Department of Breast and General Surgery, Hereford County Hospital, Hereford, UK.
Int J Clin Pract. 2010 Mar;64(4):439-41. doi: 10.1111/j.1742-1241.2009.02257.x. Epub 2009 Dec 8.
A breast lump is the most commonly presenting complaint given by GPs when making a referral to the local breast unit. This does not necessarily mean that this was the breast symptom for which the woman consulted her GP. This study aimed to assess the accuracy of women and their GPs in detecting true breast lumps.
Between October 2008 and March 2009, the patients' symptoms, the signs elicited by the GP and the examination findings of the specialist breast clinician (BC) were recorded and compared for every consecutive new referral to the symptomatic breast clinic. A true lump was considered to present if it was detectable by the BC.
Of the 282 referrals, 228 (81%) were for a lump. Women were 95% sensitive and 59% specific in detecting a true lump. GPs were 98% sensitive and 34% specific. Forty-six patients were referred by their GP with a lump but denied that one was present in themselves. Cancer was diagnosed in four of these women, three of whom suffered from dementia.
Patients' and GPs' breast assessments are highly sensitive in detecting breast lumps. The specificity of GPs' assessments is low. The results reflect the high level of awareness that breast cancer usually presents as a lump and the priority given to not missing cancer. In the subgroup of cognitively unimpaired women referred with a lump, but who themselves deny that one is present, the patient will be correct and the GP incorrect in their assessment in 96% and 95% of patients respectively.
If a woman consults her GP with breast symptoms, but has not found a lump, it is safe for her GP not to find one either. Such patients can be reassured and reviewed after a month with a view to referral, if symptoms persist.
当全科医生（GP）将患者转介到当地乳腺科时，乳腺肿块是最常见的主诉。但这并不一定意味着这是女性就诊的主要乳腺症状。本研究旨在评估女性及其 GP 检测真正乳腺肿块的准确性。
在 2008 年 10 月至 2009 年 3 月期间，记录了每位新转诊到乳腺症状诊所患者的症状、GP 引出的体征以及专科乳腺临床医生（BC）的检查结果，并进行了比较。如果 BC 能检测到肿块，则认为存在真正的肿块。
在 282 例转诊中，228 例（81%）为肿块。女性检测真正肿块的敏感性为 95%，特异性为 59%。GP 的敏感性为 98%，特异性为 34%。46 例患者由 GP 转诊，称有肿块，但本人否认存在。其中 4 例被诊断为癌症，其中 3 例患有痴呆症。
患者和 GP 对乳腺的评估在检测乳腺肿块方面具有高度敏感性。GP 评估的特异性较低。这些结果反映了人们普遍认为乳腺癌通常表现为肿块，并且非常重视不遗漏癌症。在认知无障碍且被 GP 转诊有肿块但本人否认存在的女性亚组中，患者的评估将是正确的，而 GP 的评估在 96%和 95%的患者中分别是错误的。
如果女性因乳腺症状就诊，但未触及肿块，那么 GP 未触及肿块也是安全的。对于这些患者，可以在一个月后进行复查，如果症状持续存在，则可以考虑转诊。
