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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...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2021
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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. |
format | Online Article Text |
id | pubmed-8195385 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
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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