“A CLINICAL STUDY ON ABERRATIONS OF NORMAL DEVELOPMENT AND INVOLUTION OF BREAST AND ITS MANAGEMENT IN UPPER ASSAM”

Abstract

ANDI of breast is a common phenomenon. They are more common than breast malignancy. In this study an attempt was made to study the spectrum of diseases that come under ANDI of breast, their clinical presentation, treatment and also to nd out the clinical and cytohistological correlation. Study group includes 152 cases of Upper Assam who attended the Surgery OPD of AMCH during the study period and also all the patients who were admitted in the department of surgery under the clinical diagnosis of ANDI of breast. Conrmation of diagnosis was made on the basis of history, clinical examination, pathological and radiological investigations. Pathological investigations include FNAC and HPE. Radiological investigations include Ultrasonography and mammography. The following observations were made in the present study: Ÿ The commonest disease encountered was broadenoma of breast (14.47%) followed by mastalgia (23.68%) brocystic disease (14.47%) breast cyst (9.87%). The less common are duct ectasia, scleroding adenosus and phyllodes tumour, 9.87% each. Ÿ Majority are present in the second, third and fourth decades of life. All broadenoma, brocystic disease and phyllodes tumour are present in the third decade. Youngest patient was of 11 years and oldest was of 47 years. mean age of presentation was 27.45 years and the standard deviation was 7.13. Ÿ 86.84% had regular menstrual history and 13.16% had irregular menstrual history. Majority were nulliparous (46.05%). The highest parity was 4. Ÿ 94.08% did not give history of OCP use and 98.68% did not give history of lactation. Ÿ The commonest presentation was pain in the breast (76.32%) followed by lump (71.05%). Ÿ Majority cases presented to the hospital within 3-6 months of their onset of symptoms. The minimum duration of symptom was 1 month and the maximum was 12 months. Ÿ Right breast was involved more commonly 961.84%) than the left (38.16%). Ÿ Upper outer quadrant was involved most commonly involved (34.21%) and the least commonly involved was the central quadrant (1.32%). Ÿ The majority of the breast lumps (85.05%) had size less than 5cm in their greatest dimension. 14.95% had size more than 5cm. Ÿ 63.82% of the lumps had rm consistency whereas 6.58% had soft consistency. There was no positive family history in majority of the patients (89.47%). Ÿ The correlation between clinical diagnosis and histopathological diagnosis had the following ndings: For broadenoma the sensitivity of FNAC is 84.9% and HPE is 86.54% .Both have positive predictive value of 100%.For breast cyst the sensitivity of FNAC is 93.3%.For phyllodes tumour the sensitivity of FNAC is 85.7% and HPE is 75%.. Ÿ In the management, 41.45% cases underwent excision followed by aspioration of cyst in 7.89%, microdochectomy in 7.24%, wide local excision in 3.29% and simple mastectomy in 1.97%. Among conservative treatment 14.47%b were given evening primrose oil, 12.50% were given topical analgesic and breast support and danazol was given in 5.26%. The cases were followed up at three monthly interval for a period of one year and there was no recurrence during this period.