Development and validation of a clinical prediction rule to identify suspected breast cancer: a prospective cohort study

Galvin, Rose; Joyce, Doireann; Downey, E; Boland, Fiona; Fahey, Tom; Hill, Arnold D.

doi:10.1186/1471-2407-14-743

Cited by 19 publications

(17 citation statements)

References 26 publications

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“…A recent study of Finland’s national breast cancer screening program found that breast lump or retraction reported by the woman or discovered upon clinical examination was associated with a diagnosis of cancer (OR: 6.5; 95% CI: 5.9 – 7.1 and OR: 2.2; 95% CI: 1.9 – 2.5, respectively) (21). Similarly, an examination of data collected from the National Cancer Control Programme in Ireland found that the presence of a lump (aOR: 5.6; 95% CI: 4.2 – 7.6), nipple change (aOR: 2.8; 95% CI: 1.7 – 4.6), or nipple discharge (aOR: 2.1; 95% CI: 1.1 – 4.0) among women visiting special symptomatic breast units was associated with cancer (22). …”

Section: Discussionmentioning

confidence: 99%

Reported breast symptoms in the National Breast and Cervical Cancer Early Detection Program

Ryerson

Miller

Eheman

2015

Cancer Causes Control

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Purpose The frequency and types of breast symptoms reported by women in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) have never been characterized. This study aims to establish the frequency of reported symptoms and the diagnostic outcomes associated with reported symptoms. Methods We examined the frequency of symptoms reported prior to mammography using medical record abstraction data from women in the NBCCEDP. We also calculated adjusted odds ratios (aOR) of having an abnormal mammogram, an abnormal clinical breast examination (CBE), or a final diagnosis of breast cancer by symptoms, compared to asymptomatic women. Results In our sample of women, 10.3% reported at least one symptom. Women with symptoms were younger and more likely to be non-Hispanic white. Among those reporting symptoms, breast lump (31.7%) and pain or tenderness (49.3%) was most common. A relatively low proportion of women with symptoms were diagnosed with in situ (0.9%) or invasive breast cancer (4.3%). However, a self-reported breast lump (aOR: 13.7; 95% confidence interval [CI]: 7.8 – 24.1), inflammation or changes to the skin/nipple (aOR: 27.8; 95% CI: 8.7 – 88.8) and other or unspecified symptoms (aOR: 3.4; 95% CI: 2.1 – 7.5) were associated with an increased risk of invasive breast cancer. Conclusions Although the prevalence of breast cancer among women reporting symptoms is relatively low, knowing which symptoms carry the highest breast cancer risk is important to assist in appropriate diagnostic workup.

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Section: Discussionmentioning

confidence: 99%

Reported breast symptoms in the National Breast and Cervical Cancer Early Detection Program

Ryerson

Miller

Eheman

2015

Cancer Causes Control

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“…This is slightly less than the 5% to 10% we expected based on the literature. 6,7 During ductoscopy, 8 patients with suspicious lesions were seen, of which 5 finally turned out to be (pre)malignant and 3 turned out to be benign after pathologic analysis. Two patients who turned out to have (pre)malignancy did not have suspicious findings during ductoscopy.…”

Section: Mando Dyko Filipe Et Almentioning

confidence: 99%

“…[2][3][4][5] However, when ultrasound and mammography are negative, the risk of malignancy is still around 5% to 8%. 6,7 The most common causes of PND are benign: ductal ectasia and intraductal papillomas. 8,9 Mammography and breast ultrasound are important tools for the detection of breast cancer.…”

Section: Introductionmentioning

confidence: 99%

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Interventional Ductoscopy as an Alternative for Major Duct Excision or Microdochectomy in Women Suffering Pathologic Nipple Discharge: A Single-center Experience

Filipe

Waaijer

Pol

et al. 2020

Clinical Breast Cancer

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Ductoscopy is a minimally invasive technique that is currently used to detect, and sometimes remove, lesions that cause pathologic nipple discharge (PND). This study shows that ductoscopy is an alternative for surgery in patients with PND that have negative conventional imagery for breast cancer. Additionally, this study shows that ductoscopy has a high sensitivity, specificity, and negative predictive value for the detection of breast cancer in patients with PND with negative conventional imagery. Introduction: Pathologic nipple discharge (PND) is, after palpable lumps and pain, the most common breast-related reason for referral to the breast surgeon and is associated with breast cancer. However, with negative mammography and ultrasound, the chance of PND being caused by malignancy is between 5% and 8%. Nevertheless, most patients with PND still undergo surgery in order to rule out malignancy. Ductoscopy is a minimally invasive endoscopic technique that enables direct intraductal visualization. The aim of this study was to evaluate (interventional) ductoscopy as an alternative to surgery in patients with negative conventional imaging. Materials and Methods: All patients with PND referred between 2010 and 2017 to our hospital for ductoscopy were retrospectively analyzed. Ductoscopy procedures were performed under local anesthesia in the outpatient clinic. The follow-up period was at least 3 months, and the primary outcome was the number of prevented surgical procedures. Furthermore, we evaluated possible complications after ductoscopy (infection and pain). Results: A total of 215 consecutive patients undergoing ductoscopy were analyzed. In 151 (70.2%) patients, ductoscopy was successful. In 102 procedures, an underlying cause for PND was visualized, of which 34 patients could be histologically proven and 82 patients treated. Sixty of the 215 patients were eventually operated, 8 owing to suspicious findings during ductoscopy, 42 owing to persistent PND, and 10 because of recurrent PND. In 7 patients, a malignancy was found (5 of them classified as suspicious at dusctoscopy). No serious side effects were seen. Conclusion: Ductoscopy can be safely used as an alternative for surgery in the workup for PND.

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“…45 Recent research efforts have focused on the development of a breast cancer CPR for use in primary care to aid these referral decisions. 46 However, although this CPR underwent methodologically robust development and demonstrates good predictive accuracy it is unlikely its use will impact on referral rates. This is due largely to the existence of a low-risk threshold for referral driven by a combination of factors including patient expectation, media interest and fears of medicolegal ramifications for clinicians if a diagnosis is missed.…”

Section: Discussionmentioning

confidence: 99%

Impact analysis studies of clinical prediction rules relevant to primary care: a systematic review

et al. 2016

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ObjectivesFollowing appropriate validation, clinical prediction rules (CPRs) should undergo impact analysis to evaluate their effect on patient care. The aim of this systematic review is to narratively review and critically appraise CPR impact analysis studies relevant to primary care.SettingPrimary care.ParticipantsAdults and children.InterventionStudies that implemented the CPR compared to usual care were included.Study designRandomised controlled trial (RCT), controlled before–after, and interrupted time series.Primary outcomePhysician behaviour and/or patient outcomes.ResultsA total of 18 studies, incorporating 14 unique CPRs, were included. The main study design was RCT (n=13). Overall, 10 studies reported an improvement in primary outcome with CPR implementation. Of 6 musculoskeletal studies, 5 were effective in altering targeted physician behaviour in ordering imaging for patients presenting with ankle, knee and neck musculoskeletal injuries. Of 6 cardiovascular studies, 4 implemented cardiovascular risk scores, and 3 reported no impact on physician behaviour outcomes, such as prescribing and referral, or patient outcomes, such as reduction in serum lipid levels. 2 studies examined CPRs in decision-making for patients presenting with chest pain and reduced inappropriate admissions. Of 5 respiratory studies, 2 were effective in reducing antibiotic prescribing for sore throat following CPR implementation. Overall, study methodological quality was often unclear due to incomplete reporting.ConclusionsDespite increasing interest in developing and validating CPRs relevant to primary care, relatively few have gone through impact analysis. To date, research has focused on a small number of CPRs across few clinical domains only.

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Development and validation of a clinical prediction rule to identify suspected breast cancer: a prospective cohort study

Cited by 19 publications

References 26 publications

Reported breast symptoms in the National Breast and Cervical Cancer Early Detection Program

Reported breast symptoms in the National Breast and Cervical Cancer Early Detection Program

Interventional Ductoscopy as an Alternative for Major Duct Excision or Microdochectomy in Women Suffering Pathologic Nipple Discharge: A Single-center Experience

Impact analysis studies of clinical prediction rules relevant to primary care: a systematic review

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