Guntersah Toddy, Astari Yufi K, Rinonce Hanggoro T, Hutajulu Susanna H, Puspandari Diah A
Department of Pathological Anatomy, Soehadi Prijonegoro Public Hospital, Sragen, IDN.
Department of Internal Medicine, Division of Hematology and Medical Oncology, Dr. Sardjito General Hospital, Yogyakarta, IDN.
Cureus. 2023 Sep 24;15(9):e45841. doi: 10.7759/cureus.45841. eCollection 2023 Sep.
Introduction Triple assessment, consisting of clinical breast examination, breast imaging, and fine-needle aspiration biopsy (FNAB), is the gold standard for breast lump diagnosis to avoid diagnostic errors. However, current diagnostic practices for breast lump cases in Indonesia are widely variable and evidence for triple assessment implementation is lacking. We aimed to explore the implementation of diagnostic assessments in breast lump cases, its influencing factors, and its association with diagnostic error. Methods This cross-sectional study consecutively recruited 364 females with breast lumps who underwent surgery in Soehadi Prijonegoro Public Hospital, Sragen, Indonesia. Data were retrospectively collected from patient's medical records. Diagnostic assessments were classified as single assessment with clinical breast examination, double assessment with clinical breast examination and breast ultrasonography (USG) or fine-needle aspiration biopsy (FNAB), and triple assessment. Diagnostic error was defined as a discrepancy between pre- and post-surgery diagnosis or repeated surgery without neoadjuvant chemotherapy. Factors associated with diagnostic assessment implementation, diagnostic error, and repeated surgery were analyzed using the chi-square test. Results The choice of diagnostic assessment was influenced by patients' age and health insurance (p<0.001). Triple assessment was only implemented in 21 (5.8%) breast lump cases. It was more frequently applied in patients ≥40 years (57.1%) and patients with contributory health insurance (76.2%). Diagnostic errors were observed in 84 cases (23.1%) and 47 patients out of them (47%) experienced repeated surgery. The implementation of diagnostic assessments was not associated with diagnostic error (p=0.257) but was significantly associated with repeated surgery in breast cancer (p<0.001). Repeated surgery rates were significantly lowered in cases receiving double assessment with FNAB (p<0.001). Conclusions The implementation of triple assessment in the local setting was very low. The choice of diagnostic assessment was influenced by patients' age and health insurance. Further, double assessment applying clinical breast examination and FNAB significantly decreased repeated surgery rates and thus may serve as an alternative to triple assessment in the limited resource setting.
引言 三重评估，包括临床乳腺检查、乳腺影像学检查和细针穿刺活检（FNAB），是避免诊断错误的乳腺肿块诊断的金标准。然而，印度尼西亚目前对乳腺肿块病例的诊断实践差异很大，且缺乏实施三重评估的证据。我们旨在探讨乳腺肿块病例中诊断评估的实施情况、其影响因素以及与诊断错误的关联。方法 这项横断面研究连续招募了364名在印度尼西亚斯拉根苏哈迪普里约内戈罗公立医院接受手术的乳腺肿块女性患者。数据从患者的病历中回顾性收集。诊断评估分为仅进行临床乳腺检查的单一评估、临床乳腺检查与乳腺超声（USG）或细针穿刺活检（FNAB）的双重评估以及三重评估。诊断错误定义为手术前后诊断不一致或在未进行新辅助化疗的情况下重复手术。使用卡方检验分析与诊断评估实施、诊断错误和重复手术相关的因素。结果 诊断评估的选择受患者年龄和健康保险的影响（p<0.001）。仅21例（5.8%）乳腺肿块病例实施了三重评估。在≥40岁的患者（57.1%）和有贡献性健康保险的患者（76.2%）中更频繁应用。84例（23.1%）观察到诊断错误，其中47例（47%）患者经历了重复手术。诊断评估的实施与诊断错误无关（p=0.257），但与乳腺癌患者的重复手术显著相关（p<0.001）。接受FNAB双重评估的病例中重复手术率显著降低（p<0.001）。结论 在当地环境中三重评估的实施率非常低。诊断评估的选择受患者年龄和健康保险的影响。此外，应用临床乳腺检查和FNAB的双重评估显著降低了重复手术率，因此在资源有限的情况下可作为三重评估的替代方法。
