title: Evaluation of clinical breast examination and breast ultrasonography among pregnant women in Abakaliki, Nigeria.
abstract: BACKGROUND
  Breast cancer in pregnancy accounts for 2%-3% of all breast cancers. The increased vascularity and lymphatic drainage from the breast during pregnancy potentiate the metastatic spread of the cancer to the regional lymph nodes. However, the increased breast density in pregnancy makes it difficult to detect breast lesions early.
  
  
  OBJECTIVE
  To evaluate and compare the detection rate of breast lesions using clinical breast examination (CBE) and breast ultrasonography among pregnant women.
  
  
  METHODS
  A cross-sectional comparative study involving antenatal clinic attendees at the Federal Teaching Hospital, Abakaliki, was conducted between March 3, 2014, and December 31, 2014. CBE and breast ultrasonography were done in the participants at booking and repeated at 6 weeks postpartum. Fine-needle aspiration cytology and histology were done in women with suspicious breast lesions on CBE or breast ultrasonography or both. Data analysis was both descriptive and inferential at the 95% confidence level using the Statistical Package for the Social Sciences (SPSS) software version 17.0. Test of significance was done using chi-square test. A P-value of less than or equal to 0.05 was considered statistically significant.
  
  
  RESULTS
  A total of 320 pregnant women participated in the study. Of these, 267 (83.4%) were aware of breast cancer. Although more lesions were detected with breast ultrasonography than by CBE, there was no statistically significant difference between them (25 versus 17; P=0.26). The histology of the lesions revealed 21 benign lesions and 4 normal breast tissues. The sensitivity of breast ultrasonography was 95.2%, while that of CBE was 66.7%. The specificity, positive predictive value, and negative predictive value were similar between CBE and breast ultrasonography.
  
  
  CONCLUSIONS
  The detection rates of breast lesions by both CBE and breast ultrasonography were equivalent during pregnancy and 6 weeks postpartum, making CBE a convenient and very cost-effective method of detecting breast lesions in the low-risk population. However, both CBE and breast ultrasonography should be done in women with high risk of breast malignancy.
authors.affiliation: Department of Obstetrics and Gynecology, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.
authors.forename: Paul Olisaemeka
authors.initials: PO
authors.lastname: Ezeonu
authors.affiliation: Department of Obstetrics and Gynecology, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.
authors.forename: Leonard Ogbonna
authors.initials: LO
authors.lastname: Ajah
authors.affiliation: Department of Obstetrics and Gynecology, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.
authors.forename: Robinson Chukwudi
authors.initials: RC
authors.lastname: Onoh
authors.affiliation: Department of Obstetrics and Gynecology, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.
authors.forename: Lucky Osaheni
authors.initials: LO
authors.lastname: Lawani
authors.affiliation: Department of Surgery, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.
authors.forename: Vincent Chidi
authors.initials: VC
authors.lastname: Enemuo
authors.affiliation: Department of Obstetrics and Gynecology, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.
authors.forename: Uzoma MaryRose
authors.initials: UM
authors.lastname: Agwu
keywords: Nigeria; breast lesion; breast ultrasonography; clinical breast examination; pregnant women