Showing papers on "Breast lumps published in 2001"

Breast biopsy avoidance: the value of normal mammograms and normal sonograms in the setting of a palpable lump.

Abstract: PURPOSE: To review the authors’ experience with patients who presented with breast lumps and had normal mammograms and normal sonograms. MATERIALS AND METHODS: The findings from 600 lumps in 486 women with no focal ultrasonographic (US) mass or mammographic finding in the area of clinical concern were retrospectively studied. Evaluated parameters included the individual reporting the lump, qualitative descriptors for the physical finding, mammographic density, US characteristics in the area of concern, whether there was a change in imaging and/or physical examination results, and whether there were diagnostic biopsy findings at follow-up. The study group included 540 lumps in 435 women who had a minimum mammographic and clinical follow-up of 2 years, as well as 60 additional lumps in 51 patients who underwent biopsy. RESULTS: No patient in the nonbiopsy group developed carcinoma at the initial site of concern during a mean mammographic and clinical follow-up period of 43 months, and all biopsy specimens w...

Replace fine needle aspiration cytology with automated core biopsy in the triple assessment of breast cancer.

Abstract: All patients presenting with a symptomatic breast lump are assessed by means of triple assessment (clinical examination, radiology in the form of mammography and cytology by means of a fine needle aspiration) performed by the clinician in the rapid access breast clinic at the Royal Gwent Hospital, Newport, UK. In our initial experience, it was found that a significant number of patients were returning to clinic for the results of the triple assessment to find that the cytology was not conclusive and hence needed a core biopsy, thus delaying diagnosis and definitive treatment. Therefore, a prospective study was carried out over a 6-month period, where all patients presenting with a symptomatic lump with a clinical or radiological suspicion of breast cancer had, in addition to the standard triple assessment, an automated core biopsy, thus giving rise to the quadruple assessment of the breast lump. A total of 52 patients with a clinical or radiological suspicion of breast cancer were included over this 6-month period. Of these 52 patients, 31 had a definitive diagnosis of breast cancer on fine needle aspiration (sensitivity 60%) compared with 50 of the 52 patients on core biopsy (sensitivity 96%). When radiology was diagnostic of breast cancer (R 5), the sensitivity of cytology was 61% compared with 97% with core biopsy. However, when radiology was not diagnostic of cancer (R 1-4), the sensitivity of cytology fell to 53% while the sensitivity of core biopsy remained high at 95%. The overall cellularity rate for cytology was 96%, which exceeds the BASO requirement for fine needle aspiration cytology. From these results, we conclude that automated core biopsy has a superior diagnostic power when compared with fine needle aspiration cytology and hence should replace fine needle aspiration cytology in the assessment of symptomatic breast lumps.

Benign breast disease at Wesley Guild Hospital, Ilesha, Nigeria.

Abstract: UNLABELLED A prospective survey of 225 patients carried out over a period of 7years (1992 - 1999) to determine the pattern and outcome of benign breast diseases. Two hundred and seventeen (96.4%) were females and 8 males, with the age ranging from 14-63 years, mean 28.7 SD+10.6 years. The mean age for patients with fibroadenoma was 24 years and 31.6 years for fibrocystic disease of the breast. One hundred and ninety six patients (87.2%) presented with breast lumps or mass, non-menstrual cycle and menstrual cycle related pain in 39(17.3%) and 32(13%) patients respectively and nipple discharge in 60 patients (26.7%). Mean duration of symptoms was 0.91+0.64 years, 2 + 1.2 weeks for inflammatory lesions and 0.86 + 0.56 yers for benign tumours and also menstrual cycle related breast pain. Right side was involved in 162 patients (72%), 85(38%) left side and 77(34.2%) bilateral. Clinical diagnosis was fibrocystic disease 96(42.7%). Fibroadenoma 89 (39.5%), inflammatory conditions 35(15.7%), galactocele in 9(40%) and gynaecomastia in 7(3%) of the patients. Excisional or incisional biopsy was carried out in 197 patients (87.5%), antibiotic and analgestic administration in 35(15.6%) and 29(13%), respectively. Histopathologic analysis showed fibroadenoma in 91 (46.2%), fibrocystic disease 83 (42.2%), and others in 23 (11.6%) cases. The mean follow-up period was 10 months for tumours and I month for others. Postoperative complications were infrequent, there were recurrence either on the ipsilateral or contralateral breast in 10(4.4%) patients of which 3(1.3%) cases were malignant. CONCLUSION Fibroadenoma was the most common benign breast disease, followed by fibrocystic disease of the breast. Postoperative complications were uncommon.

Evaluation of fine needle aspiration and imprint cytology in the early diagnosis of breast lesions with histopathological correlation.

Abstract: Fifty-one breast lumps were studied by fine needle aspiration cytology (FNAC) and scrape imprint cytology. Of the 51 cases, 28 were malignant and included infiltrating duct carcinoma (22), well differentiated adenocarcinoma (2), mucinous, papillary and lobular carcinoma (one each) and malignant lymphoma (one). Benign lesions were mastitis, fibroadenoma and fibrocystic disease. The diagnostic accuracy of FNAC was 90.2% and that of imprint 94.1% with no false negatives. Two imprint smears and one aspirate designated suspicious were proved to be benign. The combination of FNAC and imprint cytodiagnosis gave a diagnostic accuracy of 96% thus proving their value in the rapid diagnosis of breast lesions.

Correlation between AgNOR count and subjective AgNOR pattern assessment score in cytology and histology of breast lumps.

Abstract: OBJECTIVE To find the correlation of argyrophilic nucleolar organizer region (AgNOR) count and subjective AgNOR pattern assessment (SAPA) score in cytology and histology of breast lumps. STUDY DESIGN The study group consisted of 73 patients (46 malignant, 27 benign) with breast lumps. In all cases, fine needle aspiration cytology (FNAC) samples and histologic specimens were studied by conventional and silver staining for AgNORs. RESULTS AgNOR count and SAPA score were helpful in differentiating benign from malignant tumors in both the cytologic smear and histologic specimen. AgNOR count was 6.94+/-2.74 in FNAC and 6.57+/-2.73 in histology of malignant tumors, while in benign tumors it was 2.75+/-0.74 in FNAC and 2.68+/-0.77 in histology. SAPA score was 9.02+/-4.60 in FNAC and 8.76+/-2.34 in histology in malignant tumors and 5.87+/-0.93 in FNAC and 5.82+/- 0.83 in histology in benign tumors. CONCLUSION Both AgNOR count and SAPA score gave similar results, but SAPA score is a more convenient, reproducible and rapid method of AgNOR evaluation.

Breast lump detection training model with feedback

Abstract: The device is for the training of medical professionals and others in the detection of breast lumps. It addresses two deficiencies in other models; the ease of lump location memorization and lack of feedback in the detection of a lump. The device is a model of the human female breast consisting of the following tissue simulations; an exterior skin, an interior body, ribs, a base and multiple potential lumps. The notable innovation to breast lump trainers is the employment of tubes to simulate the breast lumps, supply feedback and reduce the user's ability to memorize lump locations. A fine elastic tube inflates at its tip to simulate a breast lump. The pressure applied to the tube is monitored and provides feedback indicating detection of a simulated breast lump. Multiples of these tubes are placed within the trainer body. The tube balloons can be inflated, or ‘turned on’, to variable sizes with air or fluid to simulate breast lumps. The tube balloons can be deflated, or ‘turned off’, and return to their original, difficult to detect, tube shape. The tubes exit the breast model through the base and are connected to a fluid pressure sensor, for breast lump detection feedback, and to an injector for inflating, deflating and changing the size of the lumps.

Assessment of breast problems.

Abstract: Patients with discrete breast lumps, irrespective of age, should be referred for assessment. Premenopausal women with equivocal lumps can be re-checked two weeks later and, if still present or dubious, sent to a breast clinic. Almost all women with breast pain do not need referral unless the symptoms are severe or prolonged. Careful examination will detect those individuals with underlying rib cage pain who can be reassured and given analgesics, if necessary, but not referred. Blood-containing nipple discharge is an indication for referral but such cases can be reassured that, in the absence of a lump, it is unlikely they have breast cancer. Most women who suspect their family history of breast cancer places them at increased risk can be safely reassured and do not need to be kept under surveillance. All those women who are eligible for the NHS screening programme should be encouraged to attend when invited.

Breast mass removal made easy by the lump extractor: introducing a new instrument in breast surgery.

Abstract: The difficulty encountered in the removal of breast lumps has been addressed by the use of a new instrument. The lump extractor described in this paper allows minimal scar surgery and prevents crushing of the breast mass.

Vacuum‐assisted biopsy: a safe and accurate alternative to excision

Abstract: Introduction: Image-detected breast lesion is becoming a concern in surgery. After triple assessment, a suspicious or indeterminate lesion will usually require excision to rule out malignancy. Vacuum-assisted biopsy is newly introduced as a minimally invasive alternative to operation in obtaining tissue for histological assessment. The early experience of this procedure in the Breast Centre of Kwong Wah Hospital is reviewed. Method: Vacuum-assisted biopsy was performed for image-detected breast lesions under local anaesthesia using the Mammotome. Lesions were either vaguely palpable or non-palpable but well seen on ultrasound scan with fine needle aspirated indeterminate cytology or benign cytology in a high risk patient. Definitive surgery was performed if the biopsy result showed malignancy or upon patient’s request. Other patients were followed up six monthly with clinical examination and ultrasound scan. Excision was indicated if there was any increase in size. The pathology was assumed to be benign if there was no change in six months time. Result: From September 1998 to May 2000, 49 female patients were included. One of them had 2 lesions making a total of 50 cases. The mean age of the patients was 45.5 (22–58). The mean size of the lesion was 10.8mm (4–19). The procedure took 5–55 min (mean 16.6). It was successful in 49 cases (98%). Four lesions were found to be malignant. Three patients had definitive operations with the pathology confirmed while one patient defaulted follow up. Amongst the 45 benign lesions, 3 were excised upon request. The pathology were all benign. For the remaining 42 patients. 23 were followed up for 12 months and 19 patients for 6 months. Three patients were found to have enlarging lesions and excisions were performed which revealed benign histology. The breast lumps of the remaining 39 patients either remained unchanged or diminished size. There were no major complications (wound haematoma, infection). The average linear pain score (minimum 1, maximum 5) was 2.0. Conclusion: Vacuum-assisted biopsy is an accurate diagnostic tool with the advantage of minimal morbidity.

Optical biopsy for the diagnosis of breast tumours

Abstract: Elastic scattering or spectroscopy offers the possibility of distinguishing between cancerous and non-cancerous tissue in suspicious breast lumps with a relatively simple optical measurement. The measurement of the relative reflection of light has previously been shown to be sensitive to both the size and distribution of intra and inter-cellular structures as well as absorption from chromophores present in the tissue. Coupling a white light source and spectrometer to optic fibres makes it possible to construct probes that can be inserted through the skin or used during the operation or on excised tissue such as the sentinel node. This 'optical biopsy' is correlated with a conventional histopathological specimen obtained at the same point. Spectra have been obtained from a large number of patients with benign and malignant lesions. Some of the differences that appear in these spectra have been identified and these are discussed. To a relatively high degree of sensitivity and specificity it is shown to be possible to distinguish between malignant tumours, benign lesions and normal tissue.

Optical biopsy for the diagnosis of breast tumors

Abstract: Elastic scattering or spectroscopy offers the possibility of distinguishing between cancerous and non-cancerous tissue in suspicious breast lumps with a relatively simple optical measurement. The measurement of the relative reflection of light has previously been shown to be sensitive to both the size and distribution of intra and inter-cellular structures as well as absorption from chromophores present in the tissue. Coupling a white light source and spectrometer to optic fibres makes it possible to construct probes that can be inserted through the skin or used during the operation or on excised tissue such as the sentinel node. This `optical biopsy' is correlated with a conventional histopathological specimen obtained at the same point. Spectra have been obtained from a large number of patients with benign and malignant lesions. Some of the differences that appear in these spectra have been identified and these are discussed. To a relatively high degree of sensitivity and specificity it is shown to be possible to distinguish between malignant tumours, benign lesions and normal tissue.© (2001) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

Morphological and color Doppler velocimetry ultrasound evaluation of breast solid lumps – a malignancy S-score proposition

Abstract: The purpose was to evaluate the sensitivity, specificity and predictives values for each morphological or CDV ultrasound criteria, alone or associated, for the prediction of breast's solid lumps malignancy and to create a malignancy's score. We studied 430 women with 502 breast lumps (359 benign and 143 malignant). They were cared at CAISM-UNICAMP from May 1998 to November 1999 when a US examination of the breast were performed and the results compared with the pathological diagnosis, the gold standard. They had been evaluated through US morphological criteria such as borders, posterior wall, ecotexture, ecogenic halo, Cooper ligaments, diameters, volume, skin, compressibility, ratio between width and depth and CDV criteria such venous flow, color index, maximum systolic velocity, resistance index, pulsatility index and A/B ratio intra- and peritumoral. For data analysis, the groups of benign and malignant tumors were compared regarding control variables adjusted by age via logistic regression. The best individual performance among the morphologic criteria, were borders, ecogenic halo, Cooper ligaments, ecotexture, width/depth ratio and biggest diameter and among the CDV criteria, they were the color index, maximum systolic velocity, pulsatility and resistance index inside tumor. In the logistic regression analysis, the criteria identified as statistically associated to the malignancy were the borders, ecogenic halo, the largest diameter and the woman's age. They compound the equation of the malignancy's score, whose performance was of 95.2%. No one CDV criteria improved the global performance of the score. Excluding subjective criteria, the logistic regression analysis selected, for compound another equation of malignancy's score, the woman's age, the lump's largest diameter, the measure of the Cooper ligament and the VSmx inside the lump. This second score had a slightly lower performance than the first one (92% against 95.2%).