University of Arkansas for Medical Sciences, Department of Surgery, Winthrop P Rockefeller Cancer Institute, Little Rock, AR.
Biamba Marie Mutombo Hospital, Democratic Republic of the Congo.
J Am Coll Surg. 2021 Apr;232(4):636-640. doi: 10.1016/j.jamcollsurg.2020.12.008. Epub 2020 Dec 19.
The vast majority of women with breast cancer in sub-Saharan Africa present with advanced stage disease, due primarily to the lack of opportunities for early detection and treatment. As part of a larger effort to increase access to diagnostic and therapeutic services for women's cancers in the Democratic Republic of Congo (DRC), we implemented a curriculum to train the local workforce and a program to build the supportive infrastructure for the diagnosis and treatment of breast cancer at a private sector health facility (Biamba Marie Mutombo Hospital) in Kinshasa.
After onsite trainings in the DRC by a US breast surgeon (RT), Congolese surgeons, general physicians, physician assistants, and nurses used the Phillips Lumify smart-phone ultrasound device to perform and interpret the results of whole breast ultrasound on symptomatic women. Surgeons were trained to perform ultrasound-guided core needle biopsy on those who met the criteria for tissue diagnosis, after which they trained nurses to do the same.
Over 3 years, 5,211 patients were identified as having a breast abnormality on clinical breast examination. Ultrasound abnormalities were noted in 1,493 (27%) patients, of which 632 (42%) met the criteria for ultrasound-guided core needle biopsy or fine needle aspiration. Pathology reports were available on 368 (58%) patients who underwent biopsy, of which 164 were malignant and 204 benign.
We demonstrated how the "ability to look" using smart technology can be successfully used to augment clinical breast exam and triage patients for biopsy in a resource-constrained African setting.
撒哈拉以南非洲绝大多数乳腺癌女性患者处于晚期疾病阶段，主要原因是缺乏早期发现和治疗的机会。作为在刚果民主共和国（DRC）扩大获得女性癌症诊断和治疗服务机会的更大努力的一部分，我们实施了一项培训当地劳动力的课程，并制定了一个计划，为金沙萨一家私营部门医疗机构（Biamba Marie Mutombo 医院）的乳腺癌诊断和治疗建立支持性基础设施。
在美国乳腺外科医生（RT）在 DRC 进行现场培训后，刚果外科医生、普通医生、医师助理和护士使用 Phillips Lumify 智能手机超声设备对有症状的女性进行全乳房超声检查并解释结果。外科医生接受了培训，以便对符合组织诊断标准的患者进行超声引导下核心针活检，之后他们培训护士进行同样的操作。
在 3 年的时间里，有 5211 名患者在临床乳房检查中被确定为患有乳房异常。在 1493 名（27%）患者中发现了超声异常，其中 632 名（42%）符合超声引导下核心针活检或细针抽吸的标准。对接受活检的 368 名（58%）患者进行了病理报告，其中 164 名是恶性的，204 名是良性的。
我们展示了如何在资源有限的非洲环境中，成功地使用智能技术的“观察能力”来增强临床乳房检查，并对活检患者进行分诊。
