Showing papers on "Breast lumps published in 2016"

Understanding pathways to breast cancer diagnosis among women in the Western Cape Province, South Africa: a qualitative study.

Abstract: Objectives The aim of this study was to explore and understand women9s pathways to breast cancer diagnosis and factors influencing this journey. Design and setting Indepth interviews were conducted with clients at a tertiary level breast cancer clinic in Cape Town, South Africa. A thematic analysis was performed underpinned by the theoretical concepts of the Model of Pathways to Treatment framework. Participants 20 women were interviewed within 1 week of being diagnosed with breast cancer. Results The average time between discovery of bodily changes to breast cancer diagnosis was 8.5 months. Deficits in breast self-awareness and knowledge of breast cancer symptoms delayed women9s interpretation of bodily changes as being abnormal. All women first noticed breast lumps; however, many did not perceive it as abnormal until additional symptoms were present. General good health, attribution of symptoms to ageing, and past benign breast disease resulted in women being complacent about bodily changes. Disclosure to family members served as a trigger to seek healthcare. The initial type of primary level care services women accessed was influenced by perceptions of care each service provided, finances, structural factors, and personal safety related to the physical location of services. Conclusions Symptom appraisal and interpretation contributed significantly to delayed presentation. To improve timely diagnosis of breast cancer, interventions that increase women9s confidence in detecting breast changes, improve knowledge of breast cancer symptoms, address myths, and encourage prompt help-seeking behaviour are required.

Pattern of Breast Cancer Distribution in Ghana: A Survey to Enhance Early Detection, Diagnosis, and Treatment.

Abstract: Background. Nearly 70% of women diagnosed with breast cancer in Ghana are in advanced stages of the disease due especially to low awareness, resulting in limited treatment success and high death rate. With limited epidemiological studies on breast cancer in Ghana, the aim of this study is to assess and understand the pattern of breast cancer distribution for enhancing early detection and treatment. Methods. We randomly selected and screened 3000 women for clinical palpable breast lumps and used univariate and bivariate analysis for description and exploration of variables, respectively, in relation to incidence of breast cancer. Results. We diagnosed 23 (0.76%) breast cancer cases out of 194 (6.46%) participants with clinically palpable breast lumps. Seventeen out of these 23 (0.56%) were premenopausal (<46.6 years) with 7 (0.23%) being below 35 years. With an overall breast cancer incidence of 0.76% in this study, our observation that about 30% of these cancer cases were below 35 years may indicate a relative possible shift of cancer burden to women in their early thirties in Ghana, compared to Western countries. Conclusion. These results suggest an age adjustment for breast cancer screening to early twenties for Ghanaian women and the need for a nationwide breast cancer screening to understand completely the pattern of breast cancer distribution in Ghana.

Clinicopathological study of benign breast diseases

Abstract: Background: Study of pattern of benign breast disease is a challenge due to variants in occurrence and presentation in different age groups and different geographical areas. The objective is to study the clinical profile and pattern of benign breast disease and its pathological correlation. Methods: This is a prospective study of females with breast disease presenting to surgery department over a period of one year. This survey was mainly meant for studying the age distribution, to evaluate the different types of benign diseases of the breast, their mode of clinical presentation and pathology and to evaluate the various modes of management for different types of Benign Breast Diseases. Patients with obvious malignancy and males were excluded from the study. Results: A total of 100 females were included in the study. Fibroadenoma (37%) and fibroadenosis (23%) were the commonest diseases,both presenting mostly at 21-30years of age. Left side involvement was most common. The commonest presentation was breast lump which comprised 84 (84%) cases, out of which 26 (26%) had associated complaints like breast pain and nipple discharge. Conclusion: Benign breast diseases are common problems of 2nd and 3 rd decade in females and raises considerable fear of malignancy. The patients of BBDs generally present with one or more of these complaints – breast lump, breast pain or nipple discharge. All the patients with discrete breast lumps should undergo a triple assessment to make an early diagnosis.

High intensity focused ultrasound in the treatment of breast fibroadenomata: results of the HIFU-F trial

Abstract: Objectives: Breast fibroadenomata (FAD) are the most common breast lumps in women. High intensity focused ultrasound (HIFU) is a non-invasive ablative technique that can be used to treat FAD but is...

FNAC Versus Core Needle Biopsy: A Comparative Study in Evaluation of Palpable Breast Lump

Abstract: Introduction Breast carcinoma is the most common malignant tumour and the leading cause of carcinoma death in women in world. The main purpose of FNAC or CNB of breast lumps is to confirm cancer preoperatively and to avoid unnecessary surgery in specific benign conditions.

Oncoplastic Surgery for Upper/Upper Inner Quadrant Breast Cancer.

Abstract: Tumors located in the upper/upper inner quadrant of the breast warrant more attention. A small lesion relative to the size of breast in this location may be resolved by performing a level I oncoplastic technique. However, a wide excision may significantly reduce the overall quality of the breast shape by distorting the visible breast line. From June 2012 to April 2015, 36 patients with breast cancer located in the upper/upper inner quadrant underwent breast-conservation surgery with matrix rotation mammoplasty. According to the size and location of the tumor relative to the nipple-areola complex, 11 patients underwent matrix rotation with periareolar de-epithelialization (donut group) and the other 25 underwent matrix rotation only (non-donut group). The cosmetic results were self-assessed by questionnaires. The average weights of the excised breast lumps in the donut and non-donut groups were 104.1 and 84.5 g, respectively. During the 3-year follow-up period, local recurrence was observed in one case and was managed with nipple-sparing mastectomy followed by breast reconstruction with prosthetic implants. In total, 31 patients (88.6%) ranked their postoperative result as either acceptable or satisfactory. The treated breasts were also self-evaluated by 27 patients (77.1%) to be nearly identical to or just slightly different from the untreated side. Matrix rotation is an easy breast-preserving technique for treating breast cancer located in the upper/upper inner quadrant of the breast that requires a relatively wide excision. With this technique, a larger breast tumor could be removed without compromising the breast appearance.

Clinicopathological Profile of Breast Cancer Patients at a Tertiary Care Hospital in Marathwada Region of Westen India

Abstract: Background Breast cancer is the most prevalent malignancy among women with wide differences in clinical profile from region to region. The present study aimed to describe the profile of breast cancer patients attending a tertiary care hospital in Marathwada region of Western India. Materials and methods In this descriptive retrospective study, we reviewed records of pathologically diagnosed patients of breast cancer managed at our center from years 2009 to 2015. Data with respect to demographic status, detailed past, medical, familial and personal history, findings of clinical examination and histological features were obtained. Patients were staged according to the Tumor Node Metastasis (TNM) system. Results Among 260 cases, mean age of presentation was 52.6, with average age of menarche of 11.3 and menopause of 52.6 years. The majority of patients were from urban regions and were postmenopausal (64.3%). Main clinical features presentation were breast lumps. Most patients were in stage II and had infiltrating duct carcinomas. Conclusions Most common risk factors for breast cancer observed are increasing age, low parity and obesity. Breast cancer was more prevalent among postmenopausal women presenting in stage II with infiltating duct carcinoma in our region of India.

Radiologic evaluation of lumps in the male breast.

Abstract: BackgroundGynecomastia has a typical appearance on mammography, and occurs frequently in men. However, imaging is often performed on men with breast lumps to exclude breast cancer, which only compr...

Random Cross-Sectional Determination of the Level of Awareness Among Female Saudi Patients About Breast Cancer.

Abstract: The purpose of this study was to randomly determine the level of awareness and knowledge among female Saudi patients about the risk factors and symptoms of breast cancer as well as any awareness about the practices for breast cancer self-examination. A random cross-sectional survey was conducted over 4 months at two private medical clinics in Riyadh, Saudi Arabia. The 4-month period was from December 2013 to March 2014. The survey instrument was a questionnaire that was both self-explanatory and user-friendly. Our study subjects included 174 randomly selected Saudi female patients with no medical history of breast cancer. These patients visited these private clinics for medical advice or for consultation on problems unrelated to breasts. Participants' perception of risk factors regarding early menses showed only 47.1 %. The most common risk factor known by the participants was a family history of breast cancer (84 %). The most widely recognized symptoms of breast cancer were occurrence of breast lumps (86.2 %) and breast pain (93.7 %). Awareness of information regarding breast self-examination (BSE) was 81.6 % in general. Many were aware of the opinion that proper and assisted knowledge about BSE can help in early detection of breast cancer. The patients were also aware that BSE is the most widely used method of screening for breast cancer in clinics and hospitals. All the participants showed sufficient knowledge about the risk factors and symptoms of breast cancer. These baseline findings are encouraging for providing more self-explanatory information (to patients) and guidance to health authorities for developing effective breast health care programs in the entire Kingdom for the female population and not only for patients visiting health care clinics for advice on other medical issues.

Comparative Study of Core Needle Biopsy and Fine Needle Aspiration Cytology in Palpable Breast Lumps: Scenario in Developing Nations.

Abstract: Objective The purpose of this study was to evaluate the utility of core needle biopsy as a diagnostic tool for palpable breast lumps in developing countries as compared to fine needle aspiration cytology. Material and method All patients attending the surgery outpatient department with palpable breast lumps were subjected to fine needle aspiration cytology and core needle biopsy by the same operator in a single session. Fine needle aspiration cytology was performed by the standard technique. Core needle biopsy was done freehand using a 14G manual core biopsy needle. Reporting categories of the two techniques were taken from the standard National Health Service Breast Screening Programme criteria and were compared with the final histopathology results. Results A total of 107 patients underwent fine needle aspiration cytology and core needle biopsy simultaneously. Histopathology was available for 85 cases. Statistical analysis of fine needle aspiration cytology and core needle biopsy showed no significant difference between the diagnoses offered by core needle biopsy and histopathology while there was a significant difference between fine needle aspiration cytology and histopathology diagnoses. Conclusion Core needle biopsy detected more breast carcinomas as compared to fine needle aspiration cytology with a sensitivity 95.83% as opposed to 64.58%. Though both the techniques were equally specific (100%), Core needle biopsy was able to correctly categorize borderline / inadequate lesions into definitely benign and malignant categories. We suggest that core needle biopsy should be preferred over fine needle aspiration cytology for the diagnosis of palpable breast lumps with fine needle aspiration cytology being reserved for definitely benign lesions.

Lupus mastitis of the male breast

Abstract: A 39-year-old male with no known co-morbid conditions presented with gradually increasing bilateral breast lumps for 1.5 years. Clinically, tender subcutaneous masses were detected. Mammograms revealed masses on both sides that on ultrasound were hyperechoic and showed internal vascularity. An MRI was suggested to assess the extent of the disease that confirmed bilateral masses but was otherwise inconclusive. Core biopsy revealed evidence of panniculitis with likely autoimmune aetiology. Evaluation of autoimmune markers was carried out that was positive and multidisciplinary team discussion concluded the diagnosis as lupus mastitis. Male breast pathology and lupus mastitis are both uncommon conditions, making lupus mastitis of male breast an extremely unusual presentation. However, its close clinical and radiological similarity with malignancy makes it important in spite of its rarity. Here we report a case of bilateral lupus mastitis in male breast with its radiological features.

Comparison of diagnostic accuracy of touch imprint cytology and frozen section techniques in detecting breast malignancies.

Abstract: OBJECTIVE To compare the diagnostic accuracy of touch imprint cytology and frozen section in the diagnosis of malignant breast lumps keeping histopathological diagnosis as the gold standard. METHODS The cross-sectional validation study was conducted at Foundation University Medical College, Islamabad, from February 2011 to February 2012, and comprised patients undergoing mastectomy/lumpectomy. The specimens were collected from the operation theatre of Fauji Foundation Hospital, Rawalpindi. After tissue fixation, three representative sections were processed and the slides were stained with haematoxylin and eosin stain. The person analysing touch imprint cytology slides was blinded to the frozen section and histopathological slide results and vice-versa. Data was analysed using SPSS 17. RESULTS Out of 76 patients with a mean age of 49±15.14 years, 61(80%) were diagnosed with malignant breast diseases. The sensitivity, specificity, positive predictive value, negative predictive value and true positives of touch imprint cytology were 96.72%, 100%, 100%, 88.24% and 96.72% respectively. The corresponding values of the frozen section were 100% each. The diagnostic accuracy calculated for touch imprints and frozen section was 97.37% and 100% respectively. CONCLUSIONS The diagnostic accuracy of frozen section was better than touch imprint cytology in rapid intra-operative diagnosis. However, touch imprints can safely be used as an alternative intra-operative procedure to ensure satisfactory results.

Fibroadenoma: Accuracy of clinical diagnosis in females aged 25 years or less

Abstract: Background: Accurate clinical diagnosis of fibroadenoma in young females is desirable because of the possibility of nonoperative treatment for those desiring it. Objectives: To determine the accuracy of the clinical diagnosis of fibroadenoma in patients aged ≤ 25 years. Patients and Methods: A prospective study of all patients with breast disease presenting to the breast clinic was conducted from January 2004 to December 2008. Results: During the study period, 145 patients aged ≤25 years presented with breast lumps. In this group, a clinical diagnosis of fibroadenoma was made in 100 (69.0%), fibrocystic disease in 32 (22.1%), breast cancer in 4 (0.03%) patients, the remaining were benign lesions. Excision biopsy was done for 81 (55.9%) patients. Of these 81 patients, only 62 (76.5%) returned with histology report. The histological diagnosis was fibroadenoma in 45 (72.5%) patients with a mean age of 21.4 years. Their ages range from 18 to 25 years. The histological diagnosis was fibrocystic disease in 9 (14.5%) and malignant phyllodes in 1 (1.6%) patient. The remaining 7 (11.3%) patients had other types of benign lesions. For fibroadenoma, true positive cases were 42, false positive 7 and false negative 3, and true negative 10. Therefore, the sensitivity of clinical diagnosis of fibroadenoma was 93.3%, while specificity was 58.8%. Conclusion: The sensitivity of clinical diagnosis of fibroadenoma in patients aged ≤25 years was good, though specificity is low.

Clinicopathologic study of breast lumps in Abakaliki, South Eastern Nigeria

Abstract: Aims and Objectives: Breast lumps are quite common, but the principal issue is differentiating malignant from the benign sub-groups. The determinants of histologic diagnosis are multifactorial, ranging from environmental, genetic to sex and age-related factors. This study aimed to document the spectrum of breast lumps in our environment. Materials and Methods: This is a descriptive prospective analysis of consecutive breast lumps biopsied at Federal Teaching Hospital Abakaliki, between December 2010 to November 2012. The data were analysed using statistical package for social sciences (SPSS) version 22.0 Results: A total of 302 patients with 359 breast lumps were seen, 298 females and 4 males giving male: female ratio of 1:75.The ages of the patients ranged between 16-82 years with a mean of 37.0 +/- SD 13.0. Majority (56.3%) of the patients had benign lumps. Fibroadenoma was the commonest (33.8%), followed closely by invasive ductal carcinoma (32.8%), then fibrocystic change (17.2%).The occurrence of breast cancer was strongly age-related, being 1 in 5 biopsies at 20-29 years and 3 in 5 biopsies at 40-49 years age groups. Over two-third (69.0%) of 132 patients with breast cancers were premenopausal. Majority (78.8%) of the 132 patients with breast cancer presented with advanced disease. At a median follow up of 9 months,13 (9.8%) and 6(4.5%) of 132 cancer patients developed recurrences and new cancer sites respectively. Conclusion: Most patients with breast complaints present with lumps and majority are benign, fibroadenoma being the commonest histology. Occurrence of breast cancer is strongly age-related with majority of cancer patients presenting late. Asian Journal of Medical Sciences Vol. 7(3) 2016 58-64

Cytomorphological Study of Palpable Breast Lumps: Spectrum of Lesions and Diagnostic Utility of FNAC.

Abstract: Background: Palpable breast lumps are quite common which can be benign or malignant. Carcinoma breast is the second most common cancer after cervical cancer. Fine needle aspiration cytology (FNAC) is a minimally invasive, rapid, reliable and cost-effective outdoor procedure to provide effective diagnosis and way to further planning of treatment without need for biopsy. The objective of the study is to study the spectrum of various breast lesions on cytomorphology and its histopathological correlation. Methods: This was a two years retrospective study from June 2014 to May 2016 including 280 cases aspirated from palpable breast lumps. Physical examination of breast lumps by palpation was done. Cytological diagnosis was made and histopathological correlation was done, wherever available . Results: On cytomorphological study of 280 breast lump aspirates 32 (11.43%) were inflammatory lesions, 180 (64.29%) benign, 6 (2.14%) atypical/probably benign, 8 (2.86%) suspicious of malignancy, 46 (16.43%) malignant and 8 (2.86%) were unsatisfactory for evaluation, of these 280 cases, 70 (25%) were available for histopathological examination. The most common benign lesion in the present study was fibroadenoma 115 (41.07%) and the most common malignant lesion was ductal carcinoma 43 (15.36%). Conclusion: Fine needle aspiration cytology is a rapid and reliable tool to provide effective diagnosis in palpable breast lumps. It should be used as routine diagnostic procedure to provide the effective health care to the patients with breast lesions.

A rare case of triple negative synchronous bilateral invasive ductal carcinoma of breast

Abstract: The occurrence of bilateral breast carcinoma is extremely rare with an incidence of 2-5% of all breast malignancies. We hereby report an unusual and interesting case of triple negative synchronous invasive ductal carcinoma (IDC) of bilateral breasts detected simultaneously in view of its rarity and therapeutic challenge it presented. A 55-year-old postmenopausal female presented with a history of lump bilateral breasts of 4 months duration. Fine needle aspiration cytology of both breast lumps showed IDC. Mammography showed Breast Imaging Reporting and Data System V both breasts. Metastatic workup was negative. She underwent bilateral modified radical mastectomy. Postoperative histopathology revealed IDC Grade III with estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2-neu negative on immunohistochemistry. She received adjuvant chemotherapy followed by locoregional radiotherapy to the right breast in view of nodal positivity. Presently on regular follow-up without any evidence of local recurrence or distant metastasis.

Fine Needle Aspiration Cytology of Breast Lumps-A correlation with histopathology diagnosis

Abstract: FNAC of breast lump is an important mode of diagnosis and forms a part of triple assessment. A retrospective study was undertaken at a tertiary hospital to know the feasibility and utility of fine needle aspiration of breast aspirates by comparing the diagnosis of malignancy with its histology. Of the 321 cases selected for the study, 93 cases were detected positive for malignancy. On reviewing, one case of false positivity and 5 cases of false negativity were detected. The sensitivity and specificity of FNAC for detecting malignancy was 98.27% and 99.49% respectively. Thus, we conclude that FNAC is a very important preliminary diagnostic test in palpable breast lumps and the results show a high degree of correlation with the final histopathology report.

Frequency of benign breast diseases in female patients presenting with breast lumps - a study at Sir Ganga Ram Hospital, Lahore

Abstract: Objective: To determine the frequency of benign breast diseases in female patients in our setup. Design: Prospective descriptive study. Place and duration of study: The study was carried on female patients presenting at surgical out door of Sir Ganga Ram Hospital, Lahore during one year i.e. January 2001 to January 2002. Patients and methods: Two hundred female patients presenting with breast lumps at surgical out door of Sir Ganga Ram Hospital, Lahore during one year were studied. All the patients were examined clinically with special emphasis on breast, axilla and supra clavicular fossae. Basic laboratory investigations including blood complete examination, urine complete examination and chest X -ray were done for all the patients. Breast imaging and FNAC of lumps were also done. Final diagnosis was based upon histological examination of the tissues biopsied from the lump. After collecting data, written in proforma, window SPSS software was used to analyze the results. Results: This study shows a high f requency of fibroadenoma (45%) in Pakistani females. Fibrocystic disease is second in frequency and accounts for 36% patients.8% patients had intraductal papilloma and three percent suffered from duct ectasia.5% patients had other conditions related to breast including two patients presenting with pre histological diagnosis of fibrocystic disease who turned out to be malignant after histopathology. Most of the patients had age range of 20-29 years. Conclusion: Fibroadenoma is the commonest of all benign breast diseases in Pakistani women. Fibrocystic change is the second in this regard. Benign lesions of the breast can resemble its carcinoma on clinical examination.

Fine Needle Aspiration Cytology Verses Trucut Biopsy In Preoperative Planning Of Surgical Treatment Of Breast Lumps

Abstract: Brest lumps are frequently found in females of different age group. So a need arises to distinguish benign and malignant lesions, prior to taking a decision regarding a definitive treatment. Increase awareness and better understanding of the problem has resulted in a marked increase in number of tumors detected. Breast lumps are detected by SBE by the patients, next a clinical breast examination by surgeon and then a breast imaging. To arrive at an accurate diagnosis a cytological analysis is needed. So an easy to perform technique like a FNAC or Trucut biopsy can be carried out which is cost effective and acceptable to the patients. It can be done in a busy out patient clinic without much preparation or expensive equipments. An excisional biopsy with a safe margin is done in case of a small lump. Combinations of various approaches tried to increase specificity and sensitivity for a proper diagnosis. Aspiration cytology was thought to be of great value provided it is positive for malignant cells. But a negative FNAC can not for sure rule out a malignancy. Though relatively easily performed, its not reliable for a presurgical decision making and adequate management of breast lump cases. Trucut biopsy can provide all necessary details to guide the surgeon to design an appropriate therapeutic strategy.

Evaluation of The Value of Core Needle Biopsy in The Diagnosis of a Breast Mass

Abstract: Background: Core needle biopsy (CNB) with histological findings is regarded as one of the most important diagnostic measures that make preoperative assessment and planning for appropriate treatment possible. The aim of this study was to determine the sensitivity and specificity of core biopsy results in our patients with benign and malignant breast lumps, especially for borderline breast lesions, by using a classification method. Methods: In this study, 116 patients who were referred to the Surgery Clinic of Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran with breast lump and underwent diagnostic procedures such as mammography and ultrasound were selected. Core needle biopsy (Tru-cut #14 or 16) was performed. After that, excisional biopsy was done. The benign, malignant and unspecified samples obtained by core needle biopsy were evaluated with the samples of the surgical and pathological findings. Then, false positive, false negative, sensitivity, specificity, and diagnostic accuracy of the core needle biopsy method were calculated. Also, the National Health Service Breast Screening Program (NHSBSP) classification was employed. Results: The mean age of the participants in this study was 39±13.13 years and the mean tumor size was 2.7 cm. An average of 3.35 biopsies was taken from all patients. Most of the pathology samples taken from CNB and excisional biopsy were compatible with invasive ductal carcinoma. Of the B type classifications, B5 was the most frequent in both methods. Borderline lesions B3 and B4 had a change in their category after surgery. About 2.5% of the samples in core biopsy were inadequate. Skin bruising was the most common core biopsy complication reported. While, the most common complication of excisional biopsy was hematoma. Accuracy, sensitivity, specificity, positive and negative predictive values of the core needle biopsy procedure compared with excisional biopsy was 95.5%, 92.6%, 100%, 100%, and 91.8%, respectively. Conclusions: Core needle biopsy has a high sensitivity and specificity with few side effects. Borderline classifications need more evaluation to rule out cancers.

Diagnostic Accuracy of FNAC in Evaluation of Breast Lumps

Abstract: Background and objectives: This study was conducted to compare the diagnostic accuracy of fine needle aspiration cytology (FNAC)in differentiating the benign and malignant lesions of palpable breast lump with histopathological correlation. Methods: This study was conducted at MNR MEDICAL COLLEGE AND HOSPITAL, Sangareddy , Telangana. The study included 50 patients who presented with palpable breast lumps to the surgical out-patient department. Thorough physical examination was done and the patients were subjected to fine needle aspiration cytology of the palpable breast lump. The cytological examination was classified as: Insufficient sample - C1, Benign - C2, Probably Benign - C3, Suspicious of malignancy - C4, Malignant - C5.All these patients were subjected to open/excision biopsy followed by histopathological examination. The diagnostic accuracy of the fine-needle aspiration was then compared with the gold standard histopathology. Results: Most of the cases were of benign pathology of which Fibroadenoma were most common (64%). It was seen that all the patients were female patients in the age group of 15-75 years. Majority of the lumps were found to be in the upper outer quadrant (46%). The sensitivity of fine needle aspiration cytology was found to be 83.33% , The specificity 100%, Positive predictive value 100% and Negative predictive value 97.77% . Conclusion: In patients with a palpable breast lump fine needle aspiration cytology can help to rule out a malignant lesion. This can hence afford as a cost –effective method in diagnosing breast lesions. Also due to its good tolerability and high diagnostic accuracy the patient need not be subjected to further evaluation which helps in the psychological well being of the patient. But, FNAC results when negative or suspicious should be correlated with clinical examination and imaging findings to prevent false positives and false negatives. A diagnosis suspicious for malignancy should be confirmed by open biopsy.

Cytomorphological study of palpable Breast Lumps by FNAC

Abstract: Aim and Objective: To assess the distribution of various cytomorphological patters of clinically palpable breast lumps by Fine Needle Aspiration Cytology technique. Materials and Methods: A retrospective study over a period of 3 years 270 breast aspirates who attended the surgery out patient department in government medical college Anantapur from January 2012 to December 2014 were studied with clinical correlation and cytological analysis with FNAC. Smears were stained with H &E stain, and correlation with imaging studies, including mammography was done. Results and Analysis: Total of 270 cases were studied, out of these 191 (70.74%) were found benign and 50 (18.51%) were malignant. 20 (7.40%) cases given un- satisfactory results. Out of 270 cases of analysis, Fibroadenoma was the most common benign lesion found in 133 (49.25%) patients, followed by fibrocystic disease 28(10.37%) and mastitis/Breast abscess 8(2.96%) were common breast lesions on cytology. Malignant breast lesions constitute 50(18.51%) cases, among which Duct cell carcinoma 47(17.40%) cases were commonest type. Conclusion: Benign breast lesions are common than malignant lesions, fibroadenoma and fibrocystic disease are more common in benign disease. Maximum number of lesions (34%) was seen in age group of 20 to 30 years, whereas IDC accounts for the highest number of malignant lesions. Fine-needle aspiration cytology is a rapid and effective method for the primary categorization of palpable breast lumps into benign, malignant, atypical, suspicious, and unsatisfactory categories.

Diagnostic Accuracy of Fine Needle Aspiration Cytology in Benign and Malignant Breast Lesions

Abstract: Background: Fine needle aspiration cytology (FNAC) or core biopsy form an integral component of the triple test which is being performed as a pre-operative test to evaluate breast lump. Aim: To study the cytomorphological pattern of breast lesions in a tertiary care hospital of Central India and to find out the accuracy of FNAC in diagnosing benign and malignant lesions of breast. Method: 200 patients presenting as breast lumps were evaluated by FNAC and correlated with histology. Result: Fibroadenoma was most common benign lesion while Infiltrating duct carcinoma was most common malignant lesion reported. Sensitivity of FNAC was 99.25% for benign lesions and 95% for malignant lesions. Specificity and PPV of FNAC in diagnosing benign lesions were 95% and 97.79% respectively while that for malignant cases were 99.25% and 98.27% respectively. The diagnostic accuracy of FNAC was 97.94% in the present study. Conclusion: FNAC serves as a rapid, economical and reliable tool for the evaluation of breast lumps. Key words: Fine needle aspiration cytology, Benign breast lesions, Malignant breast lesions, FNAC

Spectrum of lesions encountered and accuracy of core needle biopsy of breast

Abstract: Introduction: A wide spectrum of non-neoplastic and neoplastic lesions can affect the breast. Core needle biopsy (CNB) forms an integral part of the Triple test to evaluate breast lumps and is progressively replacing fine needle aspiration cytology(FNAC). The present study was planned to evaluate the accuracy of diagnosis and spectrum of lesions encountered on CNB. Methods: A retrospective analysis of CNB received over a two year period was done. CNBs were categorized using the UK National Health services breast screening programme (NHSBSP) guidelines and correlated with subsequent excision wherever available. Results: 68 CNB were received, 65/68 had a palpable lump. Malignant lesions(B5) were the most common (43%) followed by B1. Infiltrating duct Carcinoma (IDC- NST) was the most common malignancy. Proliferative and Non proliferative benign lesions, granulomatous and non-specific inflammation, Fibroadenoma and Phyllodes tumor were some of the other lesions seen. Overall concordance between CNB and final excision was 71.4%. 8/10 discordant CNB were from Category B1. For detection of malignancy overall sensitivity, specificity, positive predictive value( PPV), negative predictive value (NPV) and accuracy were 90.4%, 100%, 100%, 87.5% and 94.2% respectively. Sensitivity, specificity, PPV, NPV and accuracy in biopsies with more than 3 cores was 100%. Conclusion: A wide spectrum of lesions can be diagnosed on CNB and CNB is accurate, sensitive and specific for preoperative diagnosis. Study of more than three cores per biopsy and a multidisciplinary approach with clinicoradiologic correlation will improve overall sensitivity and NPV. Keywords: Core Needle Biopsy, Breast, Accuracy, Lesions

Cytolo-histological correlation of breast lump - as a part of internal quality control

Abstract: Introduction: Fine Needle Aspiration Cytology (FNAC) has gained increasing importance in the diagnosis of breast lumps especially it is an easy, non-invasive, simple procedure which can be done on OPD basis. The pre–operative diagnosis of breast lesions by FNAC is highly relied upon. However, there can be some cytological pitfalls in the diagnosis, especially when all the characteristic component of a lesion are not obtained in the aspirate, or when there is an overlap in the cytological features. Hence a review was undertaken with the following objectives. 1. To correlate cytologic and histopathologic diagnosis of breast lesions as a part of internal quality control. 2. To know the incidence of false positive and false negative cases. 3. To find out the sensitivity and specificity of FNACof breast lesions. Methods: This study was conducted for a period of 3 years (April 2009 to March 2012) and 200 cases of fine needle aspirates of breast lumps studied. Out of which 126 cases were followed by histopathological correlation at pathology department; the cases are collected from Mahatma Gandhi Medical College & Research Institute, Sri Balaji Vidhyapeeth University; Pondicherry. Results: Out of 200 cases studied by FNAC, histopathological correlation was available for 126 cases. Cytological diagnosis in general was divided into four categories, benign (76.19%), malignant (15.08%), suspicious (5.56%), and unsatisfactory (3.17%). Maximum patients were in age group of 21 to 30 years. There were 119 female patients and 7 male patients. Fibroadenoma (69.79%) was most common benign neoplasm. There were 5 cases (5.21%) reported by FNAC as gynecomastia. After correlation with histopathology, there was 82.26% of correct diagnosis in all benign lesions. There were 16 cases (84.21%) diagnosed cytologically as malignant and 3 cases (15.79%) as invasive duct carcinoma. Histopathologically all were confirmed as invasive duct carcinoma. Out of that one was reported in male breast. The incidence of false positive case was zero, false negative case was (1.59%). The diagnostic accuracy after histopathological correlation in malignant cases was 98.36%, sensitivity was 92.86% and specificity was 100%. Conclusion: To conclude, fine needle aspiration cytology is a fairly safe procedure in trained hands, and it gives reasonably accurate results, thereby helping the clinicians to plan the best line of treatment. Also with invention of imaging guided aspiration, FNAC went one step ahead in diagnosis of non-palpable lesion of breast. Thus a triple modality of clinical, mammographic and cytological correlation is required and for internal quality control FNAC is correlated with histopathology. Key Words: FNAC; Breast lumps; Breast neoplasm

Retrospective analysis of breast lumps in a given population: an institutional study

Abstract: Background: A lump in the breast is a common complaint presenting in the surgical outpatient department of all major hospitals, with anxiety regarding a possible malignancy being extremely common. Early presentation and prompt diagnosis is essential to relieve anxiety of non-neoplastic conditions, and in case of carcinoma, it can save the patient from metastases. This retrospective study aims to audit the clinic pathologic features of patients with breast lump at teaching hospital in northern India. Methods: A total of 138 patients were included for the present study. The data on all patients who presented with history of breast lump to the surgical outpatient department at a teaching hospital, Maharaja Agrasen Medical College, Agroha from 1st January 2013 to 31st December 2015 were retrospectively analyzed. Information on age at presentation, parity, duration of symptom before presentation, previous breast disease, side and quadrant of breast affected, maximum diameter of breast lump, clinical diagnosis made by the senior registrar or unit consultant, type of biopsy done and histology diagnosis for patients who returned with histology report were extracted from the case files. All the results were analyzed by Statistical Package for Social Sciences (SPSS) software. Chi-square test was used to measure the level of significance. Results: in our present study, out of all the patients, 7 were males and rests were females. Out of 131 females, 3 (2.1%) were premenstrual and 35 (25.4%) were postmenopausal. 39 (28.3%) female patients were nulliparous. Lump was painless in 75 (54.3%) patients. Duration from discovery of lump to presentation was 12 months in 56 (40.6%) and ranges from 2 days to 19 years. The duration was not documented in 10 (7.2%) patients. Left breast was more affected i.e. 65 (47.1%) cases than right sided. Bilateral involvement in around 12 cases (8.7%). Breast lump was presenting complaint in 138 patients in 3 years. The mean age of patients presenting with breast lump was 36.8 years (Range 15-70 years). Conclusions: Breast lump was the most common presenting complaint with most patients not presenting within one month.

Evaluation of AgNORs on FNA smears and tissue sections in benign and malignant breast diseases

Abstract: Background and Objectives: AgNOR scoring on breast tissue has shown a significantly higher count in malignant breast lesions in comparison to benign lesions and AgNOR staining on breast aspiration smears has been found superior to staining of histological sections. The present study aims at a comparative evaluation of mean AgNOR (mAgNOR) counts on the cytologic smears and the corresponding histologic sections in the various benign and malignant lesions of the breast. Methods: A one step silver colloidal staining procedure was employed for demonstration of AgNORs on aspiration smears and the corresponding histologic sections in fifty patients with breast lumps, 38 of these had a benign breast disease while 12 harboured a malignant lesion. AgNOR counts were expressed as mean AgNORs per nucleus (mAgNOR score). Results: The AgNORs in benign lesions were fewer, small, uniform, and mostly centrally placed where as those in malignant lesions were irregular, generally large and scattered. The mean mAgNOR count in benign breast lesions was 3.3; S.D 1.49 on FNA smears and 2.3; S.D 1.22 on histologic sections (p0.1). The mAgNOR scores for the malignant breast lesions were significantly higher than those for benign lesions on both cytologic smears and histologic sections (p

Study of Breast Lump- A Histopathological Audit of Five Years Specimen in a Medical College of Bangladesh

Abstract: Background: Various types of lesion from inflammation to carcinoma can affect the breast. Some lesions are common in young females while others are more common in elderly age group. Accurate diagnosis is essential to relieve anxiety of patients. In case of carcinoma, early and accurate diagnosis can save the patient from metastases thus reducing mortality and morbidity. Methods: A Retrospective study was conducted for the period of five years in the Pathology Department of Jahurul Islam Medical College and Hospital. Histopathology samples were received, processed, reported and recorded in the Pathology laboratory. Data analyzed from 2012 to 2016. Descriptive statistics was used to analyze the data. Result: 228 sample of breast tissue sent for histopathology were studied. Peak incidence of benign lesion was in the age group 21-30 years and malignant lesion was in between 4-50 years group. Cancer of the breast was seen in 12.28% of cases. In case of benign condition, fibroadenoma and fibrocystic disease were the two most common disorder and invasive ductal carcinoma was the most common malignant lesion. Conclusion: Majority of the breast lumps are benign either fibroadenoma or fibrocystic disease. Benign lesions were common in second to fourth decade and malignancy in fourth and fifth decades.