Relation between clinical and mammographic diagnosis of breast problems and the cancer/biopsy rate.
OBJECTIVE
To determine the sensitivity of mammographic and clinical assessment of breast problems, independent of one another, on the ratio of cancers found to biopsies performed (cancer/biopsy rate).


METHODS
A review of diagnoses from prospectively recorded and independently assessed clinical and mammographic examinations.


METHODS
The breast clinic in a university-affiliated hospital.


METHODS
Patients were considered in two age groups--under 50 years and over; 1251 patients underwent breast biopsy between September 1976 and November 1994 after clinical assessment and mammography.


METHODS
The cancer diagnosis rate found on biopsy as a result of clinical and mammographic findings.


RESULTS
In both age groups, mammography was significantly (p < 0.001) more sensitive than clinical assessment in cancer diagnosis but gave a significantly (p < 0.0001) higher rate of false-positive results. The cancer diagnosis rate was highest when lesions were assessed both clinically and mammographically as malignant but was of diagnostic benefit only to women in the under-50-year age group. The cancer rate was 12% when both assessments indicated a benign process and only 2% in women under age 50 years with clinically benign conditions who did not have mammography. Twenty-one percent of the biopsies were obtained in women with clinically normal breasts because of a mammographic abnormality and 17% of all the cancers found were clinically occult.


CONCLUSIONS
The sensitivity of clinical assessment, particularly in premenopausal women is low and the false-positive mammography rate is high, but the cancer/biopsy rate is sufficiently high to warrant breast biopsy if either diagnostic modality suggests a cancer. When neither modality suggests cancer, the cancer/biopsy rate is 12% in both age groups.
Sterns
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Department of Surgery, Queen's University, Kingston, Ont.
D000328:Adult; D001707:Biopsy, Needle / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D016022:Case-Control Studies; D005189:False Positive Reactions; D005260:Female; D018226:Fibroadenoma / Q000175:diagnosis / Q000453:epidemiology; D005348:Fibrocystic Breast Disease / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D066298:In Vitro Techniques; D008327:Mammography / Q000706:statistics & numerical data; D008875:Middle Aged; D017698:Postmenopause; D017697:Premenopause; D011446:Prospective Studies; D012017:Referral and Consultation; D012680:Sensitivity and Specificity