Physical Breast Exam + Ultrasound
The Efficacy of Clinical Breast Exams and Breast Self-Exams in Detecting Malignancy or Positive Ultrasound Findings Huang N, Chen L, He J, et al. (February 21, 2022) Cureus 14(2): e22464. doi:10.7759/cureus.22464
1. Internal Medicine, University of Texas (UT) Dell Medical School, Austin, USA 2. Biostatistics and Epidemiology, University of Texas Medical Branch (UTMB), Galveston, 3. Pathology, University of Texas Medical Branch (UTMB), Galveston, 4. Radiology, Baylor College of Medicine, Houston,
A breast exam is a low-risk, low-cost method for early detection, which is crucial for improved mortality. However, clinical breast exams (CBE) and breast self-exams (BSEs) remain controversial with unclear guidelines. This study analyzes the efficacy of these two exam types in evaluating palpable breast masses. Methods This retrospective cross-sectional study included 2019 medical records from Epic of women with breast lumps. Patient demographics, provider types, and breast exam types were recorded. Primary outcomes were detection of cancer and positive ultrasound finding. Fisher’s exact tests and two-sample t-tests determined the statistical significance of the association between the outcomes and categorical and continuous variables.
Of 462 breast masses, 69 demonstrated positive ultrasound findings, with 26 of those yielding cancer; 96% of cancers and 81% of ultrasound findings resulted from patient-identified lumps. Of provider-identified lumps, 100% of cancers and 92.3% of positive ultrasound findings were diagnosed by MDs (doctors of medicine) rather than midlevel providers. There was no statistically significant difference in identifying cancer or positive ultrasound finding between CBEs and BSEs (p = 0.3709 and p = 0.1556).
Despite no difference between CBEs and BSEs in identifying cancer or positive ultrasound finding, 25 of the 26 breast cancers were initially detected by patients, while only one of 26 was detected by CBE. Although some guidelines encourage CBEs over self-exams, not all CBEs are equal. “
Breast Cancer Subtype Influences the Accuracy of Predicting Pathologic Response by Imaging and Clinical Breast Exam After Neoadjuvant Chemotherapy. Anticancer Res. 2016 Oct;36(10)
“Clinical response evaluation by CBE was highly accurate for predicting pathologic residual disease in HR+ tumors (CBE PPV: 95.5% in HR+HER2-, 100.0% in HR+HER2+). In triple-negative breast cancer (TNBC), the imaging NPV was 100% and the imaging FNR was 0%. CONCLUSION: The use of imaging in HR+ tumors post-NACT may provide little to no additional value that is not already garnered by performance of a CBE. For TNBC, imaging may play a critical role in the prediction of pathologic complete response (pCR) post-NACT.” (emphasis bold added)
Palpable discrete breast masses in young women: Two of the components of the modified triple test may be adequate S. Afr. j. surg. vol.51 n.2 Jan. 2013
“Palpable breast masses in young women, though usually benign, are a common source of anxiety. …This study shows that the concordant MTT for the diagnosis of palpable discrete breast masses in women below the age of 35 years is reproducible and yields high diagnostic accuracy. Of the elements of the MTT, FNAC was the most predictive. CONCLUSION: The combinations of CBE plus ultrasound and CBE plus FNAC have high PPVs and NPVs with almost similar concordance in this population, suggesting that they can be used for diagnosis and therefore could be modeled for use in patients choosing between conservative care and excision. “ (emphasis bold added)
Clinical Data as an Adjunct to Ultrasound Reduces the False-Negative Malignancy Rate in BI-RADS 3 Breast Lesions. Ultrasound Int Open. 2016 Sep;2(3)
“Ultrasound (US) is a well-established diagnostic procedure for breast examination. We investigated the malignancy rate in solid breast lesions according to their BI-RADS classification with a particular focus on false-negative BI-RADS 3 lesions. …Clinical criteria including age, family and personal history, clinical examination, mammography and patient choice ensure adequate diagnostic procedures.” (emphasis bold added)
“After a short training interval averaging 90 minutes (range: 62 to 145 minutes), the Florida participants’ mean true positive detections (sensitivity) doubled, (p<0.001). False positive detections reduced by half, (p=0.02) and exam thoroughness (area palpated), increased from 63% pretest to 96% posttest, (p<0.001). Mayo residents’ true positives increased from a mean of 68% to 90%, (p<0.001). …” (emphasis bold added)
An Effective Multimodal Curriculum to Teach Internal Medicine Residents Evidence-Based Breast Health.J Grad Med Educ. 2014 Dec;6(4):721-5.
“Breast health is an area fraught with controversy and missed opportunities to meet women’s needs, and the state of internal medicine residency training in this area is inadequate. Our objective was to develop, implement, and evaluate a curriculum to equip internal medicine residents with the knowledge and skills to deliver high-quality, comprehensive breast health care.”…
“We developed a 4-hour curriculum for internal medicine interns. It incorporated a team-based learning format and used MammaCare breast model software to teach and evaluate the clinical breast examination. We compared interns’ precurriculum and postcurriculum test results to a historical comparison group of postgraduate year (PGY)-2 interns who did not complete the curriculum. We retested interns as PGY-2s to assess knowledge retention.”…
“A total 41 of 52 interns (79%) completed the curriculum. Their average MammaCare scores improved from 63% to 91%. Scores on a knowledge-based assessment improved from 47% on the pretest to 85% on the posttest (P < .001). Comparison PGY-2s who did not complete the curriculum averaged a score of 52% (P < .001). When retested 9 months after exposure to the curriculum, participants’ mean score was 63% (compared to historical comparison PGY-2 group, P < .001). Only 9% of interns who retook the test as PGY-2s reported having received any breast health training subsequent to curriculum completion.”…
“A targeted half-day, low-cost breast health curriculum significantly improved knowledge and skills in multiple domains, and these improvements were retained in subsequent assessment despite minimal reinforcement in residency training.” (emphasis bold added)
Funded in part by the National Science Foundation
1. The Mammacare Foundation 930 NW 8th Avenue, Gainesville, Florida 32601, contact: firstname.lastname@example.org