Accuracy of Clinical Examination of Breast Lumps in Detecting Malignancy: A Retrospective Study

Abstract

Clinical examination is a simple method to detect breast lumps and their nature as it is inexpensive and noninvasive and if found to be accurate, might be of great value as a diagnostic tool. The aim of this study was to evaluate the accuracy of clinical examination and its contribution towards the diagnosis of a palpable breast lump. The study was record based and conducted at a University Medical College Hospital and a tertiary referral centre of South India. Patient files of those women who presented with a breast lump between January to December 2011 were studied. A total of 120 patients were obtained following necessary exclusions. The accuracy of clinical assessment at an outpatient facility was determined by comparing the physician's diagnosis with the final histopathological diagnosis. The inter-observer agreement (kappa) for diagnosing a breast lump was 81 % (95 % Confidence Interval071 % to 92 %) indicating a good agreement between clinical and pathological diagnoses. McNemar test also indicated a high degree of concordance between the two diagnoses (4.17 % discordance). Sensitivity, specificity, positive and negative predictive values of clinical breast examination in comparison to histopathology were 95, 88, 87, and 95 % respectively, with an overall accuracy of 90.8 %. 11 lumps were wrongly diagnosed at the time of clinical examination. Clinical examination of breast lumps was found to have a high sensitivity (94.5 %) and specificity (87.7 %) and can be used as the diagnostic tool to identify the nature of the lump, however, its value in diagnosing breast malignancy remains contributory due to the possibility that malignant lumps could be overlooked and present as advanced cancer at a later stage. Histopathology is recommended in all cases unless clinical examination is supported with strong evidence of benignity based on repeated breast imaging via ultrasound or mammogram (>35 yrs).

Clinical study of breast lump-triple assessment does help in diagnosing it better

“…Sensitivity, specificity, positive and negative predictive values overall accuracy of clinical breast examination in comparison to histopathology was 90.8%, with sensitivity of 95% and specificity of 88%. 14…”

O conhecimento de mulheres sobre os métodos para prevenção secundária do câncer de mama

“…Studies have shown that the media is an important means of communication for dispensing knowledge on breast cancer 15 irrespective of a person's level of education or income 16 . The ECM that is carried out by health care professionals is a simple and non-invasive method without costs with a sensibility rate of 94.5% and specificity rate of 87.7% 17 . When it is done by trained professionals this can result in their detecting a tumor the size of one centimeter if it is superficial 17 .…”

“…The ECM that is carried out by health care professionals is a simple and non-invasive method without costs with a sensibility rate of 94.5% and specificity rate of 87.7% 17 . When it is done by trained professionals this can result in their detecting a tumor the size of one centimeter if it is superficial 17 . This could be useful in areas where late diagnosis is a reality due to a lack of resources for making diagnosis using images.…”

Assessment of DNA methylation patterns in breast tumours and apparently healthy subjects in Anambra state, Nigeria

“…The benign and malignant breast tumour subjects were attending clinic at the surgical unit of Nnamdi Azikiwe University Teaching Hospital Nnewi (NAUTH), Anambra State. The 50 healthy female control subjects were confirmed free from breast tumours by the physician [17]. The diagnosis of breast tumour was established by histo-pathological examination of biopsy and detection of cancer associated antigen 15-3 (CA 15-3).…”