Diagnostic efficacy of physical examination and radiological findings in palpable breast masses

Year 2022, Volume: 13 Issue: 2, 269 - 274, 30.06.2022

Ecem Memişoğlu , Ramazan Sarı , Yasin Tosun , Bağış Taşdoğan , Günay Rona

https://doi.org/10.18663/tjcl.1102235

Abstract

Aim: Clinical breast examination (CBE) is important in the early diagnosis of breast cancer, especially in low- and middleincome countries. Tru-cut biopsy (TCB) is the most used method for pathological diagnosis in patients with breast mass.
This study aimed to evaluate the advantages and diagnostic accuracy of TCB decision based on CBE in patients presenting
with a breast mass.
Material and Methods: In this prospective cohort study, the data of patients who admitted to our outpatient breast
clinic between September 2020 and March 2021 were evaluated. The presenting complaints, family history, hormone
replacement treatment, mass size, contour, mobility, radiological findings, BI-RADS classification, and pathological
diagnosis of TCB were recorded. Two hundred- two patients who underwent TCB in our outpatient breast clinic were
included in the study.
Results: The presence of irregular and fixed mass was mainly observed in the malignant group compared to the benign
group (67.1% vs 43.9%, P: 0.001; 75.9% vs 39%, P< 0.001, respectively). In regression analysis, age was significantly
associated with breast malignancy (OR: 1.12, CI %95: 1.06-1.18). CBE showed 85.5% consistency for benign pathology,
88.5% for malignancy, and 90.2% for granulomatous breast mass.
Conclusion: The patients in advanced age and postmenopausal condition with irregularly, fixed breast mass in physical
examination should be considered at high risk for breast cancer. TCB should be performed by experienced surgeons in lowmiddle-income countries and the diagnosis should be reached by reducing the long time and cost caused by radiology.

Keywords

Breast cancer, Breast mass, Clinical breast examination, Tru-cut biopsy.

Palpabl meme kitlelerinde fizik muayene ve radyolojik bulguların tanısal gücü

Abstract

Amaç: Klinik meme muayenesi (KMM), özellikle düşük ve orta gelirli ülkelerde meme kanserinin erken tanısında önemlidir.
Tru-cut biyopsi (TCB), meme kitlesi olan hastalarda patolojik tanı için en sık kullanılan yöntemdir. Bu çalışmada meme kitlesi
ile başvuran hastalarda KMM'ye dayalı TCB kararının avantajlarını ve tanısal doğruluğunu değerlendirmeyi amaçladık.
Gereç ve Yöntemler: Bu prospektif kohort çalışmada, meme polikliniğimize Eylül 2020 ile Mart 2021 tarihleri arasında
başvuran hastaların verileri değerlendirildi. Başvuru şikayetleri, aile öyküsü, hormon replasman tedavisi, kitle boyutu,
kontur, mobilite, radyolojik bulgular, BI-RADS sınıflaması ve TCB'nin patolojik tanısı kaydedildi. Çalışmaya meme
polikliniğimizde TCB uygulanan toplam 200 hasta dahil edildi.
Bulgular: Malign grupta düzensiz ve fikse kitle varlığı Benign gruba kıyasla daha fazla gözlendi (sırasıyla %67.1'e %43.9, P:
0.001; %75.9'a %39, P< 0.001). Regresyon analizinde yaş, meme malignitesi ile anlamlı olarak ilişkiliydi (OR: 1.12, CI %95: 1.06-
1.18). KMM, benign patoloji için %85,5, malignite için %88,5 ve granülomatöz meme kitlesi için %90,2 tutarlılık gösterdi.
Sonuç: Fizik muayenede düzensiz sınırlı, fikse meme kitlesi saptanan ileri yaş ve postmenopozal hastalar meme kanseri
görülmesi açısından yüksek riskli kabul edilmelidir. TCB, düşük-orta gelirli ülkelerde deneyimli cerrahlar tarafından
uygulanmalı ve radyolojinin neden olduğu zaman kaybı ve maliyet azaltılarak kısa sürede tanıya ulaşılmalıdır.

Keywords

Meme kanseri, Meme kitlesi, Klinik meme muayenesi, Tru-cut biyopsi.

References

• 1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68: 394–424.
• 2. Rikabi A, Hussain S. Diagnostic Usefulness of Tru-Cut Biopsy in the Diagnosis of Breast Lesions. Oman Med J. 2013; 28: 125-7.
• 3. Ilbawi AM, Anderson BO. Cancer in global health: how do prevention and early detection strategies relate? Sci Transl Med. 2015; 7: 278.
• 4. Kurita T, Tsuchiya S, Watarai Y, et al. Roles of fine-needle aspiration and core needle biopsy in the diagnosis of breast cancer. Breast Cancer. 2012; 19: 23-9.
• 5. Gyawali B, Shimokata T, Honda K, et al. Should low-income countries invest in breast cancer screening? Cancer Causes Control. 2016; 27: 1341–5.
• 6. Ginsburg OM. Breast and cervical cancer control in low and middle-income countries: human rights meet sound health policy. J Cancer Policy. 2013; 1: 35–41.
• 7. Dugoff L, Pradhan A, Casey P, et al. Pelvic and breast examination skills curricula in United States medical schools: a survey of obstetrics and gynecology clerkship directors. BMC Med Educ. 2016; 16: 314.
• 8. Sickles EA, D’Orsi CJ, Bassett LW. ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System. Reston, VA: American College of Radiology; 2013. ACR BI-RADS® Mammography. Available from: https://www.acr.org/-/media/ACR/Files/RADS/ BI-RADS/Mammography-Reporting.pdf
• 9. Ntirenganya F, Twagirumukiza JD, Bucyibaruta G, et al. Premenopausal Breast Cancer Risk Factors and Associations with Molecular Subtypes: A Case-Control Study. Int J Breast Cancer. 2021 ; 2021: 5560559.
• 10. Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin. 2017; 67: 7-30.
• 11. Unger-Saldaña K. Challenges to the early diagnosis and treatment of breast cancer in developing countries. World J Clin Oncol. 2014; 5: 465–77.
• 12. IARC Working Group on the Evaluation of Cancer-Preventive Interventions. Breast cancer screening. Lyon (FR): International Agency for Research on Cancer; 2016. Available from: https:// www.ncbi.nlm.nih.gov/books/NBK546556/
• 13. Nelson HD, Tyne K, Naik A, et al. Screening for Breast Cancer: Systematic Evidence Review Update for the US Preventive Services Task Force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2009 Nov. Report No.: 10-05142-EF-1.
• 14. NganTT, Nguyen NTQ, Minh HV, Donnelly M, O’Neill C. Effectiveness of clinical breast examination as a ‘stand-alone’ screening modality: an overview of systematic reviews. BMC Cancer. 2020; 20: 1070.
• 15. Duffy SW, Tabar L, Vitak B, Warwick J. Tumor size and breast cancer detection: what might be the effect of a less sensitive screening tool than mammography? Breast J. 2006; 12: 91–5.
• 16. Alba LH, Díaz S, Gamboa O, et al. Accuracy of mammography and clinical breast examination in the implementation of breast cancer screening programs in Colombia. Preventive Medicine. 2018; 115: 19–25.
• 17. Pistolese CA, Lamacchia F, Tosti D, et al. Reducing the Number of Unnecessary Percutaneous Biopsies: The Role of Second Opinion by Expert Breast Center Radiologists. Anticancer Res. 2020; 40: 939-50.