Description and Trial of a Clinical Diagnostic Index for the early Diagnosis of Mammary Carcinoma.

Abstract

A method of clinical investigation has been developed for the early diagnosis of mammary carcinoma based on the scoring of 10 Symptomatologie features of mammary nodules of doubtful malignancy. These features are: variations in size, consistency, form, surface, limits, mobility, protrusion, pain on pressure, presence and nature of secretion from the nipple, nature of axillary lymph nodes. Each feature is scored +2, + 1, 0, −1 or −2 according to whether it points to a malignant, doubtful or benign lesion, +2 and −2 indicating a more definite degree one way or the other. The number emerging from the algebric sum of the ten scores is rated as the complex score or clinical diagnostic index. The validity of the method was tested in 93 cases of clinically doubtful mammary nodules later subjected to histologic examination. The method yielded the right answer in 91 % (compared with 80 % for mammography) and false negatives in 2.2 % (compared with 15 %) of the 46 cases of mammary carcinoma. It yielded the right answer in 48.9 % (compared with 42.5 % for mammography) and 34 % false positives (same percentage as for mammography) of the 47 benign lesions. Thermography, used in about four-fifths of the cases, showed a much lower success rate. The combined outcome of clinical diagnostic index and mammography made it possible to avoid the preliminary classification of carcinomas as benign lesions. It was therefore concluded that the method is useful in uncertain mammary nodules, though the results of a larger trial, now in progress, must be awaited before expressing a definite verdict.