Diagnostic Accuracy of Breast Medical Tactile Examiners (MTEs): A Prospective Pilot Study

Background: The usefulness of clinical breast examination (CBE) in general and in breast cancer screening programs has been a matter of debate. This study investigated whether adding vision-impaired medical tactile examiners (MTEs) improves the predictiveness of CBE for suspicious lesions and analyzed the feasibility and acceptability of this approach. Methods: The prospective study included 104 patients. Physicians and MTEs performed CBEs, and mammography and ultrasound results were used as the gold standard. Sensitivity and specificity were calculated and logistic regression models were used to compare the predictive value of CBE by physicians alone, MTEs alone, and physicians and MTEs combined. Results: For CBEs by physicians alone, MTEs alone, and both combined, sensitivity was 71, 82, and 89% and specificity was 55, 45, and 35%, respectively. Using adjusted logistic regression models, the validated areas under the curve were 0.685, 0.692, and 0.710 (median bootstrapped p value (DeLong) = 0.381). Conclusion: The predictive value for a suspicious breast lesion in CBEs performed by MTEs in patients without prior surgery was similar to that of physician-conducted CBEs. Including MTEs in the CBE procedure in breast units thus appears feasible and could be a way of utilizing their skills.

Breast cancer

Breast cancer is the most common cancer affecting women worldwide. Survival at time of detection is high. Clinical presentation ranges from a highly suspicious breast lesion to a completely asymptomatic screen-detected cancer. Triple assessment is the mainstay of diagnosis (clinical history and examination, breast imaging, and pathological assessment of biopsy). All lesions need careful MDT assessment, and a thorough assessment of patient fitness. Surgical excision is the treatment of choice for all operable cancers irrespective of age with consideration of patient factors. Breast reconstruction should be considered at the time of initial decision. Adjuvant, neoadjuvant, and other types of therapy (hormone, biological, etc.) should be planned at the multidisciplinary team meeting. Advanced cases should be considered for the most effective palliative therapy where needed.