Visual analogue scale for assessing breast nodularity in non-discrete lumpy breasts: the Lucknow-Cardiff breast nodularity scale.
BACKGROUND
Objective measurement of benign non-discrete lumpy breasts is not performed routinely that would lead to disease measurement, inter-physician communication, therapeutic response assessment and a normative function of reducing unnecessary biopsies. A schematic 5-point ordinal visual analogue scale was developed.


METHODS
Two blinded experienced clinicians graded breast nodularity on a pre-determined five point analogue scale (grades 0-4) to determine its inter-observer reliability after its face validity that excluded inflammatory, nipple, areola and discrete lump problems.


RESULTS
784 Women (hospital 384; community 400) aged between 20 and 70 years (mean 31.9) underwent physical breast examination by 2 experienced clinicians. Inter-observer matched nodularity grading in women attending hospital were Grade 0 in 123 (32.03%), grade 1 in 67 (17.44%), grade 2 in 54 (14.06%), grade 3 in 52 (13.54%) and grade 4 in 23 (5.99%) and in community it was grade 0 in 172 (43%), grade 1 in 88 (22%), grade 2 in 60 (15%), grade 3 in 28 (7%) and grade 4 in 14 (3.5%) women. There was very good agreement (kappa = 0.7798) across all grades in hospital subjects and excellent agreement (kappa = 0.8659) in community subjects. Both estimates of kappa coefficients were highly significant from population kappa coefficient of zero (p < 0.001). Overall, 1/3rd normal women have absolutely smooth textured breasts.


CONCLUSIONS
User-friendly tool developed for objective evaluation of non-discrete lumpy breasts showed excellent reliability and validity. This tool should be useful for clinical drug trials in benign breast disorders and for wide routine clinical recording of patients.
Kumar
Sandeep
S
Department of Surgery, King George's Medical University, Lucknow, UP, India. k_sandeep@hotmail.com
Rai
Ruchi
R
Das
Vinita
V
Kumar
Surender
S
Dwivedi
Varsha
V
Agrawal
G G
GG
D000328:Adult; D000368:Aged; D001941:Breast Diseases / Q000473:pathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D015588:Observer Variation; D010147:Pain Measurement; D010808:Physical Examination; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D055815:Young Adult