[Hierarchy of breast examinations after twenty years experience]

To reassess the interest to establish a qualitative hierarchy of explorations for breast lesion diagnosis.

The medical files stored on perforated cards concerning 6866 patients examined in our breast disease clinic from 1974 to 1976 was compared to the computerized medical files of 14747 patients followed in the same clinic from 1990 to 1992. The hierarchy took into account, by decreasing order of importance, the significant results of cytology and radiography, clinical examination and finally thermography for the 1974-1976 patients and ultrasonography for the 1990-1992 patients.

Comparing the two groups of patients showed a stabilization of the number of cancers (100%) among the diagnoses positive for malignant lesions and of the number of benign lesions (16%) among the lesions evaluate as suspect of malignancy. There was an increase in the cancers (13%) among lesions evaluated as dubious and a decrease in the numbers of cancers (0.1%) among the lesions evaluated as benign. These improvement resulted from technical advance in mammography and the routine use of ultrasonography.

These findings confirm the importance of cytological and radiological exams for the diagnosis of breast cancer and points out the interest of routine ultrasonography of the breast.