Showing papers on "Breast lumps published in 1991"

Sclerosing lymphocytic lobulitis of the breast–evidence for an autoimmune pathogenesis

Abstract: We describe 13 cases of inflammatory lesion of breast lobules in young and middle-aged women, presenting as breast lumps, with, in five cases, associated breast pain. The patient with the most florid bilateral disease subsequently developed Hashimoto's thyroiditis. This prompted us to consider an autoimmune pathogenesis for all the breast lesions. We confirm a previously documented association of such breast lesions with diabetes mellitus and review the evidence for a possible HLA association. Increased HLA-DR expression by breast epithelial cells was observed in cases available for study. Of the seven patients screened for circulating autoantibodies, three had none, one had smooth muscle antibodies, one parietal cell, one parietal cell and thyroid microsomal, and the seventh had the thyroid autoantibodies expected in Hashimoto's disease. Five of seven patients whose HLA-status was determined were HLA-DR3, 4 or 5 positive, either singly or in combination. Immunophenotypic analysis of the mammary lymphoid infiltrate showed that the majority of infiltrating lymphocytes were B-cells.

Audit of Diagnostic Accuracy of Fna Cytology Specimens Taken By the Histopathologist In A Symptomatic Breast Clinic

Abstract: One thousand and two patients with palpable breast lumps have had fine needle aspiration at a surgical symptomatic breast clinic where the pathologist takes, stains and immediately reports the aspiration cytology smears. High levels of complete sensitivity (95.7%) and specificity (100%) have been maintained with a combined complete sensitivity for aspiration cytodiagnosis, mammography and clinical assessment of 99.7%. Significant reductions of unnecessary biopsies and out-patient revisits have allowed major resource savings to be made. In view of the high degree of accuracy obtained by this approach to the investigation of palpable breast lesions, combined clinics with their benefits for the patient, both physical and psychological, should be encouraged.

Diagnosis of breast cancer in young women.

Abstract: While the prognosis of younger women with breast cancer is controversial, there have been sevet al significant reports indicating a more unfavourable outcome of the disease in this age group. A review has been conducted of the problems encountered in the diagnosis of breast cancer in younger women. The records of 227 consecutive patients aged 30–40 years who underwent breast biopsy were retrospectively analysed, and data studied in relation to the proportion of malignant to benign biopsies, the clinical and pathological features of the malignant cases, and the method of diagnosis. A total of 235 biopsies was performed in 227 patients, of which 199 were benign (85%) and 36 were malignant (15%). giving a malignant to benign biopsy ratio of 1:5.5. Thirty-six cancers were diagnosed in 35 patients. Among these young women with breast cancer, the average duration of symptoms was 26 weeks, the mean clinical cancer diameter was 3.3 cm and only a small proportion (28%) of women had early (Stage I) disease. There were 4 women with breast cancer (11%), in whom the diagnosis of malignancy was unsuspected pre-operatively. Mammography in these younger women appears to have a more limited role, with a sensitivity of only 76%. These findings indicate that the diagnosis of breast cancer in younger women is often more difficult than in older age groups and that the presentation and detection of such cancers is often delayed. Younger women need to be educated in relation to seeking early medical review of breast lumps and clinicians need to be aware of the limitations of mammography in such cases.

Fine needle aspiration cytology, imprint cytology and tru-cut needle biopsy in breast lumps: a comparative evaluation.

Abstract: Fine needle aspiration cytology, imprint cytology and tru-cut needle biopsy were performed in 86 patients with breast lump and the results of these techniques were finally compared with the incisional or excisional biopsy in all the patients. Fine needle aspiration cytology had the sensitivity of 96.8% and specificity of 100%, the imprint cytology had the sensitivity of 98.4% and specificity of 100%. While the tru-cut needle biopsy had the sensitivity and specificity of 100% though in this technique 15 of 86 (17.4%) specimens were rejected as insufficient for any diagnosis.

Fine needle aspiration cytodiagnosis as a pre-requisite for primary medical treatment of breast cancer.

Abstract: The accurate non-surgical diagnosis of breast lumps allows assessment of breast cancer patients for conservation or neoadjuvant primary treatment before surgical intervention. We have analysed the accuracy of clinical assessment, fine needle aspiration cytology (FNAC), and mammography in over 868 women seen in a symptomatic breast clinic. Clinical examination by an experienced breast physician, together with FNAC, detected over 99% of the cancers with a 12% false positive rate. A cytological diagnosis of definite carcinoma was obtained in 69% of women with breast cancer with no false positive result from the women with benign conditions producing a 100% positive predictive value. These results indicate that it would be acceptable to give pre-surgical systemic endocrine or chemotherapy to women with positive cytology which is therefore a prerequisite for a neoadjuvant therapy programme.

Breast self-examination.

Abstract: Breast self-examination (BSE) continues to be widely promoted by Government agencies and medical practitioners in Europe and the United States. Point 10 of the European Code Against Cancer exhorts women to 'examine their breasts regularly'. Breast lumps are common and most women will detect a breast abnormality at some time in their life, irrespective of the promotion of BSE by the medical profession. It should be possible to increase a woman's ability to deal better with this anxiety-provoking situation, and to reduce the number of women presenting with locally advanced disease, by appropriate health education. But this does not mean that BSE should be promoted as a screening test for cancer, with the consequent emphasis on vigilance and early self-referral. The natural course of breast cancer is not completely understood. Although stage at diagnosis is related to survival, and mammographic screening trials suggest that early diagnosis (often before a lump is palpable) can lead to effective treatment which prolongs life, earlier treatment of a palpable lump detected by BSE is not guaranteed to improve survival. © 1991 The British Council.

Fine needle aspiration as a primary diagnostic procedure of breast lumps.

Abstract: Two hundred and sixty-seven patients from the ages between 17 to 70 years with breast lumps attending the Cytology Clinic of the Out-patients Department and Cytology Section of the Department of Pathology, M.K.C.G. Medical College, Berhampur (Orissa), were subjected to Fine-Needle Aspiration Cytology (FNAC). Sixty-four patients were discarded from study because of non-availability of biopsy specimens and unsuitable smears. When cytological results were compared with those of histological sections, 100 per cent correct diagnosis was made in chronic mastitis and lobular carcinoma, 94.24 per cent in infiltrating duct carcinoma and 84.60 percent in duct papilloma and with the maximum over diagnosis to the tune of 14.75 per cent was found in fibro-adenoma. An overall correct diagnosis was made in 88.67 percent of cases by FNAC.

Teaching employees breast self examination. Factors that may influence practice.

Abstract: Breast self examination is a widely known technique used for detection of breast lumps. Many women do not practice monthly breast self examination, although it has been proven that with early detection the prognosis of breast cancer can be improved greatly. When tend to be taught, or learn about, breast self examination at an early age. The educational techniques used during the instruction can influence the practice of BSE later on. Health professionals can make a difference in the practice of BSE by communicating the value of this detection technique. BSE is a viable breast cancer detection technique that employees can be taught easily in employee wellness programs by health professionals.

Diagnosis by team work: an approach to conservatism.

Abstract: In the Nottingham Breast Clinic 5000 new cases are seen annually; 3000 are sent because the general practitioner believes that he/she has found a lump. It is the diagnosis and management of this common problem that is considered in this chapter. The traditional management of the palpable breast lump included excision to establish accurate diagnosis; indeed up until 20 years ago even simple cysts were excised. Now most surgeons accept that a woman with no residual palpable abnormality after aspiration of blood-free fluid from a cyst requires no further treatment. Most solid breast lumps are benign on histological examination; their routine removal a mistake in judgement. The challenge in the management of a palpable lesion is to correctly diagnose all the cancers without having to remove those which are benign, unless the patient wishes.

A new breast screening programme--an audit of the first year.

Abstract: The experience of a new breast screening unit is reported. In the first 12 months there was a 72.1% response rate with 9890 women being screened. After the initial screen 598 (5.8%) were referred to the Assessment clinic. Following repeated mammography and clinical examination 166 patients were referred for a surgical opinion; 105 (1.06% of the total screened) were considered to be possibly malignant; 61 further patients with clinical and mammographically benign disease were kept under review by a single surgeon; 101 patients had excision biopsies; 28 of 32 palpable breast lumps and 36 of 69 non-palpable lesions proved to be malignant.

Doppler flowmetry and the diagnosis of breast lumps.

Abstract: The aim of the study was to ascertain the reliability of a Doppler signal in the diagnosis of breast cancer. Computerized blood flow analysis was performed on 117 patients who presented with a breast lump at the Division of Diagnostic Oncology of the Istituto Nazionale Tumori of Milan. The values of systolic peak and diastolic frequency were evaluated in relation to the histologic diagnosis. Ten patients had a spontaneous regression of the lump and were excluded from the study. The number of evaluable cases with histologic confirmation was 107: 69 carcinomas and 38 benign lesions. Systolic peak values for the 69 carcinomas ranged from 1500 to 7400 Hz, with a mean value of 3243.4 Hz; diastolic frequency ranged from 200 to 3700 Hz, with mean value of 1413.9 Hz. No diagnostic signals were found in 4 breast cancers (false negatives). Twenty-three of 38 benign lesions (60.5%) and 65 of 69 malignant nodes (94.2%) were correctly diagnosed. The Doppler signal with computerized spectral analysis in addition to more specific ultrasonographic parameters could be considered a useful tool in the diagnosis of breast cancer.

Quantitative analysis of nuclear area variation in benign and malignant breast fine needle aspirates.

Abstract: The measurement of nuclear area was carried out in 30 benign and 32 malignant breast lumps using Omnicon Alpha 500 Image Analyzer. The mean nuclear area of duct cells in malignant group was greater (157.6 +/- 58.64 sq.microns with a peak around 140 sq.microns) and more heterogenous within and amongst cases than observed in duct cells from most of the cases of fibroadenoma (85.05 ae 14.2 sq.microns with a peak around 80 sq.microns). Taking into consideration 110 sq.microns as a differentiating limit, a significant difference was observed between benign and malignant conditions (p). Similarly taking 118 sq.microns as differentiating limit duct cell carcinomas could be divided into two groups i.e. 9(28.1%) cases of small nuclear type with a range of 80-118 sq.microns and 23(71.9%) cases of large nuclear type with a range of 118-320 sq microns .6(18.8%) cases with small nuclei had an overlap with fibroadenoma. Although 13(72.2%) cases of large nuclear type carcinomas had lymph node metastasis as against 4(44.4%) in small nuclear group, the difference was not statistically significant.