نقش معاينه باليني در تشخيص بيماران مبتلا به سرطان پستان

Role of Clinical Examination in the Diagnosis of Breast Cancer

زمينه و هدف: سرطان پستان شايع‌ترين بدخيمي بين زنان در جهان است و با استفاده از روش‌هاي تشخيصي مناسب و به موقع در مراحل اوليه سرطان مي‌توان عواقب بيماري و مرگ‌ومير آن را كاهش داد. روش بررسي: در اين مطالعه مقطعي 287 نفر از زنان مراجعه‌كننده به مركز تحقيقات سرطان پستان وابسته به دانشگاه علوم پزشكي شهيد بهشتي تهران (ايران) با شكايت توده پستان تحت بررسي‌هاي لازم شامل اطلاعات دموگرافيك، تظاهرات باليني و سوابق دارويي و معاينه باليني توسط پزشك ماهر انجام شد و در نهايت اطلاعات استخراج شده از معاينه باليني با نتايج پاتولوژي مطابقت داده شد. يافته‌ها: تعداد 287 زن مبتلا به سرطان سينه با انحراف معيار±ميانگين 11/61 ± 47/7 مورد بررسي قرار گرفتند. بر اساس نتيجه آسيب‌شناسي 64 مورد (22/30%) خوش‌خيم و 223 نفر (77/70%) از بيماران توده بدخيم داشتند، در حالي كه 37 مورد (12/8%) در معاينه باليني Clinical Breast Examination (CBE) خوش‌خيم و 250 (87/6%) بدخيم بودند. حساسيت و ويژگيCBE برابر با 21/98% و 51/56% بود. همچنين 87/6% ارزش اخباري مثبت (PPV)، 89/89% ارزش اخباري منفي (NPV) ثبت شد. نتيجه‌گيري: نتايج مطالعه حاضر نشان داد كه هنوز معاينه باليني توسط افراد پزشك ماهر با حساسيت بالا مي‌تواند روش مهم و قابل اعتماد در تشخيص سرطان پستان باشد، خصوصاً در مواردي كه بيمار شيردهي بيش از 24 ماه تا 72 ماه) داشته باشد، در دوران يائسگي باشد و يا تعداد حاملگي بيش از 3 تا داشته باشد.

Background and Aim: Breast cancer is the most common malignancy among women in the world. Timely use of appropriate diagnostic methods in the early stages of this cancer can reduce its consequences and mortality. Materials and Methods: 287 women with breast mass referring to the Breast Cancer Research Center affiliated to Shahid Beheshti University of Medical Sciences, Tehran (Iran) participated in this cross-sectional study. Demographic data, clinical manifestations and drug history were recorded. Clinical examinations were carried out by a qualified physician. Finally, the correspondence between the data obtained from the clinical examinations with the pathologic results was evaluated. Results: 287 women with breast cancer (age range: 22-84 year old) participated in the study. Mean and standard deviation (SD) of participants’ age was 47.71±11.62. Based on pathology results 64 subjects (22.30%) had benign and 223 (77.70%) had malignant lesions. 37 subjects (12.89%) had benign and 250 (87.11%) had malignant lesions on the basis of the clinical breast examination (CBE). Sensitivity and specificity of CBE were 98.21% and 51.56%, and also, positive predictive value (PPV) and negative predictive value (NPV) were 87.6% and 89.19% respectively. Younger women were less likely to have malignant breast mass compared to older women. Moreover, a significant difference was found between unemployed and employed women as well as between menopausal and non-menopausal women. Conclusion: The results of the present study showed that clinical examination by skilled physicians can still be an important, highly sensitive and reliable method for diagnosis of breast cancer, especially in the patients who had breastfed their infants for more than 24 to 72 months, and menopausal women or patients with more than 3 pregnancies.