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dc.contributor.authorPace, Lydia E.
dc.contributor.authorDusengimana, Jean-Marie Vianney
dc.contributor.authorHategekimana, Vedaste
dc.contributor.authorRugema, Vestine
dc.contributor.authorUmwizerwa, Aline
dc.contributor.authorFrost, Elisabeth
dc.contributor.authorKwait, Dylan
dc.contributor.authorSchleimer, Lauren E.
dc.contributor.authorHuang, ChuanChin
dc.contributor.authorShyirambere, Cyprien
dc.contributor.authorBigirimana, Jean Bosco
dc.contributor.authorShulman, Lawrence N.
dc.contributor.authorMpunga, Tharcisse
dc.contributor.authorRaza, Sughra
dc.date2022-08-11T08:10:50.000
dc.date.accessioned2022-08-23T17:22:00Z
dc.date.available2022-08-23T17:22:00Z
dc.date.issued2022-06-20
dc.date.submitted2022-07-21
dc.identifier.citation<p>Pace LE, Dusengimana JV, Hategekimana V, Rugema V, Umwizerwa A, Frost E, Kwait D, Schleimer LE, Huang C, Shyirambere C, Bigirimana JB, Shulman LN, Mpunga T, Raza S. Clinical Diagnoses and Outcomes After Diagnostic Breast Ultrasound by Nurses and General Practitioner Physicians in Rural Rwanda. J Am Coll Radiol. 2022 Jun 20:S1546-1440(22)00414-8. doi: 10.1016/j.jacr.2022.04.009. Epub ahead of print. PMID: 35738413.</p>
dc.identifier.issn1558-349X
dc.identifier.doi10.1016/j.jacr.2022.04.009
dc.identifier.pmid35738413
dc.identifier.urihttp://hdl.handle.net/20.500.14038/48650
dc.description.abstractPURPOSE: 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.
dc.language.isoen_US
dc.relation<p><a href="https://pubmed.ncbi.nlm.nih.gov/35738413/" target="_blank" title="view article in PubMed">view article in PubMed</a></p>
dc.relation.urlhttps://doi.org/10.1016/j.jacr.2022.04.009
dc.subjectbreast cancer
dc.subjectultrasound
dc.subjectRwanda
dc.subjectAfrica
dc.subjectearly diagnosis
dc.subjectInternational Public Health
dc.subjectNeoplasms
dc.subjectOncology
dc.subjectRadiology
dc.subjectSkin and Connective Tissue Diseases
dc.subjectWomen's Health
dc.titleClinical Diagnoses and Outcomes After Diagnostic Breast Ultrasound by Nurses and General Practitioner Physicians in Rural Rwanda
dc.typeArticle
dc.source.journaltitleJournal of the American College of Radiology
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/radiology_pubs/713
dc.identifier.contextkey30355446
html.description.abstract<p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p>
dc.identifier.submissionpathradiology_pubs/713
dc.contributor.departmentDepartment of Radiology


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