.

Clinical breast examination (CBE) is traditionally taught to third-year medical students using a lecture and a tabletop breast model. The opportunity to clinically practice CBE depends on patient availability and willingness to be examined by students, especially in culturally sensitive environments. We propose the use of a hybrid simulation model consisting of a standardized patient (SP) wearing a silicone breast simulator jacket and hypothesize that this, compared to traditional teaching methods, would result in improved learning. Consenting third-year medical students (N=82) at a university-affiliated tertiary care center were cluster-randomized into two groups: hybrid simulation (breast jacket + SP) and control (tabletop breast model). Students received the standard lecture by instructors blinded to the randomization, followed by randomization group-based learning and practice sessions. Two weeks later, participants were assessed in an Objective Structured Clinical Examination (OSCE), which included three stations with SPs blinded to the intervention. The SPs graded the students on CBE completeness, and students completed a self-assessment of their performance and confidence during the examination. CBE completeness scores did not differ between the two groups (p=0.889). Hybrid simulation improved lesion identification grades (p<0.001) without increasing false positives. Hybrid simulation relieved the fear of missing a lesion on CBE (p=0.043) and increased satisfaction with the teaching method among students (p=0.002). As a novel educational tool, hybrid simulation improves the sensitivity of CBE performed by medical students without affecting its specificity. Hybrid simulation may play a role in increasing the confidence of medical students during CBE.

Hybrid Simulation in Teaching Clinical Breast Examination

This article was migrated. The article was not marked as recommended. Problem: Clinical Breast Examination (CBE) is traditionally taught to third year medical students using a lecture and a table-top breast model. The opportunity to clinically practice CBE depends on patient availability and willingness to be examined by students, especially in culturally sensitive environments. Intervention: We employed hybrid simulation of the breast and aimed to investigate its effectiveness as an educational tool for teaching CBE to medical students. The hybrid simulation model consists of a standardized patient (SP) wearing a silicone breast simulator jacket. Context: We compared the use of this tool to the traditional method using a blinded randomized controlled design. Medical students (N=82, 48.8% male) were randomized into teaching activities: hybrid simulation and control. Both groups received didactic teaching followed by a practical session. The control group practiced on the table-top model traditionally used while the intervention group practiced on the hybrid model (SP+breast jacket). Next, all students were assessed on their technical and communication skills in an Objective Structured Clinical Examination (OSCE) that included three SP stations. SPs were trained to act according to specified cultural roles: a liberal woman, a veiled woman and a moderately modest woman. Assessment employed a variety of simulated lesions. Outcomes: The hypothesized outcomes consisted of a more complete acquisition of CBE skills, improved lesion detection and better communication skills. CBE completeness scores did not differ between the two groups (p=0.889). Hybrid simulation improved lesion identification grades (p&lt;0.001) without increasing false positives. Communication skills were worse in the hybrid simulation group as graded by the SP (p&lt;0.001), but not as reported by the students (p=0.346). We commented on the students' comfort during OSCE. Hybrid simulation relieved the fear of missing a lesion on CBE (p=0.043) and increased satisfaction with the teaching method among students (p=0.002). Lessons Learned: As a novel educational tool, hybrid simulation improves the sensitivity of CBE done by medical students without affecting its specificity. Although it might not necessarily improve their communication or sensitivity to cultural aspects of CBE, hybrid simulation might have a role in increasing the self-confidence of medical students during CBE.

Performance of breast cancer screening methods and modality among Chinese women: a report from a society-based breast screening program (SBSP) in Shanghai

To evaluate the screening performance of individual and combined use of clinical breast examination, ultrasonography and mammography in Chinese women, we conducted a biennial breast cancer screening program among 14,464 women aged 35 to 74 years old who lived in Qibao County, Minhang district of Shanghai, China, between May 2008 and Sept 2012. All participants were submitted to clinical breast examination, and then women with positive results and all women at age of 45-69 years old were preformed breast ultrasonography and mammography. The examination results were compared against pathological findings as the gold standard of reference. A total of 66 women were diagnosed with breast cancer in the two rounds of the screening, yielding an incident rate of 194 per 100,000 person-years. The sensitivity of clinical breast examination, ultrasonography and mammography alone were 61.4%, 53.7% and 67.3%, respectively. While mammography performed better in elder age groups and hormone receptor positive disease groups, ultrasonography had a higher sensitivity in younger age group and did not differ in sensitivity by estrogen receptor or progesterone receptor status. Combined use of the two imaging examinations increased the sensitivity in almost all age groups, but had a higher sensitivity in hormone receptor positive cancers than in those negative. Our results suggest that the Qibao modality is an effective strategy for breast cancer screening among Chinese women, especially for early detection of elder and hormone receptor positive breast cancer.Electronic supplementary materialThe online version of this article (doi:10.1186/2193-1801-2-276) contains supplementary material, which is available to authorized users.

The impact on case findings by transferring clinical breast examination skills to female community health volunteers in limited resources country like Nepal.

e11094 Background: In limited resources countries, patients with breast cancer present to the hospital in the late stage because of lack of awareness, screening program. Clinical Breast Examination (CBE) may be the only means of detecting the breast cancer early in countries with limited resources since mammography is less likely to be cost effective approach and CBE by surgeons are also not possible because of limited health care facility. Hence CBE by FCHVs seems to be more feasible. This study was conducted to observe the skill transfer to FCHVs for detection of clinical abnormalities in breast by determining kappa agreement, sensitivity, specificity, positive predictive value and negative predictive value of CBE by FCHVs considering CBE by the Surgeon as gold standard. Methods: It is a cross-sectional study conducted in Eastern Nepal for period of one year from June 2008 to May 2009. Total 1238 women were examined by both a FCHV and the Surgeon. The results were analyzed to find out interobserver kappa agreement, sensitivity, specificity, positive predictive value and negative predictive value for detection of clinical abnormalities in breast following CBE by FCHVs considering CBE by the Surgeon as gold standard. Results: Total 1238 women received CBE by both a FCHV and the Surgeon. The interobserver kappa agreement for the detection of clinical abnormalities in breast was 67% indicating a good agreement exists between the FCHVs and the Surgeon’s CBE Sensitivity, specificity, positive predictive value and negative predictive values of “FCHVs’ CBE” to detect clinical abnormalities in breast in comparison to “the Surgeon’s CBE” as gold standard were 70%, 95%, 74% and 94% respectively. Conclusions: In view of good CBE skills transfer to FCHVs for detection of clinical abnormalities in breast, the effective training of FCHVs may diagnose and refer the women with clinical breast abnormalities to the hospital for further investigation and treatment.

Specific breast-screening programme for childhood cancer survivors following exposure to ionizing radiation

1529 Background: High number of long-term survivors after irradiation develop a second cancer. The aim of this prospective study was to evaluate the long-term risk to develop breast cancer following exposure to ionizing radiation at pediatric age and to compare the sensitivity of clinical breast examination (CBE), mammography (MX) and ultrasonography (US) for screening of such young women. Methods: We identified 86 patients from an institutional database that received chest wall radiotherapy for pediatric cancer. They accepted to be enrolled for an intensive surveillance program: CBE, US and MX were yearly performed. A screening event, that is constituted by three diagnostic procedures (two under 25 years old), takes place in a single day. Overall detection rate of breast cancer per year and sensitivity of the three diagnostic procedures were calculated. Results: Among these women, from April 2004 to May 2007, we identified 8 breast cancers. The age at diagnosis ranged between 26 to 49 yrs. Two cases were...

Efficacy of MRI and Mammography for Breast-Cancer Screening in Women with a Familial or Genetic Predisposition

The value of regular surveillance for breast cancer in women with a genetic or familial predisposition to breast cancer is currently unproven. We compared the efficacy of magnetic resonance imaging (MRI) with that of mammography for screening in this group of high-risk women. Women who had a cumulative lifetime risk of breast cancer of 15 percent or more were screened every six months with a clinical breast examination and once a year by mammography and MRI, with independent readings. The characteristics of the cancers that were detected were compared with the characteristics of those in two different age-matched control groups. We screened 1909 eligible women, including 358 carriers of germ-line mutations. Within a median follow-up period of 2.9 years, 51 tumors (44 invasive cancers, 6 ductal carcinomas in situ, and 1 lymphoma) and 1 lobular carcinoma in situ were detected. The sensitivity of clinical breast examination, mammography, and MRI for detecting invasive breast cancer was 17.9 percent, 33.3 percent, and 79.5 percent, respectively, and the specificity was 98.1 percent, 95.0 percent, and 89.8 percent, respectively. The overall discriminating capacity of MRI was significantly better than that of mammography (P<0.05). The proportion of invasive tumors that were 10 mm or less in diameter was significantly greater in our surveillance group (43.2 percent) than in either control group (14.0 percent [P<0.001] and 12.5 percent [P=0.04], respectively). The combined incidence of positive axillary nodes and micrometastases in invasive cancers in our study was 21.4 percent, as compared with 52.4 percent (P<0.001) and 56.4 percent (P=0.001) in the two control groups. MRI appears to be more sensitive than mammography in detecting tumors in women with an inherited susceptibility to breast cancer.

Effectiveness of a dynamic breast examination training model to improve clinical breast examination (CBE) skills

Despite the potential utility of clinical breast examination (CBE), doctors’ palpation skills are often inadequate and difficult to train. CBE sensitivity ranges from 39–59%, in part because current training does not effectively teach tactile skills. To address CBE training limitations, we developed a breast examination training model with 15 dynamically controlled lumps, set to desired hardness within underlying rib and muscle structures, in a silicone breast. In an experiment of 48 medical students, training with the dynamic model increased lump detection by 1.35 lumps compared to 0.60 lumps for a traditional breast model ( P=0.008), reduced false positives by −0.70 lumps compared to +0.42 lumps ( P=0.0277), and demonstrated skill transfer with a 1.17 lump detection improvement on the traditional device compared to only a 0.17 lump detection improvement by traditional device trainees on the dynamic device ( P<0.001). Findings demonstrate the advantage of the dynamic model over conventional models in training CBE tactile skills.

Predictors of sensitivity of clinical breast examination (CBE).

Clinical breast examination (CBE) is one of the most common breast cancer screening modalities, but factors that affect its sensitivity are not well understood. We examined the association between CBE sensitivity and tumor, breast and personal characteristics among members of a managed care organization's Breast Cancer Screening Program (BCSP). The study population was 468 screened women 40 years and older diagnosed with invasive breast cancer between 1988 and 1994 within 1 year of a screening CBE. Logistic regression was used to evaluate the likelihood of a true positive versus a false negative CBE result, after adjustment for age, body weight and tumor size. CBE sensitivity increased with larger tumor size (17% for tumors < or = 0.5 cm and 58% for tumors > or = 2.1 cm, adjusted p for trend < 0.001) and decreased with higher body weight (48 and 23% for the lowest and highest quartiles, adjusted p for trend < 0.001). CBE was more sensitive in Asian women compared to white women (88% v.s. 35%, adjusted p = 0.04) and in current users of estrogen and progesterone combination therapy compared to never/former users (52% v.s. 33%, adjusted p = 0.08). There was an inverted U-shaped association between age and CBE sensitivity (40-49: 26%, 50-59: 48%, 60-69: 36%, 70-79: 33%, 80+: 18%, significant for oldest and youngest groups v.s. age 50-59 years). These findings suggest certain groups of women, for example, obese women and younger women, receive less benefit from CBE.

Lump detection is enhanced in silicone breast models simulating postmenopausal breast tissue.

We varied the softness and nodularity of silicone breast models to assess the effects of age-related breast tissue characteristics on lump detection. In two sets of six silicone breast models manufactured to simulate premenopausal and postmenopausal breast tissue, respectively, 82 internal medicine attending and housestaff physicians more readily detected lumps among models simulating older breast tissue. The proportion of models with one or more false-positive findings was higher among models simulating postmenopausal breast tissue. We conclude that age-related changes in breast tissue most likely contribute to the higher sensitivity of clinical breast examination in older women.