TITLE:
The Value of Clinical Breast Examination, Imaging, and Fine Needle Aspiration and the Challenge of Diagnosing Breast Cancer in a Low Resource Setting: A Hospital-Based Analytical Study in Yaounde
AUTHORS:
C. E. Ebong, N. J. D. Kemfang, E. Atenguena, F. Essiben, J. H. Fouedjio, A. Ngassam, S. Nyada, N. F. Mangala, A. N. Ngalame, J. T. Fouogue, S. Dohbit
KEYWORDS:
Breast Cancer, Lump, Clinical Breast Examination, Breast Ultrasound, Mam-mography, Fine Needle Aspiration, Accuracy, Cameroon
JOURNAL NAME:
Advances in Breast Cancer Research,
Vol.11 No.3,
July
7,
2022
ABSTRACT: Background: Breast cancer is the most common cancer in the world, as well as in
Cameroon, where it represents about 20.1% of all cancers recorded in 2020. The
number of pathologists in the country is as few as seven for a population of
about 26 million. The diagnostic performances of diagnostic modalities other
than histology—clinical breast examination (CBE), imaging and fine needle
aspiration and cytology (FNA)—in our context are not known. Study Objectives: Our objectives were to estimate the proportions of cases managed with
mammography, breast ultrasound and FNA and to estimate the sensitivity,
specificity, positive and negative predictive values, and accuracy of CBE,
mammography, breast ultrasound and FNA; using histology as reference. Study Methodology: The study was cross-sectional and analytical, and was
carried out at the Yaoundé General Hospital. It lasted twelve months, April
2015 through March 2016 and covered the period January 2010 to February 2016.
Using histology as reference, we calculated measures of diagnostic accuracy for
all four modalities using the statistical methods of Galen and Gambino. Results: We recruited 107 cases, 105 females (98.1%) and 02 males. We had 112 breast
lumps, 106 malignant (94.6%) and 6 benign. The mean lump size was 61.1 mm. The
most frequently used diagnostic tool after CBE was FNA (49.1%), while the
diagnostic accuracies were 76.8%, 79.1%, 82.9%, and 82.0% for CBE, breast US,
mammography and FNA. Conclusion: The
four baseline diagnostic modalities for breast cancer are used sub-optimally and FNA appears to be the most commonly used in our setting after CBE. We
recommend that FNA should be considered for diagnosis as appropriate but a
negative result should not stop the quest for histological elimination of
presence of malignancy.