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

Autor:	Pace LE; Director of Women's Health Policy and Advocacy and Director of the Global Women's Health Fellowship, Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address: lpace@bwh.harvard.edu., Dusengimana JV; Partners in Health, Rwanda., Hategekimana V; Rwanda Biomedical Centre, Rwanda., Rugema V; Ministry of Health, Rwanda., Umwizerwa A; Partners in Health, Rwanda., Frost E; Director of Women's Health Policy and Advocacy and Director of the Global Women's Health Fellowship, Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts., Kwait D; Director of Women's Health Policy and Advocacy and Director of the Global Women's Health Fellowship, Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts., Schleimer LE; Columbia University Medical Center, New York, New York., Huang C; Director of Women's Health Policy and Advocacy and Director of the Global Women's Health Fellowship, Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts., Shyirambere C; District Project Director, Partners in Health, Rwanda., Bigirimana JB; Partners in Health, Rwanda., Shulman LN; Deputy Director for Clinical Services and Director of Global Cancer Medicine, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania., Mpunga T; Minister of State for Public Health and Primary Care, Government of Rwanda, Rwanda., Raza S; Director of Global Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts.
Jazyk:	angličtina
Zdroj:	Journal of the American College of Radiology : JACR [J Am Coll Radiol] 2022 Aug; Vol. 19 (8), pp. 983-989. Date of Electronic Publication: 2022 Jun 20.
DOI:	10.1016/j.jacr.2022.04.009
Abstrakt:	Purpose: To scale up early detection of breast cancer in low- and middle-income countries, research is needed to inform the role of diagnostic breast ultrasound performed by nonradiologists in resource-constrained settings. The authors examined 2-year clinical follow-up and outcomes among women who underwent diagnostic breast ultrasound performed by nonradiologist clinicians participating in a breast ultrasound training and mentorship program at a rural Rwandan hospital. Methods: Imaging findings, management plans, and pathologic results were prospectively collected during the training using a standardized form. Data on follow-up and outcomes for patients receiving breast ultrasound between January 2016 and March 2017 were retrospectively collected through medical record review. Results: Two hundred twenty-nine breast palpable findings (199 patients) met the study's eligibility criteria. Of 104 lesions initially biopsied, 38 were malignant on initial biopsy; 3 lesions were identified as malignant on repeat biopsy. All 34 patients ultimately diagnosed with cancer received initial recommendations for either biopsy or aspiration by trainees. The positive predictive value of trainee biopsy recommendation was 34.8% (95% confidence interval, 24.8%-45.0%). The sensitivity of trainees' biopsy recommendation for identifying malignant lesions was 92.7% (95% confidence interval, 84.2%-100%). Of 46 patients who did not receive biopsy and were told to return for clinical or imaging follow-up, 37.0% did not return. Conclusions: Trained nonradiologist clinicians in Rwanda successfully identified suspicious breast lesions on diagnostic breast ultrasound. Loss to follow-up was common among patients instructed to return for surveillance, so lower biopsy thresholds, decentralized surveillance, or patient navigation should be considered for patients with low- or intermediate-suspicion lesions. (Copyright © 2022 American College of Radiology. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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