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Evaluation of diagnostic ultrasound use in a breast cancer detection strategy in Northern Peru

To evaluate the diagnostic impact of point-of-care breast ultrasound by trained primary care physicians (PCPs) as part of a breast cancer detection program using clinical breast exam in an underserved region of Peru. Medical records and breast ultrasound images of symptomatic women presenting to the...

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Autores principales: Aklilu, Segen, Bain, Carolyn, Bansil, Pooja, de Sanjose, Silvia, Dunstan, Jorge A., Castillo, Vanesa, Tsu, Vivien, Contreras, Ines, Balassanian, Ronald, Hayes Constant, Tara K., Scheel, John R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8195385/
https://www.ncbi.nlm.nih.gov/pubmed/34115775
http://dx.doi.org/10.1371/journal.pone.0252902
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author Aklilu, Segen
Bain, Carolyn
Bansil, Pooja
de Sanjose, Silvia
Dunstan, Jorge A.
Castillo, Vanesa
Tsu, Vivien
Contreras, Ines
Balassanian, Ronald
Hayes Constant, Tara K.
Scheel, John R.
author_facet Aklilu, Segen
Bain, Carolyn
Bansil, Pooja
de Sanjose, Silvia
Dunstan, Jorge A.
Castillo, Vanesa
Tsu, Vivien
Contreras, Ines
Balassanian, Ronald
Hayes Constant, Tara K.
Scheel, John R.
author_sort Aklilu, Segen
collection PubMed
description To evaluate the diagnostic impact of point-of-care breast ultrasound by trained primary care physicians (PCPs) as part of a breast cancer detection program using clinical breast exam in an underserved region of Peru. Medical records and breast ultrasound images of symptomatic women presenting to the Breast Cancer Detection Model (BCDM) in Trujillo, Peru were collected from 2017–2018. Performance was measured against final outcomes derived from regional cancer center medical records, fine needle aspiration results, patient follow-up (sensitivity, specificity, positive, and negative predictive values), and by percent agreement with the retrospective, blinded interpretation of images by a fellowship-trained breast radiologist, and a Peruvian breast surgeon. The diagnostic impact of ultrasound, compared to clinical breast exam (CBE), was calculated for actual practice and for potential impact of two alternative reporting systems. Of the 171 women presenting for breast ultrasound, 23 had breast cancer (13.5%). Breast ultrasound used as a triage test (current practice) detected all cancer cases (including four cancers missed on confirmatory CBE). PCPs showed strong agreement with radiologist and surgeon readings regarding the final management of masses (85.4% and 80.4%, respectively). While the triage system yielded a similar number of biopsies as CBE alone, using the condensed and full BI-RADS systems would have reduced biopsies by 60% while identifying 87% of cancers immediately and deferring 13% to six-month follow-up. Point-of-care ultrasound performed by trained PCPs improves diagnostic accuracy for managing symptomatic women over CBE alone and enhances access. Greater use of BI-RADS to guide management would reduce the diagnostic burden substantially.
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spelling pubmed-81953852021-06-21 Evaluation of diagnostic ultrasound use in a breast cancer detection strategy in Northern Peru Aklilu, Segen Bain, Carolyn Bansil, Pooja de Sanjose, Silvia Dunstan, Jorge A. Castillo, Vanesa Tsu, Vivien Contreras, Ines Balassanian, Ronald Hayes Constant, Tara K. Scheel, John R. PLoS One Research Article To evaluate the diagnostic impact of point-of-care breast ultrasound by trained primary care physicians (PCPs) as part of a breast cancer detection program using clinical breast exam in an underserved region of Peru. Medical records and breast ultrasound images of symptomatic women presenting to the Breast Cancer Detection Model (BCDM) in Trujillo, Peru were collected from 2017–2018. Performance was measured against final outcomes derived from regional cancer center medical records, fine needle aspiration results, patient follow-up (sensitivity, specificity, positive, and negative predictive values), and by percent agreement with the retrospective, blinded interpretation of images by a fellowship-trained breast radiologist, and a Peruvian breast surgeon. The diagnostic impact of ultrasound, compared to clinical breast exam (CBE), was calculated for actual practice and for potential impact of two alternative reporting systems. Of the 171 women presenting for breast ultrasound, 23 had breast cancer (13.5%). Breast ultrasound used as a triage test (current practice) detected all cancer cases (including four cancers missed on confirmatory CBE). PCPs showed strong agreement with radiologist and surgeon readings regarding the final management of masses (85.4% and 80.4%, respectively). While the triage system yielded a similar number of biopsies as CBE alone, using the condensed and full BI-RADS systems would have reduced biopsies by 60% while identifying 87% of cancers immediately and deferring 13% to six-month follow-up. Point-of-care ultrasound performed by trained PCPs improves diagnostic accuracy for managing symptomatic women over CBE alone and enhances access. Greater use of BI-RADS to guide management would reduce the diagnostic burden substantially. Public Library of Science 2021-06-11 /pmc/articles/PMC8195385/ /pubmed/34115775 http://dx.doi.org/10.1371/journal.pone.0252902 Text en © 2021 Aklilu et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Aklilu, Segen
Bain, Carolyn
Bansil, Pooja
de Sanjose, Silvia
Dunstan, Jorge A.
Castillo, Vanesa
Tsu, Vivien
Contreras, Ines
Balassanian, Ronald
Hayes Constant, Tara K.
Scheel, John R.
Evaluation of diagnostic ultrasound use in a breast cancer detection strategy in Northern Peru
title Evaluation of diagnostic ultrasound use in a breast cancer detection strategy in Northern Peru
title_full Evaluation of diagnostic ultrasound use in a breast cancer detection strategy in Northern Peru
title_fullStr Evaluation of diagnostic ultrasound use in a breast cancer detection strategy in Northern Peru
title_full_unstemmed Evaluation of diagnostic ultrasound use in a breast cancer detection strategy in Northern Peru
title_short Evaluation of diagnostic ultrasound use in a breast cancer detection strategy in Northern Peru
title_sort evaluation of diagnostic ultrasound use in a breast cancer detection strategy in northern peru
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8195385/
https://www.ncbi.nlm.nih.gov/pubmed/34115775
http://dx.doi.org/10.1371/journal.pone.0252902
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