Breast Complaints Research Articles

Comparison of emergency pediatric breast ultrasound interpretations and management recommendations between pediatric radiologists and breast imaging radiologists

PurposePediatric patients with breast-related symptoms often initially present to the emergency department for evaluation. While pediatric radiologists are accustomed to evaluating acute infectious and traumatic etiologies, they may be less familiar with breast-specific findings. This study compares management recommendations of pediatric breast ultrasounds performed in the emergency setting between pediatric and breast imaging radiologists.MethodsThis retrospective cohort study reviewed data from all pediatric breast ultrasounds performed in the emergency setting from a single academic institution from 1/1/14 to 12/31/19. During the study period, 12 pediatric radiologists with experience ranging from 1 to 33 years interpreted pediatric breast ultrasounds. Three breast imaging radiologists (with 3, 8, and 25 years of experience) retrospectively reviewed each case and recorded whether further management was recommended. Differences in recommendations were compared using Fisher’s exact test. Cohen’s kappa was used to assess agreement between subspecialty radiologists.ResultsThis study included 75 pediatric patients, with mean age 13 ± 5.6 years and malignancy rate of 1.3% (1/75). Pediatric radiologists and the most experienced breast imaging radiologist had moderate agreement in management recommendations (k = 0.54). There was no significant difference in recommendations for further management between pediatric radiologists (22/75 [29.3%]) and the most experienced breast imaging radiologist (15/75 [20.0%]), p = 0.26.ConclusionRecommendations for pediatric breast complaints in the emergency setting are comparable between subspecialties.

114 A unilateral breast mass with bloody nipple discharge in a two-year-old girl: A case report

Objective(s): Breast diseases are very rare in childhood and adolescence, and most lesions are benign. We report a case of florid papillomatosis of the nipple. This is one of the possible differential diagnosis in children with breast complaints. Study design: Case report. Results: A two-year-old girl presented with unilateral spontaneous bloody nipple discharge and a small, translucent, bluish and palpable mass under the right nipple. The patient was in good general health and had no history of any major illnesses or surgeries.

A Comprehensive Model for Diagnosis of Primary Breast Lymphoma Differentiated From Breast Cancer and Prognosis Evaluation of Surgical Treatment.

BackgroundThe objective of this work was to discriminate between primary breast lymphoma (PBL) and breast cancer by systematically analyzing clinical characteristics, laboratory examination results, ultrasound features, and mammography findings to establish a diagnostic model for PBL and to analyze the influence of surgical treatment on the prognosis of PBL patients.MethodWe analyzed 20 PBL and 70 breast cancer patients treated during the same period by comparing several characteristics: clinical features, such as age, tumor position, and breast complaints; laboratory examination findings, such as the lactate dehydrogenase (LDH) level, and imaging features such as the maximum diameter, shape, margins, aspect ratio, and calcification of the mass and axillary lymph node involvement. A diagnostic model was then developed using logistic regression analysis. The impact of surgery on the prognosis of PBL patients was assessed through Kaplan–Meier survival analysis.ResultBreast cancer and PBL could be distinguished based on imaging features, including the maximum diameter, shape, margin, and calcification of the mass, and lymph node involvement (P < 0.05). There were no significant differences between PBL and breast cancer patients in terms of clinical features, or the LDH level. The area under the receiver operating characteristic curve was 0.821. The log-rank test showed that surgery had no significant influence on the prognosis of PBL patients.ConclusionUltrasound and mammography are the most useful methods for detecting malignant breast tumors. Compared with breast cancer tumors, breast lymphoma tumors are larger with a more regular shape and less calcification and are often accompanied by axillary lymph node involvement. Patients with a breast malignancy should not undergo surgical excision without an accurate diagnosis.

Kan 25-hidroksi D vitamini düzeyinin fibrokistik meme hastalığı ve meme yoğunluğu ile ilişkisi

Purpose: The aim of this study is to evaluate the association of blood 25-hydroxy vitamin D levels with fibrocystic breast masses and breast patterns.&#x0D; Materials and Methods: The study included 612 patients who presented with breast complaints or referred for routine screening between 2018-2021 and were requested to have breast ultrasonography (USG) and mammography (MG) examinations. Patients were divided into two groups; group 1 consisted of women with fibrocystic mass (BI-RADS 2-3) and group 2 consisted of women without breast mass (BI-RADS 1). These two groups were compared by age, breast USG, MG results, and blood 25-hydroxy vitamin D levels.&#x0D; Results: Of the 612 patients, 310 (51%) had fibrocystic mass in their breasts, while 302 (49%) had normal breasts. The mean age of both groups was similar. Those with fibrocystic mass in the breast had lower vitamin D levels and higher breast density than the control group. The group with higher breast density had lower vitamin D levels, and there was a negative correlation between vitamin D level and breast density &#x0D; Conclusion: Our study revealed that women with fibrocystic masses in their breasts (BI- RADS2 and BI-RADS3) had higher breast density and lower vitamin D levels than women without breast mass.

Diagnostic accuracy of mammography in characterizing breast masses using the 5th edition of BI-RADS: A retrospective study

Background: Breast imaging-reporting and data system (BI-RADS) is intended for standardizing mammography reporting.Objectives: We aimed to evaluate the diagnostic precision of the BI-RADS assessment scoring system using histopathological findings as the reference standard. We also aimed to assess the positive predictive value (PPV) of different morphological descriptors for malignancy.Materials and Methods: This retrospective record-based analytical study was conducted in the Department of Radiodiagnosis of Acharya Harihar Post Graduate Institute of Cancer, Cuttack, Odisha, a tertiary cancer center in eastern India. We included patients attending the breast cancer unit with various breast complaints who were subjected to mammographic imaging and histopathological examination. The primary outcomes were the sensitivity, PPV, negative predictive value (NPV), and diagnostic accuracy (DA) of the BI-RADS scores for the pathological reports; secondary objective was the evaluation of the mammographic morphological characteristics. Mammography was interpreted using the BI-RADS 5th edition guidelines, without prior knowledge of the biopsy report. A BI-RADS final assessment score between 1 and 5 was assigned, where 1 indicated a normal study, 2 benign, 3 possibly benign requiring follow up, 4 suspicious requiring biopsy, and 5 indicating likely malignant requiring biopsy and further actions.Results: Between February 2020 and December 2020, we included 247 patients. All the category 5 lesions were malignant, while 76.5% of category 4 lesions were malignant. PPVs of BI-RADS categories 4a, 4b, and 4c were 38%, 90%, and 94%, respectively. Mammography had a sensitivity, specificity, PPV, NPV, and DA of 98.7%, 47.6%, 87.5%, 90.9%, and 87.9%, respectively. Morphological features that were significantly associated with malignancy were spiculated margins (P = 0.003, PPV = 100%), microlobulated margins (P = 0.005, PPV = 96.5%), irregular shape (P = 0.002, PPV = 89.6%), microcalcification (P = 0.005, PPV = 92.8%), skin thickening (P < 0.0001, PPV = 100%), and architectural distortion (P = 0.003, PPV = 96.7%).Conclusion: Digital mammography is a sensitive tool for the evaluation of breast lumps, but BI-RADS final assessment score is subjective as it depends on the interpreter's expertise.

Reasons and Barriers of Breast Self-examination among Affluent Women: A Cross-sectional Study

Introduction: Breast Self-examination (BSE) is the simplest and easiest way to look for abnormalities. It’s an inexpensive and easy procedure that needs to be implemented from a young age. BSE will help in early diagnosis and treatment of benign and malignant tumours. Inadequate knowledge about BSE was seen usually in non affluent women. Though, affluent individuals have access to good and better healthcare, still there seems to be a lack. Aim: To understand the reasons and barriers among affluent women concerning BSE. Materials and Methods: This descriptive cross-sectional study was conducted in the field area of Ayaan Institute of Medical Sciences, Hyderabad, India, from March 2021 to February 2022. A total of 250 women were included in the study between the ages of 21-49 years. Data was collected using a predesigned pretested questionnaire to evaluate socio-demographic, reasons and barriers to BSE. Data were presented in numbers and percentages. Results: The mean age of the study population was 34.60±8.31 years. All 250 women were educated and with the majority being graduates (n=176, 70.4%), only 140 (56%) had a working occupation and the 205 (82%) were married. The feeling of mass in either of the breast (123, 49.2%), followed by family history of breast cancer (99, 39.6%) and breast pain (92, 36.8%) were the common reasons for performing SBE. The barriers to self-examination were majorly due to lack of knowledge (164, 65.6%), lack of breast complaints (164, 65.6%), absence of lump (130, 52%), followed by 115 (46%) who did not like to touch their breast. Forgetfulness was seen in 93 (37.2%) subjects. Conclusion: Poor awareness of the BSE practice exists even among affluent women. There is an urgent need for awareness about screening techniques, including BSE, in media and health facilities.

EP.TH.507An Audit of Consent Documentation and Chaperone Use in Patients Presenting to Acute Settings with Breast Complaints

Abstract Aim To compare current practice of documenting consent and offering chaperones when performing breast examinations in the acute setting, with standards set by regulatory bodies (General Medical Council, Royal College of Emergency Medicine and Royal College of Surgeons). Method Data was collected retrospectively from all patients presenting with breast complaints to either the emergency department (ED) or the surgical assessment unit (SAU) over a 34-month period. From the clerk-in notes, the role (Dr/Nurse), grade (FY1 to consultant) and gender of the examiner was noted, as well as whether consent was documented and if a chaperone was offered. Results Of the 64 patients presenting in this time frame, consent was documented in 7 sets of notes (11%). Furthermore, 17 were offered a chaperone (27%), of which examiners correctly documented the name and role of the chaperone on 11 occasions. Results also demonstrated that ED trainees were most likely to offer a chaperone and GP trainees were the best at recording consent. It also revealed that although male examiners offered a chaperone 50% of the time compared to 6% of female examiners, women examiners were better at documenting consent when compared to their male counterparts. Conclusion The audit results indicate that there is significant room for improvement across all roles, grades and genders with regards to documentation of consent and the use of chaperones within the acute setting, in order to meet current standards of practice as set out by regulatory bodies.

A new search pattern for emergency breast exams: the clinical picture.

Distinct breast diseases are readily diagnosed by clinical and ultrasound appearance that radiologists and sonographers may encounter in emergency room and urgent care patient presentations. While it may be impractical or impossible for the on-call emergency radiologist to examine a patient with breast complaints, radiologists can and should adopt the practice pattern to routinely seek out the clinical photographs in the patient's medical record while interpreting breast examinations. Imaging should be interpreted in the context of both the history and the physical findings. Sonographers play important roles in the documentation of visual inspection findings, in addition to performing high quality targeted ultrasound where applicable. This pictorial offers resources to emergency radiologists and sonographers that facilitate rapid accurate diagnosis of ten distinct breast diseases.

Idiopathic granulomatous mastitis associated with erythema nodosum may indicate a worse prognosis.

Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory breast disease of unknown etiology, and erythema nodosum (EN) is a rare extramammary manifestation of this entity characterized by reddish, tender nodules of the lower legs. We aimed to investigate whether the association of IGM with EN has a role as a prognostic indicator. There are few case reports, and only 1 original article including 12 IGM patients with EN has been reported. We present 43 women with IGM coexisting with EN and 43 with a diagnosis of IGM only, who were randomly selected from 610 patients for a control group. To the best of our knowledge, this paper comprises the first comparative study of the coexistence of IGM and EN to be reported in the literature. Our findings show that the association of IGM with EN indicates a more aggressive disease course. White blood cells, erythrocyte sedimentation rate, and C-reactive protein were significantly higher in the EN-positive group (P<.05). Arthralgia, breast feeding, fistula distribution and recurrence distributions were significantly higher in the EN-positive group (P<.05). Since fistula distribution and recurrence rates were higher in EN-positive group, association of IGM with EN may be an indictor of a worse prognosis. The present study highlights the importance of dermatological care. All physicians should not neglect questioning breast complaints in patients with EN since EN may be caused by IGM.

Late migration of silicon as a complication to breast transplant rupture: Case report and literature review.

Silicone implants have been used for breast augmentations, both cosmetically and in reconstructive surgery since the 1960s. Rupture of breast implants and silicone migration is a well-known complication. In this case report and literature review, we present a case of a 53-year-old woman with bilateral cosmetic silicone gel breast implant in 1986, and a replacement with saline gel in 2005. The patient had no breast complaints and observed no change in breast volume during this period. In 2020, silicone was randomly identified in a right-sided cervical lymph node in an attempt to remove suspicious lymphadenopathy. The source of the silicone is still doubted; that is, it is not known if the silicone originated from the saline implant or the silicone gel implant.In our literature review, we find that distant migration of silicone and lymphadenopathy have occurred for silicone breast implants although very rare for saline gel breast implants.

Breast Imaging After Dark.

Patients may present to the emergency department with breast complaints due to traumatic or nontraumatic changes in the breast. Benign and malignant breast pathologies may mimic each other both in clinical presentation and imaging appearance. A complex cystic and solid mass seen on ultrasound in a patient with a palpable mass can represent breast cancer, abscess, or hematoma. A unilateral swollen breast may result from inflammatory breast cancer, mastitis, or other benign etiologies; correlation with clinical history, physical exam, and close follow-up are required to ensure complete resolution of symptoms. Uncommon breast entities such as granulomatous mastitis and breast implant-associated anaplastic large-cell lymphoma may cause changes in the appearance of the breast that prompt a patient to seek initial evaluation in the emergency department. Imaging evaluation of the breast in the emergency department is limited, and it is important that patients with a breast complaint be referred to a dedicated breast center for complete evaluation at an appropriate time interval after their discharge from the emergency department.

Clinicopathological study of benign breast diseases a study of 50 cases

Background: Benign breast diseases are a neglected entity in developing countries despite the fact that they involved in the majority of breast complaints. Benign breast disorders can be defined as any non-malignant breast condition and involved wide range of clinical and pathological disorders. Breast diseases present as swellings. It is a symptom/sign for a different lesion varying from developmental abnormality, inflammatory lesions, epithelial and stromal proliferation to malignancy. Patients were studied on the basis of i.e., clinically, and histopathological ultrasound has done. Our purpose of study is to document various benign Brest diseases to study different mode of presentations of diseases and correlation of clinical and pathological diagnosisMethods: The given study was a prospective and observational study, undertaken in the department of general surgery, govt. medical college Surat, during the study period of March 2018 to September 2019.All the female and male patients with breast related disease were included in this study. Female patients with biopsy proven malignancy were excluded from the study.Results: The study comprised of 50 patients with benign breast diseases; the most common is Fibro adenoma which formed 68% then fibrocystic diseases 20%. With most common age group involved in our study is 21-30 years.Conclusions: Benign breast diseases are more common but ignored entity though it carries majority of complaints and occur mainly in young women less than 30 years of age and were mostly fibro adenoma and fibrocystic change.

The additive role of diffusion-weighted magnetic resonance imaging to axillary nodal status evaluation in cases of newly diagnosed breast cancer

BackgroundAxillary nodal status is crucial for the management of cases with recently diagnosed breast cancer; usually addressed via axillary ultrasonography (US) along with tissue sampling in case of suspicion. Axillary nodal dissection and sentinel biopsy may be done, but are rather invasive, carrying a potential complication risk, which raises the need for non-invasive, reliable, pre-operative axillary imaging. We aimed at evaluating the performance of diffusion-weighted imaging (DWI) regarding preoperative axillary evaluation, using functional information derived from diffusion capacity differences between benign and malignant tissue. We included 77 axillary nodes from 77 patients (age range 20–78 years, mean 50 ± 12.6 SD) in our prospective study, presenting with variable clinical breast complaints, all scoring BIRADS 4/5 on sonomammography (SM). They underwent axillary evaluation by both US and DW-MRI where US classified nodes into benign, indeterminate, or malignant by evaluating nodal size, shape, cortical thickness, and hilar fat. Qualitative DWI classified them into either restricted or not and a cut-off apparent diffusion coefficient (ADC) value was calculated to differentiate benign and malignant nodal involvement. Results for each modality were correlated to those of final histopathology, which served as the standard of reference.ResultsThe calculated sensitivity, specificity, accuracy, PPV, and NPV for US was 100%, 36.6%, 75.3%, 71.2%, and 100%, respectively. Statistical indices for qualitative DWI were 76.6%, 63.3%, 76.6%, 63.3%, and 71.4%, respectively (P value < 0.001). The calculated cut off value for ADC between infiltrated and non-infiltrated nodes was 0.95 × 10−3 mm2/s concluding statistical indices of 76.6%, 63.3%, 76.6%, 63.3%, and 71.4%, respectively (P value < 0.001).ConclusionCombining DW-MRI to conventional US improves diagnostic specificity and overall accuracy of preoperative axillary evaluation of patients with recently discovered breast cancer.

Gynaecomastia: when and why to refer to specialist care.

Gynaecomastia is the commonest male breast complaint. Most cases are benign but the condition may signify a serious underlying illness. The challenge in primary care is to identify which patients with gynaecomastia are at greatest risk of pathological aetiology, so that they may be offered prompt specialty-appropriate referral and treatment. This article offers guidance on the assessment and management of patients with gynaecomastia, including when and why to refer to secondary care. Gynaecomastia refers to the enlargement of male glandular breast tissue. The condition develops because of an imbalance in the male oestrogen:testosterone ratio from a relative oestrogen excess or testosterone deficiency. Pseudo-gynaecomastia is caused by an excess of adipose tissue and does not warrant investigation or treatment. Gynaecomastia is frequently observed in general practice. Prevalence is between 35%–65% in males aged 50–69 years in the UK.1 Patients typically describe a soft swelling in one or usually both breasts. Tenderness, social embarrassment, or worry about cancer are typical reasons for presentation to primary care. Other men are asymptomatic and gynaecomastia may be noted incidentally on physical examination of the chest. Physiological gynaecomastia is common in newborns, adolescence, and senility. Most do not require investigation or referral. Neonatal gynaecomastia arises from the placental transfer of oestrogen. Over half of all adolescent boys will experience transient gynaecomastia during puberty due to a lag in testosterone secretion, with median age of onset at 14 years.2 Physiological gynaecomastia is common among males aged >50 years as testosterone levels fall with increasing age. Adult gynaecomastia is most commonly idiopathic (Figure 1). Male …

Profiles of Breast Diseases among Women Seeking for Treatment during Covid-19 Pandemic at Surgery OPD of Medical University of Bangladesh

Background: Different pathology of breast is found among the women.&#x0D; Objective: The purpose of the present study was to see the profiles of breast disease among women seeking for treatment during Covid-19 pandemic at the OPD of medical university of Bangladesh.&#x0D; Methodology: This descriptive cross-sectional study was conducted in the Department of Surgery at Bangabandhu Shiekh Mujib Medical University, Dhaka, Bangladesh from 1 April to 31 October 2020 for a period of six months. All the women who were attended at the OPD of the Department of Surgery with the different complaints of breast at any age were selected as study population. The different disease profiles were recorded in the data sheet.&#x0D; Result: A total number of 1625 women were recruited for this study. The mean age with standard deviation of the study population was 36.4±12.54 years. Among 1492 women the most common breast complaints was mastalgia which was 492(29.9%) cases followed by fibrocystic disease, breast lump, fibroadenoma and carcinoma breast which was 296(18.0%) cases, 202(12.3%) cases, 141(8.6%) cases and 84(5.1%) cases respectively. Similarly duct ectasia, fibroadenoma, fibrocystic disease and lipoma were also most common among the less than or equal to 45 years age group of women which were 47(94.0%) cases, 137(97.2%) cases, 269(90.9%) cases and 75(51.4%) cases respectively.&#x0D; Conclusion: In conclusion breast lump and fibrocystic disease are the most common diseases among the women attending during covid19 era.&#x0D; Journal of Current and Advance Medical Research, January 2021;8(1):3-6

Point-of-care Ultrasound to Evaluate Breast Pathology in the Emergency Department.

IntroductionAs physician-performed point-of-care ultrasound (POCUS) becomes more prevalent in the evaluation of patients presenting with various complaints in the emergency department (ED), one application that is significantly less used is breast ultrasound. This study evaluates the utility of POCUS for the assessment of patients with breast complaints who present to the ED and the impact of POCUS on medical decision-making and patient management in the ED.MethodsThis was a retrospective review of ED patients presenting with breast symptoms who received a POCUS examination. An ED POCUS database was reviewed for breast POCUS examinations. We then reviewed electronic health records for demographic characteristics, history, physical examination findings, ED course, additional imaging studies, and impact of the POCUS study on patient care and disposition.ResultsWe included a total of 40 subjects (36 females, 4 males) in the final analysis. Most common presenting symptoms were breast pain (57.5%) and a palpable mass (37.5%). “Cobblestoning,” ie, dense bumpy appearance, was the most common finding on breast POCUS, seen in 50% of the patients. Simple fluid collections were found in 37.5% of patients.ConclusionOur study findings illustrate the utility of POCUS in the evaluation of a variety of breast complaints in the ED.

Breast complaints in children and the effect of family history.

To evaluate the correlation of physical examination, and radiological and pathological findings of children and adolescents with breast-related complaints. Children and adolescents with breast complaints between January 2016 and December 2019 were analyzed retrospectively. A total of 118 children and adolescent patients were included. Their ages ranged from 12 to 18years (median, 16years). Twenty-one patients had a family history of breast cancer (17.8%). The most common complaints were pain, mass, and nipple discharge. Physical examination revealed mass (41.5%), tenderness (11%), and fullness (8.5%). Thirty-nine patients were classified ultrasonographically with Breast Imaging Reporting and Data System (BIRADS) 3 (39.4%) and four patients were BIRADS 4 (4%). Excision was applied to all patients with BIRADS 4, and 13 of 39 patients with BIRADS 3. Pathological diagnoses of the patients with BIRADS 3 were fibroadenoma (n: 12, 92.3%) and benign phyllodes tumor (n: 1, 7.7%). In patients with BIRADS 4, three patients had fiboradenomas and one patient had a benign phyllodes tumor. No recurrence was observed in any patients who had an excision. Only six of the patients with positive family history had BIRADS 3 lesions, and the others were BIRADS 1. Excision was recommended in two patients and the pathological diagnoses were fibroadenoma. In this age group, the most common complaints were pain and mass, while physical examination was normal in nearly half of the patients. All of the pathological diagnoses were benign. While evaluating the patients in this age range, the experience of the clinician and radiologist is important and we think that it is necessary to increase the awareness of the patient and family about physiological breast development and self-breast examination.

Surgical Triage of Breast Disorders During the COVID-19 Pandemic: An Indian Perspective.

Breast complaints are a very common cause of healthcare visits in the female population. They range in severity from benign to malignant, and treatment options vary from simple observation to mastectomy. As healthcare facilities are overburdened with coronavirus disease 2019 (COVID-19) patients, properly triaging patients diagnosed with breast disorders is necessary for the optimal use of limited resources in developing countries. We are proposing a concise triage system for timely intervention among patients with breast disorders during the havoc of the COVID-19 pandemic.

384 Poster - Patients’ experience with mammography and attitude towards targeted breast ultrasound as initial imaging technique for the evaluation of focal breast complaints

Background: Mammography is historically used as the initial imaging technique for women with focal breast complaints that visit a hospital’s radiology department. However, the value of mammography in this setting is questionable, as according to most guidelines, regardless of the outcome of the mammogram, ultrasound will follow. This study focuses on patients’ experience with mammography and on their opinion on performing a breast ultrasound only for the assessment of their complaints.

Prevalence of Breast Complaints in Women with Mastopathy in Khorramabad

Background: Evaluation and screening of breast cancer demand significant primary care practice. Breast pain and nipple discharge are the frequent complaints owing to the benign conditions. Objective: In this study, we have investigated the prevalence of breast complaints among women referred to our clinic in Khorramabad, Iran. Methods: This is a cross-sectional study about the prevalence of breast-related complaints in women with breast problems referred to surgery clinic over a period 6 months. Results: Among 151 patients, following outcomes were seen; breast pain (60.3%), lump (27.8%), nipple discharge (4%), lump with pain (4.6%) and other (0.7%). 11 patients were presented lump malignancy (23.9%) including; fibrocystic change (56.5%) and fibro-adenoma (19.6%). Conclusion: This study showed that breast pain was the most common of all complaints and fibrocystic change was the most detected lump-type. Lumps were frequent in single women whereas, mastalgia in common in married women.