Benign Breast Lumps Research Articles

P040: Changes to the breast MDTM for benign breast lumps

Background: There has been constant increase in pressure and demand on the breast multidisciplinary team meeting (MDTM) to discuss every patient that undergoes needle biopsy as recommended by the Association of Breast Surgery. Our study aims to identify the number of benign breast cases discussed at our breast MDTM and establish how many were upgraded to the cancer pathway.

Study of clinical, imaging and pathological assessment of breast lumps: an observational study

Background: A palpable lump in a woman’s breast could be benign or malignant and it requires prompt evaluation to confirm or exclude cancer. This study aims to establish the correlation between clinical and radiological parameters for provisional diagnosis of breast lumps and the role of histopathology for final diagnosis of these breast lumps.Methods: Total 275 female patients with palpable breast lumps were included in the study, where a detailed history was recorded and clinical examination was done. All patients underwent ultrasonography of the breast along with fine needle aspiration cytology or histopathology, wherever indicated.Results: Benign breast lumps were found more commonly in 18-30 years of age group whereas malignant breast lumps were seen more commonly in the 41-60 years age group and the incidence increased with age. Fixity to skin was present in 5.1% and fixity to chest wall was present in 5.8% respectively, and all of these cases turned out to be malignant.Conclusions: Attributing factors for suspicion of malignant lumps are advanced age, fixity to surrounding structures, presence of ulceration and peau’d orange breast skin appearance. Although for confirmation of malignancy from a suspected breast lump requires either cytology or histopathology of the excised specimen.

Association of vitamin D level with breast lumps: A cross-sectional analytical study

Introduction: Breast Cancer is the second most common cause of death (1.38 million, 10.9%) out of all cancer worldwide after lung cancer. A study conducted in 2017 ranked breast cancer as the second most common cancer among Indian females with age adjusted rate of 25.8 per 100000 women and mortality of 12.7 per 100,000 women. The relation between Vitamin D level and various breast lumps, both benign and malignant remain unclear. But multiple studies have reported the association of breast cancer with vitamin D deficiency. In India, the prevalence of vitamin D deficiency ranges from 50-84%. Methodology: The study was conducted in Department of Surgery, NKPSIMS & LMH between the period of September 2017 to October 2019. A total of 90 patients with breast lumps were included in the study after taking informed consent and ruling out the exclusion criterion. Blood Vitamin D level were estimated before the commencement of treatment. After surgery, the specimen was sent for histopathological study. Result: A total of 90 patients were enrolled in this study, 56 patients with benign breast lump and 34 patients with malignant breast lump. Out of 56 patients with benign breast lump, 44 had Vitamin D deficiency. Out of 34 patients with malignant breast lump, 32 had vitamin D deficiency. The p-value was 0.04 which is significant. Conclusion: Vitamin D deficiency is highly prevalent among Indian females. This problem could be addressed by adequate sun exposure and dietary supplementation. Most of the vitamin D studies support the direct association between vitamin D deficiency and breast cancer risk. Further researches will strengthen this association of vitamin D deficiency and breast cancer.

Study of benign breast lumps in females

Study of benign breast lumps in females

Evaluation of breast Leisons in young females

Introduction: There has been a progressive increase in young women presenting with breast lumps. Benign breast conditions causing lumps or tumors are quite common in young women. Among those, incidence of fibroadenoma is highest in young women. Study aimed to analyse incidence and type of benign breast lumps in young females. Material and Methods: This was a retrospective record based study conducted in the Department of General Surgery Belgavi Institute of Medical Science, Belagavi from January 2017 to December 2017. Patients were examined clinically and ultrasonography, FNAC were done. Patients fit for surgery were admitted in surgery ward and operated. Specimen were sent for histopathological studies and postoperatively patients were assessed for wound infection seroma formation and recurrence.Results: Fibroadenoma were seen in more number followed by fibroadenosis. Fibroadenomas were commonly of 2-2.9 cm size. Patients were investigated with FNAC and ultrasonography, most of the lumps were benign which usually does not need any surgical treatment only proper education and counseling needed.Conclusion: Fibroadenomas are benign disease of the breast. Mainly seen in young females of age 16-40 years. Breast lumps are of different sizes and are usually spherical in shape. They are more commonly seen on left side in upper and outer quadrant. Triple examination is important in breast lump cases i.e. clinical examination, ultrasonography and FNAC. Though conservative management or observation can be followed in young girl or excision biopsy can be done.

Needle biopsy in young women (age

Needle biopsy in young women (age <25 years) presenting with a clinically and radiologically benign noncystic breast lump can safely be avoided.

A clinicopathological study to determine age specific prevalence rate of benign breast lumps

Background: The pathogenesis involves disturbance in the breast physiology extending from an extreme normality to well defined disease processes. The clinician must provide a degree of diagnostic accuracy while at same time ensuring that an excessive biopsy rate is prevented. The aim of this study was to evaluate the benign breast lumps in different age groups and to determine the prevalence of benign breast lumps among the breast symptomatic.Methods: This clinico-pathological cross sectional study was conducted with a sample size of 100. The study was conducted during the period from July 2018 to June 2019 which included all patients presenting with benign breast lump during the study period.Results: Out of 100 studied cases of benign breast diseases, the most common benign breast tumor found as fibro adenoma and majority of the fibro adenoma found in the 2nd and 3rd decade of life. Right breast and upper outer quadrant were most commonly affected. Majority of benign breast lesions presented with painless lump in the breast and most of them were from rural background. Majority of benign Breast lumps (45%) cases were found in the age group of 21-30 years. Majority of the patients (60%) attain menarche between ages 13-15 years. Majority of cases (55%) were belonged to lower socio economic status.Conclusions: Our study indicates that FNAC is diagnostically more accurate, safe, cost effective and OPD procedure, however when FNAC was inconclusive, biopsy is the best choice for breast tumors.

Technical Note: A new method to rapidly identify benign and malignant breast lumps through bioelectrical impedance spectroscopy.

To evaluate the effectiveness of Bioelectrical Impedance Spectroscopy (BIS) in order to rapidly distinguish malignant vs benign breast masses. A total of 622 breast masses from 489 patients were collected from January 2015 to June 2017. Every specimen was evaluated by a breast tissue bioimpedance analyzer (MScan1.0B) followed by morphological examination by pathologists. The results from BIS were compared with the morphological results from pathology (as a gold standard). The specificity and sensitivity of BIS were evaluated and the consistency test was performed. Compared with the pathology standard, BIS had good sensitivity (92.4%), specificity (96.0%), false positive rate (3.96%), and false negative rate (7.58%). The positive likelihood ratio, negative likelihood ratio, positive predictive value, and negative predictive values of BIS were 23.36, 0.0789, 73.49%, 99.07%, respectively. The kappa value of BIS was 0.794 ± 0.038 in the consistency test. Compared with the pathology standard, the BIS is an effective, convenient, and economical detection method to quickly differentiate benign and malignant breast masses with high accuracy. It may serve as a potential supplement of intraoperative pathological examinations.

Effect of para areola incision on the cosmetic surgery of multiple benign breast lumps

Objective To investigate the effect of para areola incision on the appearance of breast after excision of multiple benign breast lumps. Methods From February 2010 to November 2017, 60 females of multiple benign breast tumor underwent surgical resection in the Fifth People's Hospital of Datong were selected and randomly divided into study group (n=30) and control group (n=30), respectively received periareolar incision and traditional incision surgery.The operation time and operation effect were compared between the two groups.VSS was used to compare the postoperative scar score between the two groups.The satisfaction for breast shape was also compared between the two groups. Results The operation time of the study group [(25.36±7.69)min] had no statistically significant difference compared with that of the control group (t=0.264, P>0.05). The incision length and the amount of bleeding in the study group were (5.86±2.49)mm, (9.69±5.68)mL, respectively, which were significantly lower than those of the control group (t=8.621, P<0.05; t=2.549, P<0.05). The obvious effective rate(53.33% vs.43.33%), effective rate(40.00% vs.33.33%) and total effective rate(93.33% vs.76.67%) between the study group and control group had statistically significant differences (χ2=5.264, 7.127, 13.267, all P<0.05). The scar and breast shape scores of the study group were better than those of the control group[ VSS: (4.35±1.67)points vs.(7.92±2.51)points, breast appearance: (1.38±0.61)points vs.(4.92±1.67)points, t=7.264, 6.621, all P<0.05]. Conclusion The resection of breast multiple benign masses by parareone incision has less trauma, high resection rate, concealed incision and good cosmetic effect after operation, which meets the needs of the patients. Key words: Para areola incision; Breast tumor; Mammary gland; Beauty

Epidemiological Study of Breast Lump Cases

Background In the present era of increased awareness and fear about malignancy in the general population, and promotion of self breast examination, many patients are presenting to the clinic with history of breast lump. They expect proper guidance and effective treatment from the treating surgeon. Lesions in the breast vary from the most common and benign condition, such as fibroadenoma, to various commoner carcinomas, like infiltrating ductal carcinomas, to rarer entities, such as malignant transformation of phyllodes tumor and carcinoid tumors. Method The aim was to study the epidemiology of breast lumps cases attending the surgery OPD and to study the distribution of various pathological entities presenting as breast lump. The focus of this study was for a better understanding of the breast lump which will help to cure more and more patients at an earlier stage Results Patients presenting with the complaints of breast lump, most common age group affected was of 21–30 years. Incidence of the benign lumps was significantly higher than other lumps i.e. 44%, closely followed by malignant lumps i.e. 36% and inflammatory lumps i.e. 10%. Benign breast lump had peak incidence in the age group of 21–30 years, fibroadenoma being the most common entity (40.98%). The upper-outer quadrant was the most frequently involved (57%). There was no significant association between accuracy of FNAC in diagnosis of breast lump in malignancy and non-malignancy (p&gt;0.05). The accuracy of diagnosing malignancy was 87.81%, whereas for benign lumps it was 83.33%. Conclusions Benign breast lesions were the commonest cause of the breast lump before the age of 40yrs. Among the benign lumps fibroadenoma was the most common cause (40.98%), and had a peak in the age group of 21-30yrs (age group of 16-45yrs) with varying number and size. The upper and outer quadrant was the most common site of primary tumor.

Epidemiology of benign breast lumps, is it changing: a prospective study

Background: There are wide range of benign breast diseases reported from India. Breast lumps are one of the commonest presentations. Although most of the breast lumps are benign but patient become anxious due to fear of malignancy. Due to this, there is an increase in the use of screening mammography and the fine needle aspiration cytology (FNAC) or core needle biopsy (CNB), most of which yield benign findings. This study is aimed to evaluate the incidence of different types of benign breast lumps in respect to age, size, side and site, relation with parity and use of oral contraceptive pills and analyses of this result in relation with the past and recent study on benign breast diseases.Methods: This study was conducted at Rajendra Institute of Medical Sciences, Ranchi (India) over a period of one and half years. Inclusion criteria was the cases with palpable breast lumps which were reported benign on either FNAC or CNB and exclusion criteria was the cases with breast malignancy and inflammatory breast lumps.Results: Most common benign breast lump (BBL) was fibroadenoma followed by fibrocystic disease of breast. Fibroadenoma was mainly presented with lump only whereas fibrocystic diseases of breast presented with lump and pain. Most of the BBL was found in nullipara and OCP non-users.Conclusions: Epidemiology of BBL is still the same when analyzed with past and recent study on the benign breast diseases. Triple assessment remains the key in the evaluation of breast lumps.

Spectrum of Diseases among Patients Attending a Breast Clinic at a Tertiary Level Hospital of Bangladesh

Background: Breast problems are a burning health issue for today’s women. Breast clinics provide a competent and complete diagnosis for women with any breast symptoms or problems and give appropriate management of the problem. The aim of this study is to determine the disease spectrum among the patients visiting a breast clinic for assistance.&#x0D; Methods: This was a cross section study of all female patients visiting a breast clinic with breast problems. The study was conducted at BIRDEM General Hospital-2 over a period of 3 years from March 2015 till March 2018. Patients suffering from superficial skin lesions of the breast were excluded. The findings were tabulated and analyzed for frequency of each problem.&#x0D; Results: A total of 1279 patients visited the breast clinic during the period of March 2015 till March 2018. Among them 1204 patients were selected after considering eligibility criteria. The age of the patients ranged from 15 to 80 years. Ten percent of these patients were asymptomatic and attended the clinic for breast screening. Among the symptomatic patients mastalgia was the most common presentation (36.65%) followed by fibrocystic disease (22.26%). Benign Breast lump was seen in 14.96% patients. Ten percent patients presented with breast abscess. Nipple discharge and ductal ectasia was seen in 2.66% patients. Breast cancer was found in 2.33% patients. Other rare entities like milk fistula, giant fibroadenoma were also noted.&#x0D; Conclusion: Breast clinincs provide comprehensive assistance to both benign and malignant breast diseases. Breast cancer is the leading cause of cancer deaths in females. Breast screening ensures early detection of breast cancer. Besides malignant disease benign breast diseases also cause much morbidity to female health. This study shows the spectrum of patients coming with breast complaints to such a breast clinic.&#x0D; Birdem Med J 2019; 9(1): 11-13

The accuracy of fine needle aspiration biopsy to diagnose breast neoplasm

Breast lump is a very common complaint among women, especially during the reproductive year. Fine needle aspiration biopsy (FNAB) is a less invasive procedure. It is usually performed as an initial diagnosis prior to the operative procedure. The accuracy of the FNAB in Indonesia needs to be elaborated. The study aimed to evaluate the sensitivity and specificity of FNAB in diagnosing breast neoplasm. This is a retrospective study with cross sectional design, involving 145 patients with breast lump who underwent FNAB and histopathology examination in Dr. Sardjito General Hospital, Yogyakarta, from 2012 to 2014. Data analysis showed that female to male ratio was 23. 2:1 commonly occurred at 41-50 years old. Forty-one cases (28.28%) diagnosed as a benign lesion with fibrocystic changes as the most frequentcase (11.19%). The malignant case was 104 cases (71.72%) with ductal carcinoma as the highest case (51.49%). FNAB achieved a sensitivity of 85.58%, a specificity of 100% and a total accuracy of 89.66% in determining the benign or malignant breast lump. The accuracy, sensitivity and specificity of FNAB in diagnosing ductal carcinoma were 83.58%, 85.51% and 81.54%, respectively. The accuracy, sensitivity and specificity of FNAB to diagnose fibrocystic changes lesion were 85.82%, 26.67% and 93.28%, respectively. FNAB can be used as an alternative diagnostic tool to diagnose breast neoplasm. It provides rapid, cheaper, effective, valuable, and less invasive procedure in diagnosis of breast lump.

DEFICIENCY OF SERUM 25-HYDROXYVITAMIN D IN PATIENTS WITH BREAST CANCER IN IRAQ

Background: Many studies defined the association between vitamin D and breast cancer. The relation between human epidermal growth factor receptor 2 (Her2/nue), estrogen or progesterone receptors and vitamin D in breast cancer patients was not clear, since few studies was conducted. Objective: To find out the association of deficiency of vitamin D and breast cancer. The effect of Her2/neu, estrogen, and progesterone receptors on vitamin D in the breast cancer patients was also studied. Methods: Forty patients with benign breast lump as a control group and 40 patients with breast cancer early diagnosed were included in the study. Blood samples (5 mL) were taken from the control and patient groups and analyzed for serum 25-hydroxyvitamin D by using chemiluminescent immunoassay technology. Serum cancer antigen (CA15-3) was measured by using monoclonal antibodies against CA15-3. HER2/neu, estrogen and progesterone receptors were determined in breast cancer patients by immunochemical method. Results: Serum vitamin D in the breast cancer patients before surgery was significantly lower (p ≤ 0.05) than that in the control group. Preoperatively, serum CA15-3 in Her2/neu positive patients was significantly (p ≤ 0.05) higher than that in Her2/neu negative patients. Postoperatively, serum CA15-3 in Her2/neu positive patients was not significantly different from that in Her2/neu negative patients. Serum vitamin D, after surgery, in Her2/neu positive patients was not significantly different from that in Her2/neu negative patients. Serum vitamin D was not significantly different in estrogen and progesterone positive patients from that in estrogen and progesterone negative patients, respectively. Conclusion: Severe deficiency of vitamin D was noticed in breast cancer patients in Iraq, and mild deficiency in benign subjects. Serum CA15-3 was higher in positive Her2/neu than negative patients before operation. Her2/neu, estrogen and progesterone positive receptors have no effect on serum vitamin D level in breast cancer patients. Keywords: Vitamin D, breast cancer, CA15-3, Her2/neu Citation: Al-Saigh THT. Deficiency of serum 25-hydroxyvitamin D in patients with breast cancer in Iraq. Iraqi JMS. 2018; 16(4): 400-404. doi: 10.22578/IJMS.16.4.7

Association of Serum Leptin and C-Reactive Protein in Women with Breast Cancer

This study was conducted to evaluate the association of serum leptin and hs C-reactive protein with breast cancer. Two groups were included in the study. The first group included 45 newly diagnosed women with breast cancer. The second group included 42 women with benign breast lump as a control group. Blood samples (5 mL) were taken from the patient and the control groups and analyzed for serum leptin and hs C-reactive protein. Serum CA15-3 was also measured in breast cancer patients. The epidermal growth factor receptor 2 (HER2/neu), estrogen and progesterone receptors were determined in breast cancer patients by using immune-chemical method. Serum leptin was significantly higher (p ≤ 0.05) in breast cancer patients than that in the control group; however, no significant difference was noticed between the two groups for serum hs C-reactive protein. No significant difference was noticed between HER2/neu positive or negative in breast cancer patients for serum leptin or hs C-reactive protein. However, serum CA15-3 in HER2/neu positive patients was significantly higher (p ≤ 0.05) than that in HER2/neu negative patients. No significant difference was noticed between positive and negative estrogen breast cancer patients for serum leptin, hs C-reactive protein or CA15-3. In addition, no significant difference was noticed between positive and negative progesterone for serum leptin, hs C-reactive protein or CA15-3. A strong significant positive correlation was noticed between serum leptin and BMI in the control group; however, no significant correlation was noticed between serum leptin and BMI in the breast cancer patients. In conclusion, serum leptin may be used as a prognostic factor for breast cancer. Serum C-reactive protein in HER2/neu positive breast cancer patients is higher than in HER2/neu negative patients.

Association of Serum Leptin and C-Reactive Protein in Women with Breast Cancer

This study was conducted to evaluate the association of serum leptin and hs C-reactive protein with breast cancer. Two groups were included in the study. The first group included 45 newly diagnosed women with breast cancer. The second group included 42 women with benign breast lump as a control group. Blood samples (5 mL) were taken from the patient and the control groups and analyzed for serum leptin and hs C-reactive protein. Serum CA15-3 was also measured in breast cancer patients. The epidermal growth factor receptor 2 (HER2/neu), estrogen and progesterone receptors were determined in breast cancer patients by using immune-chemical method. Serum leptin was significantly higher (p ≤ 0.05) in breast cancer patients than that in the control group; however, no significant difference was noticed between the two groups for serum hs C-reactive protein. No significant difference was noticed between HER2/neu positive or negative in breast cancer patients for serum leptin or hs C-reactive protein. However, serum CA15-3 in HER2/neu positive patients was significantly higher (p ≤ 0.05) than that in HER2/neu negative patients. No significant difference was noticed between positive and negative estrogen breast cancer patients for serum leptin, hs C-reactive protein or CA15-3. In addition, no significant difference was noticed between positive and negative progesterone for serum leptin, hs C-reactive protein or CA15-3. A strong significant positive correlation was noticed between serum leptin and BMI in the control group; however, no significant correlation was noticed between serum leptin and BMI in the breast cancer patients. In conclusion, serum leptin may be used as a prognostic factor for breast cancer. Serum C-reactive protein in HER2/neu positive breast cancer patients is higher than in HER2/neu negative patients.

Tuberculosis of breast: an Indian scenario

Background: Tuberculosis of breast is quite rare in relation to all breast pathology that we encounter in our daily practice. Ever since it was first described in 1829 many reports have been published. There has been an increasing incidence since the resurgence of AIDS.Methods: This study was done to see the incidence, presentation and investigative modality of tuberculosis of breast in our hospital.Results: A total of 986 patients out of which 585 were fibrocystic breast disease, 238 were malignant, 84 cases presented as abscess, followed by 45 cases as galactocele. 34 cases were diagnosed as tuberculosis of breast. Presentation of tuberculosis of breast was lump 19cases. 9 cases presented as abscess of breast, 4 cases had discharging sinus out of which 2 had developed them after being operated elsewhere for benign breast lump and abscess. Core needle biopsy was done in 4 cases with 2 cases coming out to be positive. Incisional biopsy was done on 2 cases which had come with mutilated breasts and they were positive for tuberculosis. 2 patients underwent excision of small lump diagnosed as fibroadenoma on FNAC, which came out as tuberculosis on biopsy. FNAC of the axillary lymph node showed a positivity rate of 43%. 9 cases were negative.Conclusions: Thus, breast lesions has to be dealt with carefully keeping in mind tuberculosis of breast, as it is a potentially curable disease and we can avoid a lot of morbidity if we can diagnose and start early ATT.

A Prospective Observational Study of Breast Lumps in Adolescent Girls: Tertiary Care South Indian Teaching Hospital Experience.

The aim of the current study was to assess the incidence and varying clinical presentations of benign breast lumps in adolescent age group in a Tertiary care Medical College Hospital. This was a prospective, observational study of 6-year duration (2011 to 2017) conducted in a Medical College, South India. All adolescent age group patients visiting the outpatient department (OPD) with complaints of breast lump were enrolled into the study. Triple assessment comprising of clinical examination, imaging, and core biopsy was used for diagnosis and identification of type of tumor. Management of tumors was based on pathology of core biopsy. During the study duration (2011 to 2017), a total of 15 pediatric patients of age between 11 to 14 years, presented with complaints of breast lumps. The most common symptom included painless lump in breast in 11 patients (73.34%). The histopathological examination (HPE) reported 12 cases (80%) as fibroadenomas and only 3 cases (20%) were phyllodes tumors. Based on the results of HPE, majority of the patients (53.34%) underwent circumareolar cosmetic incision. The most common lesions in pediatric age group are benign fibroadenomas; however, phyllodes are also not rare, and to manage them appropriately, they should be diagnosed preoperatively with core biopsy. Cases of malignancy, including phyllodes tumors, ductal adenocarcinomas, and metastatic lesions, have been documented in children and adolescents. Therefore, malignancy should be considered in the diagnosis of a pediatric and adolescent breast mass until formally ruled out.

A teenager with ductal carcinoma in situ arising in a fibroadenoma: a case report

Breast cancer arising within fibroadenomas (BcaFad) is a very rare finding. BcaFad occurs mostly in women between the ages of 40 and 50. This report details the unique case of an 18-year-old woman with bcafad. We present an 18-year-old woman with a ductal carcinoma in situ (DCIS) arising within a fibroadenoma. This is the youngest reported case of BcaFad in the literature. Clinically, the mass presented characteristics of a benign breast lump. Microscopically, an atypical proliferation of luminal epithelial cells was classified as a low-grade DCIS. As a very rare presentation at an especially unusual age, this case challenges the current risk evaluation and management in young women diagnosed with fibroadenoma.

Clinical radiological and pathological assessment of benign breast lumps: our institutional experience

Background: With increased awareness about breast cancer, many women with breast lumps are attending clinics. Though benign breast lumps are most common, they may be associated with morbidity and have become cause for concern to patients. Triple assessment by clinical, radiological and pathological examination is a standard approach in the evaluation of breast lumps. Even in cases of benign breast diseases, multimodality tests are being preferred to give reassurance to patients. This study was aimed to study distribution of various benign breast lumps in relation to age at presentation, to identify sensitivity and specificity of clinical breast examination, Ultrasonography (USG) and Fine needle aspiration cytology (FNAC) methods in the evaluation of benign breast lumps and to compare with final histopathological diagnosis.Methods: A retrospective study was conducted in department of general surgery at Malla Reddy institute of medical sciences, Hyderabad from August 2013 to July 2017. 202 females with benign breast lumps were evaluated by clinical breast examination, ultrasonography (USG) and Fine needle aspiration cytology (FNAC) methods. All patients underwent excision biopsy of lump. Final histopathological report was taken as reference standard.Results: Fibroadenoma was most common in 2nd decade. Clinical breast examination and USG showed good sensitivity but less specificity than FNAC. FNAC showed both good sensitivity and specificity. There was very good degree of agreement between FNAC and histopathological diagnosis (Kappa=0.911).Conclusions: Good clinical examination can give accurate preoperative diagnosis of benign breast lumps. Triple assessment by clinical breast examination, USG and FNAC can be useful in the evaluation of benign breast lumps.