Osuch J R, Bonham V L, Morris L L
Michigan State University, East Lansing, Mich., USA.
Medscape Womens Health. 1998 Oct;3(5):4.
Missed breast cancer is the most common malpractice suit filed in the US. But even without a biopsy of every mass, clinicians can reduce the risk of failed diagnosis to 1% by using a triple-diagnosis method to working up a breast mass, according to these experts, who offer a step-by-step guide. Includes QuickTimeTM video of breast exam. Failure to diagnose breast cancer in a timely manner is the most common reason for malpractice litigation in the US. Unless the potential for false-negative results of physical examination, mammography, ultrasound, and fine-needle aspiration biopsy (FNAB) is recognized, delay in the diagnosis of breast cancer will continue to occur. A systematic, thorough approach to the workup of any breast mass-- including a careful history, clinical breast examination, and documentation--is crucial. Upon detection of a mass, distinguishing the cyst from the solid mass (often by fine-needle aspiration or FNAB) is one of the most important tasks facing the clinician. Although most cysts resolve upon aspiration, solid masses require further workup to rule out cancer. Because of the false-negatives associated with individual methods of diagnosis, the authors recommend the triple-diagnosis method of detection. Simultaneous evaluation of a breast mass using clinical breast examination, radiography, and FNAB can lower the risk of missing cancer to only 1%, effectively reducing the rate of diagnostic failure and increasing the quality of patient care.
漏诊乳腺癌是美国最常见的医疗事故诉讼类型。但这些专家表示，即使不对每个肿块进行活检，临床医生通过采用三重诊断法来检查乳房肿块，也可将漏诊风险降至1%，他们还提供了一份详细步骤指南。其中包括乳房检查的QuickTimeTM视频。未能及时诊断乳腺癌是美国医疗事故诉讼最常见的原因。除非认识到体格检查、乳房X光检查、超声检查和细针穿刺活检（FNAB）出现假阴性结果的可能性，否则乳腺癌诊断延误仍将继续发生。对任何乳房肿块进行系统、彻底的检查方法——包括详细的病史询问、临床乳房检查和记录——至关重要。发现肿块后，区分囊肿和实性肿块（通常通过细针穿刺或FNAB）是临床医生面临的最重要任务之一。尽管大多数囊肿在穿刺后会消退，但实性肿块需要进一步检查以排除癌症。由于个别诊断方法存在假阴性，作者推荐采用三重诊断检测法。同时使用临床乳房检查、影像学检查和FNAB对乳房肿块进行评估，可将漏诊癌症的风险降至仅1%，有效降低诊断失败率并提高患者护理质量。
