Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Department of Pathology, University of California San Francisco, San Francisco, CA.
JCO Glob Oncol. 2021 Jan;7:146-152. doi: 10.1200/GO.20.00279.
Clinical breast examination (CBE) is one of the most common methods used for early detection of breast cancer in low- and middle-income countries. CBE alone is limited by lack of specificity and may result in unnecessary diagnostic procedures. We evaluated the feasibility of integrating CBE, fine-needle aspiration biopsy (FNAB), and rapid on-site evaluation (ROSE) in triaging palpable breast masses for specialized cancer care.
An intensive breast cancer screening event was conducted at a national trade fair by a multidisciplinary team of care providers targeting a healthy population in Dar es Salaam, Tanzania. All adults age ≥ 18 years were invited to participate. CBE was performed by oncologists and/or pathologists. FNAB was performed by a pathologist on palpable masses that were then categorized as benign, indeterminate, or suspicious for malignancy or definitively malignant based on ROSE.
A total of 208 individuals (207 females, one male; median age, 36 years; range, 18-68 years) were screened. Most (90.8%, 189 of 208) had normal findings, whereas 7.2% (15 of 208), 1% (2 of 208), and 1% (2 of 208) had a palpable mass, breast pain, and nipple discharge, respectively. Two participants had lesions too small for palpation-guided biopsy and clinically consistent with fibroadenomas; the participants were counseled, and observation was recommended. FNAB was performed on 13 breast masses, with 9 of 13 (69%) categorized as benign and 4 of 13 (31%) suspicious for malignancy. Final cytopathologic review of referred patients confirmed one case to be breast adenocarcinoma, one was suggestive of fibroadenoma, and two showed inflammations.
Integration of CBE with ROSE and FNAB was feasible in a breast cancer screening program in Tanzania. In settings with constrained resources for cancer care, this may be an effective method for triaging patients with breast masses.
临床乳房检查（CBE）是中低收入国家用于早期发现乳腺癌的最常用方法之一。CBE 本身受到特异性不足的限制，可能导致不必要的诊断程序。我们评估了在为专门的癌症护理对可触及的乳房肿块进行分类时，将 CBE、细针抽吸活检（FNAB）和现场快速评估（ROSE）整合在一起的可行性。
一个多学科的医疗团队在坦桑尼亚达累斯萨拉姆的一个全国贸易博览会上进行了一项密集的乳腺癌筛查活动，目标是健康人群。所有年龄≥18 岁的成年人都被邀请参加。CBE 由肿瘤学家和/或病理学家进行。对可触及的肿块进行 FNAB，然后根据 ROSE 将其分类为良性、不确定、恶性或明确恶性。
共有 208 人（207 名女性，1 名男性；中位年龄 36 岁；范围 18-68 岁）接受了筛查。大多数（90.8%，189/208）有正常发现，而 7.2%（15/208）、1%（2/208）和 1%（2/208）分别有可触及的肿块、乳房疼痛和乳头溢液。两名参与者的病变太小，无法进行触诊引导活检，临床一致认为是纤维腺瘤；对这些参与者进行了咨询，建议进行观察。对 13 个乳房肿块进行了 FNAB，其中 9 个（69%）归类为良性，4 个（31%）可疑为恶性。对转诊患者的最终细胞病理复查证实了 1 例乳腺癌，1 例提示纤维腺瘤，2 例显示炎症。
在坦桑尼亚的乳腺癌筛查计划中，将 CBE 与 ROSE 和 FNAB 相结合是可行的。在癌症护理资源有限的情况下，这可能是一种对乳房肿块患者进行分类的有效方法。
