Clinical Diagnoses and Outcomes After Diagnostic Breast Ultrasound by Nurses and General Practitioner Physicians in...

Area of Science:

• Global Health
• Medical Imaging
• Oncology

Background:

• Early breast cancer detection is crucial in low- and middle-income countries (LMICs).
• Diagnostic breast ultrasound by nonradiologists is a potential solution in resource-constrained settings.
• A training and mentorship program was implemented in rural Rwanda.

Purpose of the Study:

• To evaluate the role of diagnostic breast ultrasound by nonradiologists in LMICs.
• To assess clinical follow-up and outcomes of breast ultrasound in Rwanda.
• To inform strategies for scaling up breast cancer detection.

Main Methods:

• Prospective collection of imaging findings, management, and pathology.
• Retrospective review of patient follow-up data (January 2016 - March 2017).
• Analysis of 229 palpable breast findings in 199 patients.

Main Results:

• Trainees demonstrated high sensitivity (92.7%) in recommending biopsies for malignant lesions.
• Positive predictive value for trainee biopsy recommendation was 34.8%.
• A significant proportion (37.0%) of patients advised for follow-up did not return.

Conclusions:

• Nonradiologist clinicians in Rwanda successfully identified suspicious breast lesions via ultrasound.
• High loss to follow-up among patients with low- or intermediate-suspicion lesions was observed.
• Recommendations include lower biopsy thresholds and enhanced patient navigation for surveillance.