The Value of Clinical Breast Examination, Imaging, and Fine Needle Aspiration and the Challenge of Diagnosing Breast Cancer in a Low Resource Setting: A Hospital-Based Analytical Study in Yaounde

Abstract

Background: Breast cancer is the most common cancer in the world, as well as in Cameroon, where it represents about 20.1% of all cancers recorded in 2020. The number of pathologists in the country is as few as seven for a population of about 26 million. The diagnostic performances of diagnostic modalities other than histology-clinical breast examination (CBE), imaging and fine needle aspiration and cytology (FNA)-in our context are not known. Study Objectives: Our objectives were to estimate the proportions of cases managed with mammography, breast ultrasound and FNA and to estimate the sensitivity, specificity, positive and negative predictive values, and accuracy of CBE, mammography, breast ultrasound and FNA; using histology as reference. Study Methodology: The study was cross-sectional and analytical, and was carried out at the Yaoundé General Hospital. It lasted twelve months, April 2015 through March 2016 and covered the period January 2010 to February 2016. Using histology as reference, we calculated measures of diagnostic accuracy for all four modalities using the statistical methods of Galen and Gambino. Results: We recruited 107 cases, 105 females (98.1%) and 02 males. We had 112 breast lumps, 106 malignant (94.6%