During the global pandemic of COVID-19, Prof Wang Benzhong and its team, the Breast Surgery Department of the First Affiliated Hospital of Anhui Medical University, published the clinical research results of breast palpation imaging online in Medical Science Monitor magazine at the end of 2020. Its abstract is as follows:
Background: Breast diseases pose increasing threat to women health as people lifestyle changes. The aim of this study was to investigate the clinical application value of Palpation Imaging (PI) in the diagnosis of breast diseases.
Material/Methods: From October 2019 to February 2020, 184 patients with 225 breast lesions were examined by using PI, ultrasound, and mammography in the department of Breast Surgery, the First Affiliated Hospital of Anhui Medical University. All cases were confirmed pathologically by core-needle biopsy or excisional biopsy. The cut-off value of the PI tests was determined by receiver operating characteristic (ROC) curve. We compared the examination results of PI with ultrasound and mammography to analyze the diagnostic value of PI.Results: Pathological examination revealed that 186/225(82.67%) lesions were benign, while 39 were malignant. All 8 parameters of PI were significantly correlated with pathological findings (P<0.05). The best cut-off value for the PI score was 19.5 and the area under the curve (AUC) for the PI was 0.921 (95% CI: 0.874–0.968, P<0.001) with 89.7% sensitivity and 86.0% specificity. PI showed greater sensitivity (89.7%) and its specificity (86.0% vs.86.4%, P=0.931) and accuracy (86.7% vs. 84.6%, P=0.604) were similar to those of mammography. The combination of 3 types of test is superior to a single examination. The sensitivity was 100% and the specificity was 98.8%.
Conclusions: Palpation imaging has high clinical value in differentiating benign and malignant breast lesions. Combination examination has the potential to improve the detection of breast cancer in screening and diagnostic capacities and can be used as a supplement to ultrasound and mammography.
The paper suggested that the negative predicted value(NPV) and false negative rate (FNR)of palpation imaging was 97.6% and 10.3% respectively. It is known that the aim of screening is to efficiently identify high-risk groups and the aim of diagnosing is to better implement precise treatment. For breast cancer with a high prevalence rate in total population, the negative predicted value of 97.6% is very good, with sensitivity rate of 89.7%, and the value for clinician to identify benign and malignant breast lesions is high enough.
What clinicians and public health experts concerned differently with the same statistical indicator, eg. clinicians worried more about the missed diagnosis, that is the higher sensitivity, the better. while public health experts focused on social economics, which means the higher sensitivity is good, but is more afraid of people accepting unnecessary examination just because of no missing 1 patient in 1 thousand people. Therefore, many studies on early finding, early treatment and social economic benefits about breast cancer were published. Eg, Mo Miao et al reported that in the two forms of breast cancer screening, the screening cost per capita is 208 yuan and 21 yuan respectively, and the total screening cost of each patient is 72,453 yuan and 11,640 yuan respectively. The average total cost in the organized screening group was 103,650 yuan, significantly higher than the 50,712yuan in the opportunistic screening group and 35,413yuan in the control group. Both organized screening and opportunistic screening can find BC early. Organized screening costs is higher than opportunistic screening projects, but the direct medical cost of first hospitalization is lower and the overall cost effect is better, which can be considered in women of the right ages in economic developed areas of China.
Although there is still a gap between various breast cancer screening techniques and ideal conditions in reality, the consensus of experts on breast cancer diagnosis is the trio protocol of clinical breast examination, imaging of ultrasound and mammography, and pathology examination. How to achieve the ideal socioeconomic effect through the trio protocol in selective & sequential order, more controlled research and real-world study are needed to verify.