Breast cancer diagnostic study of choice: Difference between revisions

Jump to navigation Jump to search
 
(8 intermediate revisions by the same user not shown)
Line 3: Line 3:
{{CMG}}; {{AE}} {{Soroush}}
{{CMG}}; {{AE}} {{Soroush}}
== Overview ==
== Overview ==
 
Biopsy is the gold standard test for the diagnosis of breast cancer. Meanwhile, the diagnostic study of choice for breast cancer screening is mammography. [[Magnetic resonance imaging]] ([[Magnetic resonance imaging|MRI]]) is also recommended in selected patients. Compared to the [[Mammography|Mammography,]] [[Magnetic resonance imaging|MRI]]<nowiki/>has higher [[Sensitivity (tests)|sensitivity]] and lower [[Specificity (tests)|specificity]].
<br />
== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==


=== Study of choice ===
=== Study of choice ===
Biopsy is the gold standard test for the diagnosis of breast cancer. Either fine needle aspiration (FNA), core needle aspiration, or surgical biopsy (excisional biopsy) might be the first step or confirmatory test in selected patients. Meanwhile, the diagnostic study of choice for breast cancer screening is mammography. for more information please refer to [[breast cancer screening]].  
Biopsy is the gold standard test for the diagnosis of breast cancer. Either fine needle aspiration (FNA), core needle aspiration, or surgical biopsy (excisional biopsy) might be the first step or confirmatory test in selected patients. Meanwhile, the diagnostic study of choice for breast cancer screening is mammography. [[Magnetic resonance imaging]] ([[Magnetic resonance imaging|MRI]]) is also recommended in selected patients. Compared to the [[Mammography|Mammography,]] [[Magnetic resonance imaging|MRI]] has higher [[Sensitivity (tests)|sensitivity]] and lower [[Specificity (tests)|specificity]]. '''For more information please refer to [[breast cancer screening|<u>breast cancer screening</u>]]'''. '''For more information about <u>breast biopsy please click [[Breast Biopsy|here]].</u>'''
 
OR
 
There is no single diagnostic study of choice for the diagnosis of breast cancer.
 
OR
 
There is no single diagnostic study of choice for the diagnosis of breast cancer, but breast cancer can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
 
OR
 
breast cancer is primarily diagnosed based on the clinical presentation.


OR
'''Investigations:'''


Investigations:
* Among the patients who present with clinical signs of breast cancer, the Mammography is the most specific test for the diagnosis.
* Among the patients who present with clinical signs of breast cancer, the [investigation name] is the most specific test for the diagnosis.
*Estimates of mammography [[Sensitivity (tests)|sensitivity]] range between 75% and 90% with [[Specificity (tests)|specificity]] between 90% and 95%. The [[Positive predictive value|PPV]] ranges from 20% in women under age 50 to 60% to 80% in women age 50-69. Although there are reports of the sensitivity (67.8%) and specificity (75%), particularly in older studies.<ref name="pmid17404353">{{cite journal| author=Qaseem A, Snow V, Sherif K, Aronson M, Weiss KB, Owens DK et al.| title=Screening mammography for women 40 to 49 years of age: a clinical practice guideline from the American College of Physicians. | journal=Ann Intern Med | year= 2007 | volume= 146 | issue= 7 | pages= 511-5 | pmid=17404353 | doi=10.7326/0003-4819-146-7-200704030-00007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17404353  }} </ref>
* Among the patients who present with clinical signs of breast cancer, the [investigation name] is the most sensitive test for diagnosis.
* Among the patients who present with clinical signs of breast cancer, the MRI is the most sensitive test for diagnosis.<ref name="pmid10189447">{{cite journal| author=Orel SG| title=Differentiating benign from malignant enhancing lesions identified at MR imaging of the breast: are time-signal intensity curves an accurate predictor? | journal=Radiology | year= 1999 | volume= 211 | issue= 1 | pages= 5-7 | pmid=10189447 | doi=10.1148/radiology.211.1.r99ap395 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10189447  }} </ref><ref name="pmid10189459">{{cite journal| author=Kuhl CK, Mielcareck P, Klaschik S, Leutner C, Wardelmann E, Gieseke J et al.| title=Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions? | journal=Radiology | year= 1999 | volume= 211 | issue= 1 | pages= 101-10 | pmid=10189459 | doi=10.1148/radiology.211.1.r99ap38101 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10189459  }} </ref>
* Among the patients who present with clinical signs of breast cancer, the [investigation name] is the most efficient test for diagnosis.


==== The comparison of various diagnostic studies for breast cancer ====
==== The comparison of various diagnostic studies for breast cancer ====
Line 35: Line 23:
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
! style="background: #696969; color: #FFFFFF; text-align: center;" |Mammography
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |75-90%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |90-95%
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
! style="background: #696969; color: #FFFFFF; text-align: center;" |Breast MRI
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |37-97%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |99%
|}
|}
<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>
<small>Mammography is the preferred investigation based on the sensitivity and specificity and cost effectiveness. In selected cases MRI is recommended.</small>  


===== Diagnostic results =====
===== Diagnostic results =====
The following finding(s) on performing [investigation name] is(are) confirmatory for breast cancer:
The following finding(s) on performing biopsy are confirmatory for breast cancer:
* [Finding 1]
* Increased mitosis
* [Finding 2]
* Pleomorphism
*Calcification
*Necrosis
*Invasion
*For more detailed information please refer to [[breast cancer pathophysiology]].


===== Sequence of Diagnostic Studies =====
===== Sequence of Diagnostic Studies =====
The [name of investigation] must be performed when:
The biopsy must be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* The patient presented with lamps and bumps in breast, or [[axillary]] [[lymphadenopathy]] without sign and symptoms of infectious disease.
* A positive [test] is detected in the patient, to confirm the diagnosis.
* A positive/doubtful [[mammography]] or [[Magnetic resonance imaging|MRI]] suggesting [[Cancer|malignancy]], to confirm the diagnosis.
 
OR
 
The various investigations must be performed in the following order:
* [Initial investigation]
* [2nd investigation]


=== Name of Diagnostic Criteria ===
=== Name of Diagnostic Criteria ===
'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''
breast cancer is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of breast cancer.
OR
There is no single diagnostic study of choice for breast cancer, though breast cancer may be diagnosed based on [name of criteria] established by [...].
OR
The diagnosis of breast cancer is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
OR
The diagnosis of breast cancer is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
OR
breast cancer may be diagnosed at any time if one or more of the following criteria are met:
* Criteria 1
* Criteria 2
* Criteria 3
OR
'''IF there are clear, established diagnostic criteria'''
The diagnosis of breast cancer is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
OR
The diagnosis of breast cancer is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
OR
The diagnosis of breast cancer is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
OR
'''IF there are no established diagnostic criteria'''


There are no established criteria for the diagnosis of breast cancer.
There are no established criteria for the diagnosis of breast cancer.

Latest revision as of 15:17, 15 October 2019

Breast Cancer Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Breast cancer from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic study of choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

CT scan

MRI

Echocardiography or Ultrasound

Other Imaging Studies

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Breast cancer diagnostic study of choice On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Breast cancer diagnostic study of choice

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Breast cancer diagnostic study of choice

CDC on Breast cancer diagnostic study of choice

Breast cancer diagnostic study of choice in the news

Blogs on Breast cancer diagnostic study of choice

Directions to Hospitals Treating Breast cancer

Risk calculators and risk factors for Breast cancer diagnostic study of choice

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]

Overview

Biopsy is the gold standard test for the diagnosis of breast cancer. Meanwhile, the diagnostic study of choice for breast cancer screening is mammography. Magnetic resonance imaging (MRI) is also recommended in selected patients. Compared to the Mammography, MRIhas higher sensitivity and lower specificity.

Diagnostic Study of Choice

Study of choice

Biopsy is the gold standard test for the diagnosis of breast cancer. Either fine needle aspiration (FNA), core needle aspiration, or surgical biopsy (excisional biopsy) might be the first step or confirmatory test in selected patients. Meanwhile, the diagnostic study of choice for breast cancer screening is mammography. Magnetic resonance imaging (MRI) is also recommended in selected patients. Compared to the Mammography, MRI has higher sensitivity and lower specificity. For more information please refer to breast cancer screening. For more information about breast biopsy please click here.

Investigations:

  • Among the patients who present with clinical signs of breast cancer, the Mammography is the most specific test for the diagnosis.
  • Estimates of mammography sensitivity range between 75% and 90% with specificity between 90% and 95%. The PPV ranges from 20% in women under age 50 to 60% to 80% in women age 50-69. Although there are reports of the sensitivity (67.8%) and specificity (75%), particularly in older studies.[1]
  • Among the patients who present with clinical signs of breast cancer, the MRI is the most sensitive test for diagnosis.[2][3]

The comparison of various diagnostic studies for breast cancer

Test Sensitivity Specificity
Mammography 75-90% 90-95%
Breast MRI 37-97% 99%

Mammography is the preferred investigation based on the sensitivity and specificity and cost effectiveness. In selected cases MRI is recommended.

Diagnostic results

The following finding(s) on performing biopsy are confirmatory for breast cancer:

Sequence of Diagnostic Studies

The biopsy must be performed when:

Name of Diagnostic Criteria

There are no established criteria for the diagnosis of breast cancer.

References

  1. Qaseem A, Snow V, Sherif K, Aronson M, Weiss KB, Owens DK; et al. (2007). "Screening mammography for women 40 to 49 years of age: a clinical practice guideline from the American College of Physicians". Ann Intern Med. 146 (7): 511–5. doi:10.7326/0003-4819-146-7-200704030-00007. PMID 17404353.
  2. Orel SG (1999). "Differentiating benign from malignant enhancing lesions identified at MR imaging of the breast: are time-signal intensity curves an accurate predictor?". Radiology. 211 (1): 5–7. doi:10.1148/radiology.211.1.r99ap395. PMID 10189447.
  3. Kuhl CK, Mielcareck P, Klaschik S, Leutner C, Wardelmann E, Gieseke J; et al. (1999). "Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions?". Radiology. 211 (1): 101–10. doi:10.1148/radiology.211.1.r99ap38101. PMID 10189459.

Template:WH Template:WS