How to know if a lump is cancerous
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How to Know if a Lump is Cancerous
Triple Assessment for Breast Lumps
Physical Examination, Imaging, and FNAC
The triple assessment method, which includes physical examination, imaging (mammography and ultrasound), and fine-needle aspiration cytology (FNAC), is a standard and highly effective approach for diagnosing breast cancer. This combination is more accurate than any single modality alone . Physical examination alone has a positive predictive value (PPV) of 58.9% and is highly dependent on the experience of the clinician. When combined with imaging techniques, such as mammography and ultrasound, the PPV increases significantly to 81.3%. FNAC, a cost-effective diagnostic tool, has a sensitivity ranging from 73.2% to 98% and a specificity between 98% to 100% for palpable breast lumps .
Core Biopsy and Histopathological Correlation
Core biopsy is another reliable diagnostic tool, with a diagnostic accuracy of 95.5%. It is particularly useful when FNAC results are inconclusive. Histopathological examination remains the gold standard for confirming the diagnosis of breast cancer, with clinical examination showing a sensitivity of 97.96% and a specificity of 96.08% when correlated with histopathological results.
Imaging Techniques: Mammography and Ultrasound
Mammography
Mammography is essential for detecting microcalcifications, which are significant indicators of breast cancer. It detects microcalcifications in 30-50% of breast cancers. Routine mammographic screening can reduce the incidence of breast cancer by 30%.
Ultrasound
Ultrasound is particularly useful for evaluating radiologically dense breasts and for guiding biopsy techniques. It is also the preferred imaging modality for pregnant women, as it poses no risk to the embryo or fetus. Ultrasound can effectively differentiate between benign and malignant lumps, especially when combined with other diagnostic methods .
Clinical-Radiological-Cytological Triad
The clinical-radiological-cytological triad, which includes physical examination, mammography, and FNAC, has shown high diagnostic efficacy. The sensitivity of this triad increases to 95% when all three tests are used together. The predictive value of a positive response from the triad is significantly high, making it a reliable method for diagnosing breast lumps.
Artificial Intelligence and Low-Cost Ultrasound
In low- to middle-income countries, where access to advanced diagnostic tools may be limited, the use of artificial intelligence-based computer-assisted diagnosis (CADx) with low-cost portable ultrasound systems has shown promise. This approach allows minimally trained healthcare workers to triage palpable breast lumps effectively, ensuring that resources are dedicated to suspicious lesions requiring further workup.
Conclusion
The combination of physical examination, imaging (mammography and ultrasound), and FNAC, known as the triple assessment, is the most effective method for diagnosing breast cancer. Core biopsy and histopathological examination provide additional diagnostic accuracy. The clinical-radiological-cytological triad further enhances diagnostic efficacy. In resource-limited settings, AI-based CADx with portable ultrasound systems offers a practical solution for triaging breast lumps. Early and accurate diagnosis is crucial for effective treatment and improved outcomes.
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