Breast Complaints Research Articles

General practitioners’ perspectives on targeted breast ultrasound as primary diagnostic test in women with focal breast complaints: An interview study

IntroductionThe high diagnostic accuracy of ultrasound opens possibilities to shift towards an initial ultrasound approach for the evaluation of focal breast complaints in women, with only additional DBT in case of unclear or suspicious ultrasound findings. As general practitioners (GPs) are important stakeholders in the diagnostic pathway, this study focuses on GPs perspective on ultrasound as primary diagnostic imaging test, as well as the GP referral process. MethodsSixteen Dutch GPs were interviewed on the referral process and their perceived barriers and facilitators of initial ultrasound diagnostics in women presenting with focal breast complaints. Interview data were transcribed verbatim and analyzed thematically. ResultsThematic analysis identified themes related to 1) the routine breast consult (consult characteristics, referral decision, referral rationale and diagnostic imaging decision) and 2) considerations of an ultrasound-only approach. Regarding the latter, the theme diagnostic workflow emphasizes GPs concerns regarding long waiting times for ultrasound. Professional communication describes communicational barriers on patient-radiologist and radiologist-GP level. In the theme doctor-patient relationship shared decision-making was highlighted, while concerns existed on the lack of patient return to the GP after result disclosure at the hospital. Effectiveness of imaging is associated with GPs’ acceptance of the diagnostic performance of ultrasound as stand-alone modality. Personal expertise and workload is related to consequences of an initial ultrasound approach on GPs workload and professional tasks. Regarding the patient benefit-harm trade-off, various patient (dis)advantages were highlighted. Decentralization of diagnostic evaluation was considered a potential practical implication of ultrasound as primary diagnostic test. ConclusionParticipants seemed to welcome ultrasound-only diagnostics for the evaluation of women's focal breast complaints, emphasizing multiple benefits for both the patients and GPs. They, however, also addressed various challenges that should be taken into consideration when actually practicing an initial ultrasound approach.

ThP1.1 - Unilateral Nipple Discharge: Contemporary Approaches to Investigation and Management across a Multi-site Trust

Abstract Nipple discharge, in the absence of a palpable breast lump, constitutes 3-9% of referrals to breast services[i],[ii]. While the ABS released updated guidelines on nipple discharge in 2019, a standardised management protocol is yet to be established. This study aims to scrutinize the efficacy of imaging (mammogram, USS, MRI) and nipple discharge cytology in predicting malignancy outcomes in patients with unilateral nipple discharge. Aims Determine the incidence of malignancy in women presenting with unilateral nipple discharge. Assess sensitivity, specificity, and positive predictive value of imaging modalities (mammogram, USS, MRI) and cytology. Methodology 110 patients presenting with unilateral nipple discharge between 11/2022-12/2023 were retrospectively analysed. Data encompassing patient demographics, diagnostic procedures, and outcomes were systematically collected. Results 31.6% underwent surgical intervention, revealing a malignancy rate of 5.6%. Positive predictive values for detecting malignancy were 75% for mammogram, 50% for ultrasound, and 66% for nipple discharge cytology. No patients underwent MRI or ductoscopy as part of investigations. Conclusion This study highlights variable diagnostic accuracy of imaging and cytology and the necessity for large-scale collaborative data to draw substantive conclusions. The National Unilateral Discharge Study is anticipated to provide comprehensive insights and contribute to the establishment of a national investigative framework for patients presenting with unilateral nipple discharge. [i] Vargas HI, Romero L, Chlebowski RT. Management of bloody nipple discharge. Curr Treat Options Oncol 2002; 3: 157–161. [ii] Seltzer MH. Breast complaints, biopsies, and cancer correlated with age in 10,000 consecutive new surgical referrals. Breast J 2004; 10: 111–117.

ESR Essentials: diagnostic work-up in patients with symptomatic breast disease-practice recommendations by the European Society of Breast Imaging.

Breast complaints are frequent reasons for consultations in primary care or breast clinics. Breast pain, breast lumps, and nipple discharge are the most common complaints. Less common symptoms such as skin changes and axillary abnormalities also require specific diagnostic approaches. Imaging the symptomatic breast should be performed by appropriately trained breast radiologists following the best practice guidelines and quality standards. Full-field digital mammography (FFDM), digital breast tomosynthesis (DBT), and breast ultrasound (US) are the main modalities used in this primary setting. The choice depends on the patient's age and symptoms. Women younger than 30-years-old are first imaged byUS, whereas women over 40-years-old usually require both FFDM or DBT and US. For women between 30-years-old and 40-years-old, the US is the modality of choice, whereas FFDM or DBT might also be performed if needed. Pregnant or lactating women with palpable lesions or nipple discharge are imaged with US as the first method; FFDM or DBT can also be performed depending on the degree of suspicion as the dose to the fetus is minimal, and shielding may even further reduce the dose. More advanced techniques such as breast magnetic resonance imaging or contrast-enhanced mammography are not indicated in this first diagnostic setting and are reserved for cases of established malignancy (local staging) or rare cases of equivocal findings not otherwise resolved or inflammatory breast cancer. Last, but not least, male breast symptoms should also be addressed with US and/or FFDM. CLINICAL RELEVANCE STATEMENT: It is equally important to correctly diagnose an underlying malignancy and to avoid false positives that would lead to unnecessary biopsies, increased costs, and anxiety for the patient. Proper use of imaging modalities ensures optimal diagnostic approach and minimizes false negatives. KEY POINTS: Ultrasound, full-field digital mammography, or digital breast tomosynthesis are the main imaging modalities in the diagnostic setting, while MRI or contrast-enhanced mammography should be reserved to selected cases. Initial imaging modality includes ultrasound combined with mammography or digital breast tomosynthesis depending on women's age and the presence (or not) of inconclusive findings. A negative imaging evaluation should not deter biopsy when a highly suspicious finding is found on physical examination.

Value of digital breast tomosynthesis in characterization of breast lesions in dense breast

BackgroundPatients with dense breasts have a higher risk factor for developing breast cancer. Digital mammography (DM) exhibits a reduced sensitivity in dense breast tissue as a result of overlapping fibro-glandular tissue. Digital breast tomosynthesis (DBT) solves this problem, so allows better characterization of masses, asymmetries, and parenchymal distortion. It is useful in screening studies for early detection of breast lesions by accurate detection and description of their margins, shape, and extent as well as surrounding structures.ObjectiveWe aimed to evaluate the added value of DBT in characterizing of different breast lesions in dense breasts compared to DM.MethodsA Prospective Cohort study involved ninety female cases having dense breast parenchyma (ACR C & ACR D) having breast complaint lesions detected by DM or ultrasound or recalled from screening units, during the period from June 2021 to Jan 2023.All patient underwent DM and DBT with correlation with the pathological finding or follow up.ResultsAs regards the characterization of breast mass DBT had higher sensitivity, higher specificity (98%, 87% respectively). However, DM showed less sensitivity, less specificity (58%, 80%,) with (p < 0.0001, p = 0.0005 respectively).ConclusionsDBT effectively visualizes overlapping tissue in dense breasts. DBT is important due to its ability to detect breast cancer earlier, characterize lesions accurately, and inspect the margins of masses precisely, along with decreasing recall rates for false-positive results.

Screening for those at risk for anxiety and depression warranting further clinical evaluation among patients presenting to breast services: a single-centre, cross-sectional study

ObjectivesStudies show that anxiety and depression are widespread across patients presenting to outpatient services for medical illnesses. We expect similar or even higher prevalence in patients with breast complaints owing...

Women's Experiences with Digital Breast Tomosynthesis and Targeted Breast Ultrasound for Focal Breast Complaints: A Survey Study.

Background: Owing to its high sensitivity, as concluded in the Breast UltraSound Trial (BUST), targeted ultrasound (US) now seems a promising accurate stand-alone modality for diagnostic evaluation of breast complaints. This approach implies omission of bilateral digital breast tomosynthesis (DBT) in women with clearly benign US findings. Within BUST, radiologists started with US followed by DBT. This side-study investigates women's experiences with DBT, their main motivation to undergo diagnostic imaging, and their view on US as a stand-alone modality. Methods: A subset of BUST participants completed a questionnaire on their DBT experiences, reason for undergoing diagnostic assessment, and view on US-only diagnostics. Responses were analyzed with descriptive statistics and logistic regression analyses. Results: In total, 778 of 838 women (response rate 92.8%) were included (M = 47, SD = 11.16). Of them, 16.8% reported no burden of DBT, 33.5% slight burden, 31.0% moderate, and 12.7% severe burden. Furthermore, 13% reported no pain, 35.3% slight pain, 33.2% moderate, and 11.3% severe pain. Moreover, 88.3% indicated that the most important reason for breast assessment was explanation of their complaint and to rule out breast cancer, whereas 3.2% wanted to "check" both breasts. And 82.4% reported satisfaction with US only in case of a nonmalignancy. Conclusions: Our study shows that most women in the diagnostic setting experience at least slight-to-moderate DBT-related burden and pain, and that explanation for their symptoms is their main interest. Also, the majority report satisfaction with US only in case of nonmalignant findings. However, exploration of women's perspectives outside this study is needed as our participants all underwent both examinations.

Breast Carcinoma among Patients Undergoing Breast Diagnostic Ultrasonography in a Tertiary Care Hospital in Nepal

Background Ultrasonography (US) is an important modality for investigating breast lesions, as it lacks radiation exposure, differentiates between solid tumor and fluid-filled cysts, and is particularly-useful for young females with dense breast tissue. This study aimed to determine test characteristics (sensitivity, specificity, positive and negative predictive values, and accuracy), and the prevalence of breast cancer, among patients undergoing diagnostic breast US for clinically-detected abnormalities in a tertiary care cancer hospital in Nepal, comparing US findings with histopathology and cytopathology.Data and Methods A cross-sectional study was conducted among a convenience sample of 418 female patients who underwent diagnostic breast US between April 15 and September 10, 2022. Data were entered and analyzed on SPSS 25.0. Prevalence of cancer was determined among US patients who were referred for tissue diagnosis on the basis of clinical or US findings. Sensitivity, specificity, positive and negative predictive values, and accuracy of US in detecting breast lesions in comparison to histopathology and cytopathology findings were calculated. Results The study respondents’ age ranged from 13 to 75 (±11.8) years. Among 97 patients who underwent fine needle aspiration or biopsy based on US findings, 52 (12.4% of total) were diagnosed with breast carcinoma. The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of US to detect breast cancer were 94%, 100%, 93.7%, 100%, and 96.9%, respectively. Conclusion Among women with breast complaints or physical examination findings, diagnostic US revealed a high prevalence in the population investigated and demonstrated very good sensitivity, specificity, and accuracy to detect breast cancer. This study confirms the important role of ultrasound in the evaluation of breast lesions, particularly in underdeveloped countries.

Clinicopathological study of benign breast diseases in Bundelkhand regions

Background: Benign breast diseases are a neglected entity despite the fact that it constitutes the majority of breast complaints and that the vast majority of the lesions that occur in the breast are benign. Aims and Objectives: The aims and objectives of the study are to analyze the percentage of incidence, age distribution, and other associated factors of benign breast diseases. Materials and Methods: The prospective study was conducted on 100 cases of benign breast diseases in Maharani Laxmi Bai Medical College, Jhansi, between January 2021 and June 2022. Results: Lump was found in all participants (100%) in which incidence of painless and painful lump was for 94% and 6%, respectively. 6% lump was found to be associated with non-cyclical mastalgia and 2% lump had having association with discharge. Milky discharge (1%) was found in the case of galactocele and serous discharge (1%) was found in duct ectasia. Benign breast diseases were found most commonly in premenopausal women (97%) in comparison to post-menopausal women (3%). Breast lump was investigated by fine needle aspiration cytology which was consistent with a lump of fibroadenoma and fibroadenosis in 95% of cases. Rest 5% of breast lumps were non-consistent. 90% of cases were found of fibroadenoma. All patients underwent surgical line of management except for fibroadenosis which was managed conservatively. Cases of breast abscess, fibroadenoma, duct ectasia, and galactocele admitted in hospital, for which mean hospital stay was 4.28 plus or minus 6.21 days. Conclusion: The most common benign breast disease encountered in clinical practice is fibroadenoma followed by fibroadenosis. They are most common in 15–25-year age group and its presentation is found to be more in married woman.

Breast cancer early diagnosis detection of breast cancer through education of primary healthcare providers in Côte D'Ivoire.

e18767 Background: In Côte d'Ivoire, &gt; 70% of women with breast cancer present with stage III/IV disease. To improve early detection, we designed and implemented an educational curriculum (EC; the Breast Health Program) for primary healthcare providers (PCPs). Methods: We performed in-depth interviews with key stakeholders to identify barriers and facilitators of breast cancer early detection. Interviews were audio-recorded, transcribed, double-coded and analyzed via thematic analysis. The EC was designed based on interview results and implemented during a one-day educational session for PCPs. Participating PCPs completed pre- and post-session surveys to assess knowledge. Data were analyzed using Fisher’s exact test. All p-values were two-sided. Results: Eighteen stakeholders participated in the interviews: 7 (39%) physicians, 5 (28%) medical students, 3 nurses, 2 cancer survivors, and 1 midwife. Identified barriers to early detection included: lack of awareness-raising campaigns to encourage earlier presentation (50%), need for patient follow-up and support after presentation to primary healthcare centers (50%), financial barriers (39%), delays due to lack of coordination in diagnosis and treatment (22%), and lack of mammography and biopsy capacity outside of the private sector (11%). Based on the interviews, the following topics were included in the EC: breast cancer and benign breast disease diagnosis and treatment, patient communication/support, clinical breast exam (CBE), symptom management, and financial navigation to assist patients access diagnosis. A total of 36 PCPs from five healthcare centers attended the educational session: 75% were female; the mean age was 41.3 years (SD 7.2); Nine (28%) were physicians, 6 (17%) nurses, 18 (50%) midwives; the median years of work experience was 7 years (range 3-32). At baseline, 18 (50%) PCPs felt qualified to evaluate patients with breast complaints; 10 (28%) did not, vs. 32 (89%) and 2 (6%) respectively at follow-up (χ2 = 8.75 p = 0.003). 15 (42%) providers felt qualified to help patients overcome barriers to diagnosis, and eleven (31%) felt unqualified/neutral at baseline, vs. 31 (86%) and 4 (11%) respectively at follow-up (χ2 = 7.67, p = 0.006). There were no statistically significant differences between baseline-follow-up in feeling qualified to perform CBE (27 (75%) vs. 32 (89%)) or ability to refer patients for diagnostic workup (29 (81%) vs. 34 (94%)). Conclusions: We identified multiple barriers to early breast cancer detection in Côte d’Ivoire. The EC was effective in improving confidence among PCPs and evaluation of breast complaints and addressing barriers to cancer diagnosis. There were no differences in feeling qualified to perform CBE or ability to refer patients to diagnostic workup, which were high at baseline. Future work includes expanding the program reach and evaluating impact on time to diagnosis.

Guidelines and Protocol of Managing Patients with Breast Problems during Pregnancy and Lactation

Most of the breast lesions found during pregnancy are benign. Pregnancy associated breast cancer (PABC) is defined as cancer that occurs during pregnancy or within 1 year of delivery. Aim of the study: To diagnose breast lesions during pregnancy, detect incidenceof masses as well as the incidence and early diagnosis of PABC. Patients and methods: 500 pregnant women (190 primigravida, 254 mutigravidaand 56 lactating) attending Kasr Al Ainy outpatient clinic having breast complaints were included in the study. Ultrasound was performed for all patients. Further investigations were performed when indicated (Mammography, MRI or core biopsy). Results: Incidence of breast mass was 25.6%. Within those cases, 5.46 had PABC. The overall incidence of PABC was 1.4%. Biopsy was performed in 13 patients (9 pregnant and 4lactating). We diagnosed 7 malignant masses (4 lactating and 3 pregnant). Pathology revealed5 invasive duct carcinoma, 1 inflammatory carcinoma and 1 adenocarcinoma. Positive family historywas found in 85.7% of malignant cases. Conclusion: Most breast masses were benign. The overall incidence of PABC was 1.4% and 5.46% within patients diagnosed with a breast mass. Obstetricians should be aware of the importance of breast examination when there is a breast complaint during pregnancy.

US and Digital Breast Tomosynthesis in Women with Focal Breast Complaints: Results of the Breast US Trial (BUST).

Background Digital breast tomosynthesis (DBT) followed by targeted US is commonly performed to evaluate women with localized breast complaints. However, the added value of DBT in addition to targeted US is unknown. Omitting DBT may be cost-effective and improve patient comfort but may miss potential breast cancer. Purpose To assess whether an imaging protocol consisting of targeted US alone may be feasible for the diagnostic work-up of women with localized symptoms and to assess the supplemental value of DBT in this reversed setting. Materials and Methods This prospective study enrolled consecutive women aged 30 years or older with focal breast complaints in three hospitals in the Netherlands between September 2017 and June 2019. In all participants, first, targeted US was evaluated, and if needed, biopsy was performed, followed by DBT. The primary outcome was the frequency of breast cancer detected with DBT when US was negative. Secondary outcomes were frequency of cancer detected with DBT elsewhere in the breast and combined overall sensitivity of US plus DBT. The reference standard was 1 year follow-up or histopathologic examination. Results There were 1961 women (mean age ± SD, 47 years ± 12) enrolled. Based on initial US alone, 1587 participants (81%) had normal or benign findings and 1759 (90%) had a definitive accurate diagnosis. In total, 204 breast cancers were detected during initial work-up. The frequency of malignancy was 10% (192 of 1961 participants) with US (US sensitivity, 98.5% [95% CI: 96, 100]; US specificity, 90.8% [95% CI: 89, 92]). DBT depicted three unobserved malignant lesions at the complaint site and 0.41% (eight of 1961 participants) of incidental malignant findings in participants without symptomatic cancer. Conclusion Compared with combined US and DBT, US was accurate as a stand-alone breast imaging modality in the assessment of focal breast complaints. The rate of cancer detection of cancers elsewhere in the breast with DBT is comparable to cancer detection rate of screening mammography. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Newell in this issue.

Abstract P1-05-08: Assessment and Diagnosis of Breast Pathology in Young Women: What Can We Learn?

Abstract Introduction: Women 30 years-old or older that present with a breast complaint typically receive a standard work-up, which includes a diagnostic mammogram ultrasound. Because women under 30 years-old have extremely dense breast tissue, the initial imaging work-up begins with ultrasound. The American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) describes and categorizes imaging findings using a standardized language to convey to non-radiologist physicians and patients the risk associated with a described breast lesion. Interpretation of the results can be problematic in young women (&amp;lt; 18 y.o) that may undergo imaging at a pediatric facility, often without on-site breast imaging specialists and standard breast imaging protocols in place, including the usage of the BI-RADS lexicon. Appropriateness of biopsy and surgical management require careful consideration especially in a setting where the pathology is often benign. We describe our 5-year experience of 482 young women undergoing breast imaging at a single institution to identify key features characteristic of young women with malignant lesions. Methods: A retrospective cohort study was conducted on all patients between the ages of 9-29 years old that presented to a breast imaging center for evaluation of a breast complaint from January 2017 through December 2021. Patients were identified via an Epic SlicerDicer query based on age and breast imaging procedure. A retrospective chart review was conducted on this cohort to capture demographic information (Table 1), medical history and family history. Information related to radiographic evaluation, biopsy procedures, and post-operative pathology was also recorded. Results: Four hundred-eight two patients with mean age of 23.8 3.7 years were seen for a breast complaint at the imaging center, of which 462 underwent breast ultrasound (96.7%). A BI-RADS classification was assigned in 418 reports (87%). Fifty-eight patients (12%) had imaging at an outside facility before coming to our dedicated breast imaging center. The mean maximal dimension at presentation was 1.3 1.6 cm. A BI-RADS classification of 4 was assigned to 46 patients (9.6%). A core needle biopsy (CNB) was performed in 63 patients (13.1%). Seventy-seven patients (16%) underwent surgery. Of the patients undergoing surgery, 38 (49.4%) had a CNB prior to surgery and the mean pre-operative maximal dimension on ultrasound was 3.1 1.6. Reason for excision included: mass size (30.3%), symptoms (27.6%), biopsy result (21.1%) and growth (19.7%). Eight patients (12.7%) were found to have a malignancy on CNB. Fibroadenoma (64.5%) was the most common pathology after surgery. A phyllodes tumor was identified in 8 patients, of which 6 were benign (7.9%) and 2 were classified as borderline (2.6%); there were no malignant phyllodes in the cohort. The mean size for phyllodes lesions were 3.8 1.8 cm. Six of 8 patients had a malignant lesion on final surgical pathology (7.9%); the other 2 patients achieved a pathologic complete response (pCR). Details regarding malignant lesions can be found in Table 2. Conclusions: While the American College of Radiology helps provide guidance for appropriate imaging evaluation in young women, there are no treatment algorithms that address the appropriateness of surgical treatment in this age group where the diagnosis is often benign. Radiologist and surgeons that specialize in breast disease may be asked to provide guidance on management decisions for a population they may rarely see (patients &amp;lt; 18 years-old), just as pediatrician or pediatric surgeons may feel pressure to making management plans for complaints they rarely encounter (breast). The value of using standardized imaging and treatment protocols with dedicated breast radiologist and surgeons may offer the best comprehensive approach to this unique subset of patients and deserves further evaluation. Table 1. Demographic and medical history. Values are n (%) or median [interquartile range]; BMI, body mass index Table 2. Characteristics of masses in young women. Values are n (%) or median [interquartile range].; *including juvenile fibroadenoma; **benign cyst, ductal ectasia, normal breast tissue, and papilloma; independent t-test was used to compare means for continuous variables; Pearson’s chi-squared test was used for categorical data; BMI, body mass index; NS, not significant Citation Format: Stephanie A. Ramirez, Brian A. Menegaz, Ashley Roark, Elizabeth Bonefas, Karla A Sepulveda, Alastair M. Thompson, Stacey Carter. Assessment and Diagnosis of Breast Pathology in Young Women: What Can We Learn? [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-05-08.

Breast myofibroblastoma in a woman: a case report

Breast myofibroblastoma is a rare benign neoplasm of mesenchymal origin with fibroblastic and myofibroblastic characterizations. Myofibroblastoma has a higher incidence in men between the ages of 50 and 70 years and is less common in women. It is described as a solitary, unilateral, painless and mobile tumor, with a firm consistency and slow growth. Microscopically, it is a non-encapsulated tumor, with lobular growth, consisting of spindle cells organized in short, intersecting fascicles and interrupted by bundles of hyalinized collagen. On ultrasound, it can manifest as a hypoechoic solid mass, well circumscribed, homogeneous and similar to fibroadenoma; whereas, on mammography, a single, well-defined, rounded or discretely lobulated lesion can be observed, without calcifications. We report here the case of a 58-year-old patient with no previous breast complaints, who presented with changes in ultrasound and mammography examinations performed for breast cancer screening. The examinations revealed a suspicious lump in the left breast, classified as BIRADS 4C. Core biopsy described a low-grade spindle cell neoplasm, showing no signs of invasion, with immunohistochemistry results suggesting myofibroblastoma. As treatment, a sectorectomy was performed, and the reevaluated material confirmed the diagnosis of myofibroblastoma due to the positive expression of the markers calponin, CD34, BCL2 and CD99.

Pattern of Various Male Breast Diseases in a Tertiary Care Centre of Aurangabad District, Maharashtra, India- A Prospective Interventional Study

Introduction: A small percentage of men are affected by breast diseases and awareness of male breast disease is less and presentation is often delayed due to embarrassment. The most common presentation is gynaecomastia, where cosmetic correction is sought. Over the last two decades the rate of male breast complaints increased from 0.8% to 2.4%, while 1% of all breast cancer occur in males. Aim: To study the pattern of various male breast diseases in a tertiary care centre of Aurangabad District in Maharashtra, India. Materials and Methods: This prospective clinical interventional study was carried out in 44 male patients above age of 12 years coming with complaints related to breast to Department of General Surgery of Government Medical College, Aurangabad from 1st August 2017 to 31st July 2019. Detailed history was taken and any underlying causative disease/risk factor or medication if any was noted. Thorough clinical examination and laboratory investigations were done. Ultra-sonography of breast was done in all patients. Mammography was done in three patients who were having clinical suspicion of malignancy. Continuous variables were presented as mean, Standard Deviation (SD) or median if the data is unevenly distributed. Categorical variables are expressed as absolute numbers and percentages. Data was analysed using Statistical Package for the Social Sciences (SPSS) version 17.0. Results: The youngest patient was 12 years old and eldest was 85 years old. In the present study, 38 benign and 6 malignant male breast diseases were diagnosed. Out of total, 33 had gynaecomastia, 2 had breast abscess, 5 Infiltrating duct carcinoma and 1 each of mastitis, eczema of nipple, sebaceous cyst of areola and primary breast sarcoma. Out of 44 patients, 12 patients underwent surgery for benign and malignant breast diseases, 24 patients of gynaecomastia were managed by reassurance, 5 males with infiltrating ductal carcinoma were managed by modified radical mastectomy and 3 patients by medical therapy. Conclusion: It was concluded that benign male breast diseases were more common and ultrasound together with mammography should be used to differentiate characteristics of benign and malignant male breast lesions.

The Effect of Targeted Ultrasound as Primary Imaging Modality on Quality of Life in Women with Focal Breast Complaints: A Comparative Cohort Study.

Background: The high diagnostic performance of modern breast ultrasound (US) opens the possibility to shift toward targeted US as initial imaging test in women with breast complaints. This comparative cohort study investigates the effects of starting with US followed by digital breast tomosynthesis (DBT), as practiced in the breast ultrasound study (BUST), on women's health-related quality of life (QoL). Methods: Fifty BUST participants and 50 "controls" who underwent DBT and US in regular order filled out the EQ-5D-3L three times during their visit: BUST participants before US (T1), after US (T2), and after DBT (T3) and non-BUST participants before DBT (T1), after DBT (T2), and after US (T3). Changes in QoL from baseline to T2 and T3 were assessed using generalized least squares, also taking into account the effects of biopsy, age, and complaint type. Results: Participants' mean age was 50.6 years (BUST: SD = 12.1, controls: SD = 11.5). At T2 the overall QoL was higher [t(102.9) = 2.4, p = 0.017] and anxiety levels were lower [t(98.7) = -2.4, p = 0.020] in BUST participants compared with controls. However, from T2 to T3 these effects equalize, resulting in similar performances in QoL and anxiety at T3, respectively [t(97.6) = -2.3, p = 0.023] and [t(97.2) = 3.1, p = 0.002]. Compared with BUST participants, controls show a clear decrease in pain after US [t(106.5) = -2.8, p = 0.006]. Women undergoing biopsy had lower QoL [t(167.1) = -2.4, p = 0.017] and pain [t(154.1) = -2.1, p = 0.038], and more anxiety [t(187.4) = 4.3, p = 0.000]. Conclusions: The results suggest that changing the radiological order by starting with US has a short-term positive effect on overall QoL, anxiety, and DBT pain experience in symptomatic women. Owing to its negative impact, biopsies should be performed cautiously. In conclusion, the moment of reassurance for women advances by reversing the radiological order according to the BUST, showing the high importance of human interaction in diagnostic care in addition to the clinical performance of imaging modalities.

276 (PB-100) Poster - What are women’s perceptions of diagnostic DBT and targeted breast ultrasound for the evaluation of their focal breast complaints?

Background: In the Breast Ultrasound Study (BUST) the diagnostic accuracy of ultrasound (US) and the additional cancer yield of digital breast tomosynthesis (DBT) in the clinical setting was assessed. Within BUST, the radiological order of imaging was reversed, starting with US. This side-study to the BUST focuses on patients’ perceptions of US and DBT.

An observational study on benign breast diseases in a tertiary healthcare centre in Chengalpettu district

Background: Benign breast disorders constitute the majority of breast complaints presented by young females to a surgical OPD. It is 10 times more common than cancerous conditions and deserves attention due to its high prevalence, impact on woman’s life associated anxiety and possibility of some turning into cancerous conditions. It is divided into aberrations and abnormalities in development, epithelial and stromal proliferations, inflammations and neoplasms. In this study we aim at finding the prevalence, age, clinical presentation of commonest benign breast conditions and its correlation with pathological and radiological studies.Methods: The 98 cases of benign breast diseases between the age group of 15-45 years underwent triple assessment consisting of clinical examination, ultrasonography and fine needle aspiration cytology. Patients who were diagnosed with malignancy were excluded from the study.Results: Out of 98 breast lesions the commonest presentation was breast lump and found most commonly in right upper quadrant. The most common age was 20-30 years and fibroadenosis was most common benign lesion followed by fibroadenoma, mastalgia, breast abscess and nipple discharge.Conclusions: BBDS are a common problem among females in the reproductive age group. It is important to differentiate between fibroadenoma and fibroadenosis. FNAC and ultrasonography are a useful aid in diagnosis of benign breast lesions.

Evaluation of Arab Cultural Barriers That Influence Muslim Arab Iraqi Women's Breast Cancer Screening Behavior.

Little is known about Iraqi women's practice towards breast cancer screening (BCS), breast self-examination (BSE), clinical breast examination (CBE) and mammography, and the influence of Arab culture. The aim of this study was to assess women's behavior towards BCS, and to explain the influence of specific Arab culture barriers. This descriptive study was carried out with 1,066 women. Three structured questionnaires were used in the data collection. Descriptive statistics and multivariable logistic regression were used for data evaluation. Many Iraqi women did not practice regular BSE, CBE, and mammography. The most common reason was "not having a breast complaint". Specific Arab cultural barriers such as exposure [odds ratio (OR) = 0.545; 95% confidence interval (CI) = 0.440 to 0.674; p<0.001], environment (OR = 0.571; 95% CI = 0.464 to 0.703; p<0.001) and uneasiness barriers (OR = 0.736; 95% CI = 0.557 to 0.974; p=0.032) were predictors for BSE while exposure (OR = 0.553; 95% CI = 0.447 to 0.684; p<0.001), and environment barriers (OR = 0.585; 95% CI = 0.474 to 0.772; p<0.001) was predictor for CBE. Additionally, exposure (OR = 0.324; 95% CI = 0.251 to 0.419; p<0.001), environment (OR = 0.636; 95% CI = 0.500 to 0.809; p<0.001), and uneasiness barriers (OR = 0.644; 95% CI = 0.464 to 0.893; p = 0.008) were predictors for mammography screening of Iraqi women. Arab specific cultural barriers may be one of the key obstacles to BSC uptake in Iraq. Health education, including cultural education, may have the potential to increase BCS awareness and down-staging of the disease at presentation.

Mastalgia is Not An Indication for Mammogram.

Mastalgia is a common breast complaint that is worrisome to patients. This study was performed to determine if mastalgia is a sign of breast cancer and to evaluate the benefit of its work up. METHODS: Retrospective review of prospectively collected data on 8960 consecutive patients at a safety net institution from June 1, 2006 to December 31, 2020. Data on patient reported mastalgia and diagnosis of breast cancer were collected. RESULTS: 8960 patients had a mean age of 45 years. The population was predominantly underinsured, 70% Hispanic, and 16% had adequate health literacy. Approximately 31% (2820 of 8960) of patients presented with a complaint of breast pain. Of 2820 patients with breast pain, 20 (0.7%) were found to have breast cancer. The average age of patients with breast cancer was 49 years. Physical examination identified a mass in 6 patients and only 3 patients had pain limited to the side of the cancer (10 bilateral, 7 contralateral). Of 1280 patients who were under age 40 years, 88% underwent breast imaging. The Cancer Detection Rate (CDR) was 0.9 per 1000 examinations. For 950 patients age 40 to 49 years and 590 patients age 50 years and older, 98% and 99% underwent breast imaging, respectively. The CDR was 10 per 1000 examinations for age 40 to 49 and 14 per 1000 examinations for age 50 years and older. CONCLUSIONS: Mastalgia is rarely associated with breast cancer. In the absence of other findings, imaging of patients less than age 40 is not recommended. Any workup beyond routine screening mammography in age-appropriate patients, to identify the "cause" of breast pain, does not seem warranted.

Management of breast complaints and high-risk lesions

Benign breast disease including palpable breast mass, mastalgia, skin changes, and nipple discharge are common gynecologic symptoms. Practitioners should be well versed in the components of clinical breast care. Workup begins with taking a thorough medical and family history to assess risk and performing a clinical breast examination. Breast imaging is often indicated for further evaluation. A structured approach to the evaluation and management of these breast conditions is critical to distinguish benign disease from malignancy. High-risk breast lesions such as atypical hyperplasia and lobular carcinoma in situ are also frequently encountered, and while benign, they do increase the future risk of breast cancer and patients should be offered intensive surveillance and chemoprevention.