Visual analogue scale for assessing breast nodularity in non-discrete lumpy breasts: the Lucknow-Cardiff breast nodularity scale

Abstract

Background: Objective measurement of benign non-discrete lumpy breasts is not performed routinely that would lead to disease measurement, inter-physician communication, therapeutic response assessment and a normative function of reducing unnecessary biopsies. A schematic 5-point ordinal visual analogue scale was developed.

Methods: Two blinded experienced clinicians graded breast nodularity on a pre-determined five point analogue scale (grades 0-4) to determine its inter-observer reliability after its face validity that excluded inflammatory, nipple, areola and discrete lump problems.

Results: 784 Women (hospital 384; community 400) aged between 20 and 70 years (mean 31.9) underwent physical breast examination by 2 experienced clinicians. Inter-observer matched nodularity grading in women attending hospital were Grade 0 in 123 (32.03%), grade 1 in 67 (17.44%), grade 2 in 54 (14.06%), grade 3 in 52 (13.54%) and grade 4 in 23 (5.99%) and in community it was grade 0 in 172 (43%), grade 1 in 88 (22%), grade 2 in 60 (15%), grade 3 in 28 (7%) and grade 4 in 14 (3.5%) women. There was very good agreement (kappa = 0.7798) across all grades in hospital subjects and excellent agreement (kappa = 0.8659) in community subjects. Both estimates of kappa coefficients were highly significant from population kappa coefficient of zero (p < 0.001). Overall, 1/3rd normal women have absolutely smooth textured breasts.

Conclusion: User-friendly tool developed for objective evaluation of non-discrete lumpy breasts showed excellent reliability and validity. This tool should be useful for clinical drug trials in benign breast disorders and for wide routine clinical recording of patients.