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Breast transillumination a viable option for breast cancer screening in limited resource settings?
Abstract
Background: Mammography is an established screening tool for breast
cancer in high-income countries but may not be feasible for most resource
poor nations. Alternative modalities are needed to mitigate the impact of the increasing incidence and mortality due to breast cancer. This may require the development of new technologies or reevaluation of old technologies applicable to resource limited settings.
Objective: To determine the sensitivity and specificity of breast transillumination as compared to mammography and to describe features
of benign and malignant breast lesions as seen with breast transillumination.
Methods: A single group descriptive analytical study was conducted
over a six month period (2011) in the breast unit of Mulago National
hospital. Eligible participants were consecutively sampled. Participants
underwent Clinical Breast Examination (CBE), breast transillumination
(BT), mammography (MG) and histopathological analysis of identified
breast lumps. Sensitivity, specificity and predictive values were
calculated. Features of the masses detected by transillumination were
then described.
Results: The number of participants recruited was 201 (mean age 42
years, range 30-80 years). The average palpable lump size was 3.8
cm (range 0.5 to 10 cm). BT had a sensitivity of 63.2% (PPV 86.8%) and
a specificity of 89.5% (NPV 61.2%) with mammography as the reference
standard. Also, 73.3% of breast lumps with irregular margins and 88.5%
with dense opacity at transillumination turn out to be malignant at
histopathology examination.
Conclusion: The Breast transillumination technique had a moderate
sensitivity of 63.2%. This warrants a large scale population-based
evaluation of BT as a screening tool. This technique may not substitute
mammography but to be considered an option where mammography
access is limited.
cancer in high-income countries but may not be feasible for most resource
poor nations. Alternative modalities are needed to mitigate the impact of the increasing incidence and mortality due to breast cancer. This may require the development of new technologies or reevaluation of old technologies applicable to resource limited settings.
Objective: To determine the sensitivity and specificity of breast transillumination as compared to mammography and to describe features
of benign and malignant breast lesions as seen with breast transillumination.
Methods: A single group descriptive analytical study was conducted
over a six month period (2011) in the breast unit of Mulago National
hospital. Eligible participants were consecutively sampled. Participants
underwent Clinical Breast Examination (CBE), breast transillumination
(BT), mammography (MG) and histopathological analysis of identified
breast lumps. Sensitivity, specificity and predictive values were
calculated. Features of the masses detected by transillumination were
then described.
Results: The number of participants recruited was 201 (mean age 42
years, range 30-80 years). The average palpable lump size was 3.8
cm (range 0.5 to 10 cm). BT had a sensitivity of 63.2% (PPV 86.8%) and
a specificity of 89.5% (NPV 61.2%) with mammography as the reference
standard. Also, 73.3% of breast lumps with irregular margins and 88.5%
with dense opacity at transillumination turn out to be malignant at
histopathology examination.
Conclusion: The Breast transillumination technique had a moderate
sensitivity of 63.2%. This warrants a large scale population-based
evaluation of BT as a screening tool. This technique may not substitute
mammography but to be considered an option where mammography
access is limited.
