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Breast Cancer: Likelihood Ratios

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Prevalence

Population / Calculator	Prevalence	Comments / Study / Link
Nipple discharge	6%	6-12% of patients with unilateral nipple discharge have breast carcinoma
Screening Population	0.5%	J Natl Cancer Inst 2000 Jun 21;92(12):971-6. PMID 10861308
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The likelihood ratios of findings for Breast Cancer are listed below. See the left navigation bar to change the display.

Pre-Test Probability (Prevalence): %.	Post-Test Probability (Predictive Value): %.	Switch to display mode.
Note that calculating probabilities from more than one** finding is inherently inaccurate because findings are not independent. (For example, using two positive findings that share a common pathogenesis is likely to overestimate the true probability.)

Good Positive and Negative Likelihood Ratios
Finding	Result	+LR	-LR
[ + ] Mammography, Screening	+ 0 -	21.5	0.1
Sensitivity and specificity of mammography vary widely from study to study Study: Influence of personal characteristics of individual women on sensitivity and specificity of mammography in the Million Women Study: cohort study. Banks E; Reeves G; Beral V; Bull D; Crossley B; Simmonds M; Hilton E; Bailey S; Barrett N; Briers P; English R; Jackson A; Kutt E; Lavelle J; Rockall L; Wallis MG; Wilson M; Patnick J BMJ 2004 Aug 28;329(7464):477. PMID 15331472 Diagnostic performance of digital versus film mammography for breast-cancer screening. Pisano ED; Gatsonis C; Hendrick E; Yaffe M; Baum JK; Acharyya S; Conant EF; Fajardo LL; Bassett L; D'Orsi C; Jong R; Rebner M N Engl J Med 2005 Oct 27;353(17):1773-83. Epub 2005 Sep 16. PMID 16169887
[ + ] MRI	+ 0 -	7.2	0.2
Most studies have evaluated MRI in high risk populations. Study: Table 1 of this paper has a summary of results from multiple studies comparing mammography to MRI for breast cancer detection in high risk patients Breast MRI for cancer detection and characterization: a review of evidence-based clinical applications. DeMartini W, Lehman C, Partridge S. Acad Radiol. 2008 Apr;15(4):408-16. PMID 18342764 Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. Kriege et al N Engl J Med. 2004 Jul 29;351(5):427-37. PMID: 15282350 http://content.nejm.org/cgi/content/abstract/351/5/427
[ + ] Clinical Breast Exam	+ 0 -	8.9	0.4
in screening population by community practitioners another similar study found spec = 99.4% In the latter study, for diagnostic breast exams (i.e. for a complaint) specificity was only 68.7%. Study: J Natl Cancer Inst 2000 Jun 21;92(12):971-6. PMID 10861308 J Gen Intern Med. 2007 Mar;22(3):332-7. PMID 17356964

Poorly Diagnostic Findings
Finding	Result	+LR	-LR
[ + ] Core Needle Biopsy		Sensitivity = 98%
versus open surgical biopsy sensitivities were quite similar between ultrasound-guided and stereotactic biopsy Study: Bruening W, et al. "Systematic Review: Comparative Effectiveness of Core-Needle and Open Surgical Biopsy to Diagnose Breast Lesions". Ann Int Med. http://www.annals.org/content/early/2009/12/08/0003-4819-152-1-201001050-00190.abstract

Findings With Unspecified Accuracy
Finding	Result	+LR	-LR
[ + ] Ultrasound		No accuracy specified.
Study: no study specified.
[ + ] CA 15-3		No accuracy specified.
Study: no study specified.