A Comparison of Clinical Breast Exam Techniques

Western countries utilize mammographic screening to detect breast cancer, but developing countries rely on clinical breast examination (CBE). Previous studies have found CBE to be an effective early detection strategy, but it remains unclear which technique is most optimal. A cross-sectional study presented at the San Antonio Breast Cancer Symposium compared four common techniques of CBE: dial of clock (Dc), vertical stripes (Vs), quadrant (Qn), and concentric (Cc).

Women presenting to the breast clinic of All India Institute of Medical Sciences, New Delhi with breast complaints were included. Patients were excluded if they had a history of breast surgery. Examinations were conducted by a senior professor, a resident trainee, and a trained female nurse; the latter two received initial training on 10 patients from the professor. Patients were recruited for the study three at a time and randomized to examination by three examiners with four techniques (one technique was used at a time) of breast palpitation. Abnormality was defined as detection of a nodularity or lump detected. The CBE findings were compared to a breast sonogram.

Final analysis included 55 women (mean age, 39.6 years; standard deviation, 11.8 years) with palpitation findings on both breasts. Most women had a lump (69.0%) and pain (27.3%). Across all three examiners, the Dc technique had the highest values for diagnostic indices. The Dc technique’s sensitivities for the professor, resident, and nurse were 74.51%, 64.71%, and 82.35%, respectively. Likelihood ratios (+) were 3.663, 3.471, and 2.858, respectively; likelihood ratios (–) were 0.3200, 0.4338, and 0.2479, respectively; and diagnostic odds ratios were 11.45, 8.00, and 11.53, respectively. Sensitivity values for the other techniques for the professor were 64.7% with Cc, 58.8% with Qn, and 49.0% with Vs. For the resident, the sensitivity values were 60.7% for Vs, 58.8% for Qn, and 56.8% for Cc; for the nurse, the values were 76.4% for Vs, 74.5% for Cc, and 72.5% for Qn.