A Low-Cost, Low-Skill Model for Efficient Breast Cancer Screening in Low Resource Rural Settings of a Developing Country

Abstract

Objective To suggest a low-cost, easily-operable, non-invasive imaging modality for cancer detection in rural settings. Method A total of 212 cases with palpable breast masses aged 18 - 65 years were enrolled and underwent thorough clinical, mammographic, and ultrasonographic (USG) evaluation. Imaging findings were reported using the American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS®) criteria. The findings were confirmed histopathologically. Data were analyzed using the Chi-square test. Results The malignancy rate was 35.8% (n = 76). On mammography, lesions size, margins, shape, calcification, and distorted arch/skin thickening were significantly associated with malignancy. On USG, the number of nodules, shape, margins, echotexture, posterior wall echo, through transmission changes, distorted arch/skin thickening, microlobulation, duct extension, and height/width ratio were significantly associated with malignancy. Independently, mammography and USG had a sensitivity of 78.1% and 80.3%, respectively, and a specificity of 83.3% and 89.0%, respectively. Using a positive result of either study as the criteria, the sensitivity was 97.4% and the specificity was 80.1%. Conclusion The combined use of mammography and USG provides high sensitivity and specificity, thus showing that a combination of two can be used as a screening tool for use in low resource rural settings.

Keywords: breast cancer; low resource rural settings; mammography; usg.

Figure 1. A 44-year-old female patient with intraductal carcinoma variant

A) Mammographic craniocaudal and B) mediolateral oblique views of the left breast show a high-density mass in inferomedial quadrant (white arrow), along with ipsilateral axillary lymphadenopathy (black arrow). C) High-resolution ultrasonography image of the left breast shows a heterogeneously hyperechoic mass with anechoic component with fine internal echoes at 5 o'clock position. D) Photomicrograph of this section shows glands in cribriform pattern lined by atypical pleomorphic cells with hyperchromatic nuclei and high nuclear:cytoplasmic ratio (hematoxylin and eosin stain 10X).

Figure 2. A 35-year-old female patient of phyllodes tumor

A) Mammographic craniocaudal and B) mediolateral oblique views of left breast shows a large, lobulated high density mass occupying the entire upper quadrant (white arrow). C) High-resolution ultrasonography image of left breast shows a large, lobulated heterogeneously hypoechoic mass occupying the entire right breast extending from 8 o'clock to 4 o'clock position (red arrow). D) Photomicrograph of this section shows marked stromal proliferation with stroma bulging into the glandular lining forming a leaf like architecture (hematoxylin and eosin 4X).