Assessing Diagnostic Practices for Breast Lumps: A Cross-Sectional Study in Sragen, Indonesia

 

Assessing Diagnostic Practices for Breast Lumps: A Cross-Sectional Study in Sragen, Indonesia

Breast cancer is a prevalent and significant health concern for women globally. In Indonesia, where breast cancer incidence remains high, early and accurate diagnosis is critical for effective treatment. The gold standard for diagnosing breast lumps is triple assessment, which includes clinical breast examination, breast imaging, and fine-needle aspiration biopsy (FNAB). However, the implementation of this approach varies widely in Indonesia, and there is limited evidence regarding its effectiveness. This study aims to explore the current diagnostic practices for breast lumps in Indonesia, the factors influencing these practices, and their association with diagnostic errors.

Methods:

This cross-sectional study enrolled 364 female patients with breast lumps who underwent surgery at Soehadi Prijonegoro Public Hospital in Sragen, Indonesia. Data were retrospectively collected from medical records. Diagnostic assessments were categorized into four groups: single assessment (clinical breast examination), double assessment with breast ultrasonography (USG) or FNAB, and triple assessment. Diagnostic errors were defined as discrepancies between pre- and post-surgery diagnoses or repeated surgeries without neoadjuvant chemotherapy. Factors influencing diagnostic assessment implementation, diagnostic errors, and repeated surgeries were analyzed using the chi-square test.

Results:

1. Choice of Diagnostic Assessment:

   - Single assessment (clinical breast examination) was the most common (44.8%).

   - Double assessment with FNAB followed closely (28.8%).

   - Triple assessment was rarely used, only in 5.8% of cases.

2. Factors Influencing Diagnostic Assessment:

   - Patients' age and health insurance significantly influenced the choice of diagnostic assessment.

   - Triple assessment was more common in patients aged ≥40 (57.1%) and those with contributory health insurance (76.2%).

   - Clinical breast examination and breast USG were more frequent in patients under 40.

3. Diagnostic Errors and Repeated Surgeries:

   - Diagnostic errors occurred in 23.1% of cases.

   - Repeated surgeries were significantly associated with diagnostic assessment.

   - Single assessment and double assessment with breast USG had the highest rates of repeated surgery (48.9% and 100%, respectively).

   - Double assessment with FNAB had significantly lower repeated surgery rates (84.9%).

Discussion:

This study highlights the low implementation of triple assessment in breast lump cases in Indonesia. The choice of diagnostic assessment was influenced by patients' age and health insurance coverage. Despite limited resources, double assessment with clinical breast examination and FNAB demonstrated high accuracy and reduced repeated surgery rates, making it a cost-effective alternative to triple assessment.

Conclusion:

In Indonesia, the implementation of triple assessment for breast lump diagnosis remains limited. Double assessment with clinical breast examination and FNAB emerges as a viable alternative in resource-constrained settings, offering accuracy and cost-effectiveness. Future research should delve into clinician-related factors and explore strategies to enhance the adoption of evidence-based diagnostic practices. Ultimately, improving breast lump diagnosis can contribute to better breast cancer management and outcomes in Indonesia.