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Measuring performance in clinical breast examination.

G C Wishart¹, J Warwick, V Pitsinis

¹Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. gordon.wishart@addenbrookes.nhs.uk

The British Journal of Surgery

|July 6, 2010

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Clinical breast examination (CBE) performance varies significantly among clinicians. New indicators can help identify those needing further training to improve breast cancer detection sensitivity.

Area of Science:

Oncology
Radiology
Clinical Medicine

Background:

Clinical breast examination (CBE) is crucial for breast lump assessment.
Currently, no standardized performance measures exist for CBE.
This study aimed to develop such measures.

Purpose of the Study:

To compare the performance and accuracy of CBE.
To identify key indicators for prospective monitoring of CBE performance.

Main Methods:

Retrospective audit of 16,585 patients undergoing CBE.
Analysis of clinical examination findings (E1-E5) from electronic records.
Calculation of sensitivity, specificity, and ROC curves stratified by age, mammographic density, and clinician.

Main Results:

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Significant variation in CBE sensitivity among clinicians (44.6-65.9%).
Decreased sensitivity correlated with lower classification of malignant lumps (E5).
Proposed indicators: trend in E5 classification and proportion of E4/E5 cancers classified as E5.

Conclusions:

Developed performance measures can identify clinicians with lower CBE sensitivity.
These measures can guide targeted feedback and further training.
Improving CBE performance enhances diagnostic accuracy in breast cancer assessment.