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

• Published in: PloS one Vol. 16; no. 6; p. e0252902
• Main Authors: 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
• Format: Journal Article
• Language: English
• Published: San Francisco Public Library of Science 11-06-2021; Public Library of Science (PLoS)
• Subjects: Accuracy; Algorithms; Biopsy; Breast cancer; Data analysis; Data collection; Decision making; Diagnosis; Diagnosis, Ultrasonic; Drafting software; Editing; Evaluation; Global health; Health care facilities; Health facilities; Local communities; Mammography; Medical diagnosis; Medical imaging; Medicine and Health Sciences; Methodology; Midwifery; Patients; People and Places; Physicians; Primary care; Public health; Quality assurance; Quality control; Radiology; Research and Analysis Methods; Surgeons; Training; Ultrasonic imaging; Ultrasound; Womens health; Peru; San Francisco California; California; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0252902

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.