Benign Breast Disease Research Articles

Correlation of clinical features, cytological, and histopathological findings of breast lumps

Background: Breast carcinoma is the most common malignant tumor of females worldwide. Variety of breast lesions ranging from inflammatory to benign to malignancy can present as palpable breast lump. Early diagnosis and prompt treatment of this lump can prevent a significant morbidity and mortality associated with the disease. Fine needle aspiration cytology (FNAC) is simple, readily available, rapid, and accurate diagnostic tool for evaluating breast lump. Aims and Objectives: (i) Correlation of FNAC findings with histopathology (HPE) diagnosis; (ii) To evaluate clinical presentation and demographic profile of patients with breast lump. Materials and Methods: This study was carried out from June 2021 to July 2022 at C. U. Shah Medical College and Hospital, Surendranagar, in the General Surgery department along with the Pathology department. It was a prospective observational type of study which included 75 patients presented with breast lump. All the patients were evaluated clinically and then investigated by FNAC and either core biopsy or excision biopsy then sample sent to the pathology department. Results of the FNAC were categorized and correlated with HPE findings. Results: In our study, benign lesions were more common than malignant ones on FNAC. Among benign lesions, fibroadenoma was the most common (36/75 cases) lesion involving the young females (20–29 years), followed by fibrocystic disease (16/75 cases). Malignant lesions-carcinomas were found (6/75 cases) in the age group of 30–39 years. Two out of 75 cases were of phyllodes tumors, followed by other benign lesions in small numbers. Cytological findings were consistent with HPE reports in 72 cases with the sensitivity of 100% and 98.55% specificity. Conclusion: Findings of FNAC are correlated well with HPE reports which are considered the gold standard method for tissue diagnosis. In addition, FNAC is a simple, rapid, easily available, outpatient department based, and cheap procedure with high sensitivity and specificity. Hence, it can be used as an early diagnostic tool for evaluation of the patient with breast lump and ultimately will guide the clinician to determine the line of treatment.

Swiss cheese disease: A rare case of juvenile papillomatosis of the breast mimicking carcinoma in a young female

Juvenile papillomatosis is a rare benign proliferative lesion of breast seen in young females. These patients have been reported to have a strong family history for carcinoma breast. <i>It is rarely diagnosed preoperatively but has distinct histopathological features on postoperative examination. The subsequent treatment and prognosis vary accordingly.</i> Here, we report a case of a 38-year-old female who was operated with a preliminary diagnosis of Mucinous carcinoma of left breast.

Cytomorphological overview of fine-needle aspiration breast utilizing the International Academy of Cytology – Yokohama system of reporting

Background: Benign and malignant lesions of breast are one of the most common causes of palpable masses seen in women. Fine-needle aspiration cytology (FNAC) is the important modality of diagnosis of breast lumps. Previously, there were no uniform criteria for reporting breast FNAC. To overcome this problem, the newly designed system – International Academy of Cytology (IAC) – Yokohama system of reporting was implemented in 2016. The system offers a structured report to the patient. Aims and Objectives: This study aims to categorize breast FNAC according to the IAC – Yokohama system of reporting, to calculate the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of the test, and to analyze the cytomorphological spectrum of various breast lesions. Materials and Methods: A total of 210 patients presenting with breast lump in cytology section were subjected to FNAC using a 22 gauge needle under all aseptic precautions. Detailed clinical history was taken. All cytology and histopathology examination slides (wherever available) were thoroughly studied. FNAC smears were reported using IAC – Yokohama system of reporting. Results: In our study, benign category (C2) was most commonly seen in 73.33% of cases, followed by 10.48% of cases of atypical probably benign (C3), 2.38% of cases were reported as suspicious (C4), and 11.43% of cases were reported as malignant (C5). Cytohistopathological concordance was seen in 38 cases (88.4%) whereas five cases were reported as discordant. Sensitivity and specificity of the test for the diagnosis of malignancy were 81% and 100%, respectively. PPV was 100%. NPV was 90.90%. Diagnostic accuracy of the test was 93.47%. Conclusion: The newer IAC – Yokohama system of reporting of breast FNAC is simple, has clear diagnostic criteria hence boost up the confidence as well has uniformity of reporting by cytopathologist, and increases the understanding and uniformity in assessment by the attending clinician which help in improving the communication between the pathologist and the treating clinician.

Breast lesions with resistive and pulsatility index by ultrasound in region Faisalabad

Aim: Breast cancer is the second leading cause of death in women. This study sought to evaluate the role of ultrasonography in identifying benign from malignant breast tumors using the Resistive Index and Pulsatility Index values. Materials and Methods: The data were collected from 60 patients having breast cancer between the ages of 20-60 who visited the Allied Hospital for breast imaging by close-ended questionnaire. The data were analyzed by correlation with the help of SPSS V22. Results: Patients were divided into two groups; benign (35 cases) and malignant (25 cases). Fibroadenoma was the most common benign tumor while invasive ductal carcinoma was the most common malignant tumor. There was no obvious difference in the location of benign and malignant breast lesions, but the majority of lesions (40%) were located in the upper outer quadrant. After combining all benign and malignant lesions, the correlation coefficient, or r value, was 0.399 (P=0.066). The resistive index revealed 25 malignant cases (41%) and 35 benign cases (58%) which were not statistically significant (P=0.16). However, Pulsatility Index revealed 34 benign cases (57%) and 26 cancer cases (43%) which were statistically insignificant (P=0.13). However, ultrasound’s sensitivity, specificity, and positive and negative predictive values were 93.8%, 86.5%, 86.9%, and 93.8% respectively. Conclusion: This study showed that malignant lesions had higher values for the Doppler parameters (RI, PI), while benign lesions had lower values while benign lesions are more common than malignant ones. RI helps radiologists when to perform a biopsy.

A meta-analysis study to comparing MR spectroscopy and Intravoxel Incoherent motion (DWI) in the differentiation of benign and malignant breast lesions

A meta-analysis study to comparing MR spectroscopy and Intravoxel Incoherent motion (DWI) in the differentiation of benign and malignant breast lesions

Fractal Dimension Analysis of Pixel Dynamic Contrast Enhanced-Magnetic Resonance Imaging Pharmacokinetic Parameters for Discrimination of Benign and Malignant Breast Lesions

Breast cancer is the most frequent cancer in women worldwide. However, its diagnosis mostly depends on visual examination of radiologic images, leading to an overdiagnosis with substantial costs. Therefore, a quantitative approach such as dynamic contrast enhanced (DCE)-magnetic resonance imaging (MRI) through pharmacokinetic (PK) modeling is required for reliable analysis. As PK parameters lack information on parameter heterogeneity, texture-based analysis is required to quantify PK parameter heterogeneity. Therefore, this study focused on determining the usefulness of fractal dimension (FD) as a potential imaging biomarker of tumor heterogeneity for discriminating benign and malignant breast lesions. Parametric maps for PK parameters, extravasation rate of contrast agent from blood plasma to extravascular extracellular space (Ktrans) and volume fraction of extravascular extracellular space (ve), were generated for the regions of interest (ROIs) under the standard model using 18 lesions. Then, tumor ROI and pixel DCE-MRI time-course data were analyzed to extract pixel values of Ktrans and ve. For each ROI, FD values of Ktrans and ve were computed using the blanket method. The FD values of Ktrans for benign and malignant lesions varied from 2.96 to 3.49 and from 2.37 to 3.16, respectively, whereas FD values of ve for benign and malignant lesions varied from 3.01 to 5.15 and 2.42 to 3.44, respectively. There were significant differences in FD values derived from Ktrans parametric maps (P = .0053) and ve parametric maps (P = .0271) between benign and malignant lesions according to the statistical analysis. Incorporating texture heterogeneity changes in breast lesions captured by FD with quantitative DCE-MRI parameters generated under the standard model is a potential marker for prediction of malignant lesions.

Identification of Risk Factors for Mastalgia and Its Relationship with Benign or Malignant Breast Diseases.

Mastalgia is a medical condition that primarily affects women of all age groups. Affected individuals experience excruciating pain, tightness, or a burning sensation in the breast tissue. The aim of this study is to observe the clinicopathologic features of women with mastalgia and compare these features with asymptomatic cases. A total of 524 female patients who applied to the general surgery outpatient clinic were prospectively evaluated. The patients were divided into two groups. Group 1 (G1) included patients with mastalgia, while Group 2 (G2) included asymptomatic patients. The two groups were compared in terms of clinical, radiological, and pathological features. This study was conducted on 524 women, among whom the prevalence of mastalgia was found to be 61.45%. There were 322 patients in G1 and 202 patients in G2. The mean age was significantly higher in G2 compared to G1 (46.33±10.33 vs. 43.58±10.33, respectively; p=0.001). Premenopausal women rates for G1 and G2 were 73.91% and 59.4%, respectively (p=0.001). The regular exercise rate in G1 was 18.01%, while it was 25.74% in G2 (p=0.034). The past history of breast cancer rate was significantly higher in G2 than in G1 (p=0.015). The consumption of analgesics was significantly lower in G2 compared to G1 (p=0.05). Non-steroidal anti-inflammatory drugs were the most commonly used analgesic drug class in both groups, with significant intergroup differences (G1: 27.63%, G2: 19.8%, p=0.043). Screening mammography with or without ultrasound examination was performed significantly more often in G2 compared to G1 (66.33% vs. 55.27% and 82.17% vs. 72.98%, p=0.012 and p=0.016, respectively). No significant difference was found concerning the frequency of benign or malignant pathologies between the groups. Breast pain is common and should be considered physiological without other breast symptoms and after excluding non-breast causes. It is safe to provide symptom control advice and reassurance to patients who have breast pain but do not have signs or symptoms indicating a possible serious underlying condition requiring further medical intervention.

When Friend Becomes Foe: Complications of Fibroadenoma Imaging Spectrum

AbstractFibroadenoma are the most common benign breast lesions. Complications in fibroadenoma although rare in occurrence, are reported. It is important to be aware of the possible complications, both benign and malignant which may require surgical management. Commonly encountered benign complications in a fibroadenoma are infarction, rapid increase in size, and lactational changes. A common differential of a giant fibroadenoma is phyllodes tumor which has subtle imaging differences. Malignant transformation of a fibroadenoma is very rare although cases are reported (0.02%). Breast is a dynamic organ and is influenced by the hormone surges occurring typically during pregnancy and lactation, it causes changes in morphology of prior existing fibroadenoma which may mimic like a malignancy and hence knowledge of these benign complications in a fibroadenoma is also important. To identify the subtle radiologic imaging features which may suggest complication developing in a known fibroadenoma, prompting for a histopathological examination correlation. In this article, we discuss the imaging features of complications in a fibroadenoma—benign and malignant. Sinister etiology secondarily engulfing a fibroadenoma and sinister focus developing in a fibroadenoma will be discussed. Also, the benign complications in a fibroadenoma like lactational changes, spontaneous infarction within a fibroadenoma, and excessive increase in the size of fibroadenoma with degenerative changes due to the estrogen and progesterone effect which can mimic like a malignancy will be illustrated. A careful history, meticulous scanning, close monitoring, and histopathological correlation is invaluable to identify these complications in a known fibroadenoma and thus guide in the appropriate management of these lesions.

Fibrocystic disease of mammary gland in a Guinea pig: A case report

Fibrocystic disease of mammary gland in a Guinea pig: A case report

Superb Microvascular Imaging for the Differentiation of Benign and Malignant Breast Lesions: A System Review and Meta-Analysis.

To evaluate the diagnostic performance of SMI in the diagnosis of benign and malignant breast lesions. A systematic search of PubMed, EMBASE, Cochrane, OVID, SCI, and SCOPUS was performed to find relevant studies which applied SMI to differentiate benign and malignant breast lesions. All the studies were published before October 10, 2022. Only studies published in English were collected. Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was applied to assess the quality of the included studies. Summary receiver operating characteristic (SROC) modeling was also performed to the diagnostic performance of SMI in the diagnosis of benign and malignant breast lesions. Subgroup analyses and meta-regression were performed to find out the heterogeneity. Twenty studies which include a total of 2873 lesions (1748 benign and 1125 malignant) in 2740 patients were evaluated in this meta-analysis. The summary sensitivity and specificity were 0.82 (95% confidence interval [CI]: 0.76-0.86), 0.70 (95% CI: 0.64-0.76) for SMI vascular degree, 0.77 (95% CI: 0.67-0.84), 0.79 (95% CI: 0.75-0.83) for SMI vascular distribution, 0.78 (95% CI: 0.70-0.84), 0.75 (95% CI: 0.69-0.80) for SMI vascular morphology, 0.81 (95% CI: 0.72-0.87), 0.80 (95% CI: 0.75-0.85) SMI penetration vessel. For SMI overall vascular features, the summary sensitivity and summary specificity were 0.74 (95% CI: 0.61-0.84) and 0.80 (95% CI: 0.76-0.84). The result of subgroup analysis and meta-analysis showed malignant rate and country might be the cause of heterogeneity of diagnostic accuracy of vascular grade and morphology. SMI vascular features have high sensitivity and specificity in the differentiation of benign and malignant lesions. Future international multicenter studies in various regions with large sample size are required to confirm these findings.

An overview of inflammatory breast cancer

Inflammatory breast cancer is an uncommon and severe malignancy that frequently goes undiagnosed at first because it presents similarly to more benign breast diseases like mastitis, resulting in delayed treatment. Inflammatory breast cancer affects 1% to 5% of all occurrences of breast cancer and accounts for 8% to 10% of all breast cancer-related deaths. Erythema, skin abnormalities, nipple inversion, edema, and warmth of the affected breast are all signs of inflammatory breast cancer. Recognized risk factors for inflammatory breast cancer include young age at the time of diagnosis, obesity and African American ethnicity. Rapid onset within 3 months and pathologic evidence of invasive carcinoma leads to diagnosis of disease further including erythema occupying at least one-third of the breast, tumour may or may not be present in this case. Chemotherapy, surgery, and radiation make up the trimodal therapy used to treat inflammatory breast cancer. A modified radical mastectomy performed as part of an aggressive surgical strategy improves survival rates. Although patients with inflammatory breast cancer have worse outcomes than those with noninflammatory breast cancer, those who complete trimodal therapy have a positive locoregional control rate, highlighting the significance of an early diagnosis. Physicians must be aware and examine any clinical manifestation of inflammatory breast cancer if present to make a prompt diagnosis and refer patient for expert care timely also awareness and cancer screening can help in prevention of disease. The purpose of this research is to review the available information about an overview of inflammatory breast cancer.

Histopathological Characteristics of Breast Lesions in a Tertiary Health Institution in Southwest Nigeria; A 9-year Review

Background: The breast is affected by several diseases, including developmental, inflammatory, and neoplastic. While benign breast neoplasms are usually more common, breast cancer is the most common nonskin cancer and the leading cause of cancer-related deaths in women after lung cancer in the world. Objective: The review aimed to assess the histopathological diagnosis of breast lesions over a period of 9years Methods: This was a retrospective review of eight hundred and fourteen histopathologic cases of breast lesions accessed through laboratory records of all breast lesions cases seen. The demographic data were obtained and the patient’s histology slides were reviewed. The tumors were classified according to the WHO International Classification of breast tumors and Malignant breast tumors were graded according to the Nottingham grading system. Data were analyzed using SPSS version 25. Results: The majority of breast cancer cases were seen in patients below 40 years, malignant cases were predominant in older age groups (40 – 59 years; 57.4%, 60 years and above; 23.3%) and malignancy was significantly associated with age group, p-value &lt; 0.05. The prevailing neoplasm was Benign type (68.3%) while malignant neoplasm accounted for 30.2% and invasive ductal carcinoma (89.1%) was most prevalent. Moreso, the majority were in grade 2; 152 (76.8%) using the Nottigham grading system. However, the commonest benign neoplasm was fibroadenoma (53.7%) followed by fibrocystic change (20.1%). Conclusion: Breast lesions are common in this environment. Benign breast neoplasms are commoner than malignant diseases. One in three of every sub-Saharan woman diagnosed with malignant breast lesion may not survive five years post-diagnosis. The prognosis of breast malignancies in sub-Saharan is poor due to late Presentation, ignorance and poverty.

Idiopathic Granulomatous Mastitis and History of Hypothyroidism: Intervening Data of a Prospective Multicenter Trial and Meta-Analysis of the Existing Literature

Background: Idiopathic granulomatous mastitis (IGM) is a rare benign breast disease that mostly occurs in reproductive ages in parous women. Hormonal, autoimmune, and microbial causes have been implicated as causes. We carried out this prospective study to investigate the reproductive factors and underlying disease states in IGM. Methods: This study was conducted in two phases. In the first phase, we evaluated the reproductive factors, anthropometric parameters and past medical histories of participants of an ongoing multicentric clinical trial. In the second phase, we performed an extensive review of the literature for studies that had considered patients with a histologic-proven diagnosis of IGM without date limitations, and extracted the data about parity, breastfeeding, oral contraceptive pill use and past medical histories. We then carried out a meta-analysis. Results: Data of 123 patients were included. The mean age was 35.11±7.07 years, and the mean body mass index was 27.41±4.74. Overall, %93.8, 90.27% and 28.7% of patients were parous, had breastfed, and had used OCP, respectively. Hypothyroidism represented the most common (18.94%) previous medical disease. We included 89 studies in our search. Considering these studies and ours, the pooled prevalence of rates of parity, breastfeeding and oral contraceptive pill consumption were 96%, 89%, and 29%; and the pooled prevalence of hypothyroidism, diabetes and hypertension were 9%, 5% and 5%, respectively. Although not exactly comparable, these rates of hypothyroidism were higher than those reported in women in the general population (4.2% in one large study in Iran). Conclusion: Our study suggests a possible relation between a past history of hypothyroidism and IGM. We propose a study that investigates the occurrence of IGM in some large cohorts of healthy women, and the retrospective assessment of thyroid tests in the primary serum samples.

Performance of risk prediction models in breast cancer screening among women in Cyprus.

Tools that can predict breast cancer risk in women will have a significant impact on women and healthcare systems in low- and middle-income countries. We compared the performances of the Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) model, the International Breast Cancer Intervention Study (IBIS) model, and the Gail model in predicting breast cancer risk among women in Cyprus. We recruited 655 women from Dr Burhan Nalbantoglu Devlet Hastanesi Hospital in Lefkosa: 318 had breast cancer and 337 did not have breast cancer (hospital-based controls). We collected retrospective data from the hospital's medical records and interviews with the women after informed consent. Data collected included: age, age at diagnosis, age at menarche, menopausal status, presence of benign breast disease, breast cancer in relatives, BRCA-1 and BRCA-2 mutations, history of hormone replacement therapy, and breast density. We calculated the 5-year risk of breast cancer and the risk values were used to plot receiver operating curves. For the area under the curve (95% confidence interval, CI), sensitivity and specificity for the models were: BOADICEA 0.81 (95% CI: 0.77-0.84), 26.4% and 98.8%; IBIS 0.80 (95% CI: 0.77-0.84), 19.4% and 97.3%; and Gail 0.76 (95% CI: 0.73-0.80), 17.3% and 98.5%. The breast cancer risk prediction models performed similarly although on closer appraisal, the BOADICEA and IBIS models performed slightly better. These models are simple, appropriate, cost-effective, and non-invasive tools for identifying high-risk women in low- and middle-income countries who could benefit from mammography screening.

Histopathological Characteristics of Breast Lesions in a Tertiary Health Institution in Southwest Nigeria: A 9-year Review

Background: The breast is affected by several diseases, including developmental, inflammatory, and neoplastic. While benign breast neoplasms are usually more common, breast cancer is the most common nonskin cancer and the leading cause of cancer-related deaths in women after lung cancer in the world.&#x0D; Objective: The review aimed to assess the histopathological diagnosis of breast lesions over a period of 9years&#x0D; Methods: This was a retrospective review of eight hundred and fourteen histopathologic cases of breast lesions accessed through laboratory records of all breast lesions cases seen. The demographic data were obtained and the patient’s histology slides were reviewed. The tumors were classified according to the WHO International Classification of breast tumors and Malignant breast tumors were graded according to the Nottingham grading system. Data were analyzed using SPSS version 25.&#x0D; Results: The majority of breast cancer cases were seen in patients below 40 years, malignant cases were predominant in older age groups (40 – 59 years; 57.4%, 60 years and above; 23.3%) and malignancy was significantly associated with age group, p-value &lt; 0.05. The prevailing neoplasm was Benign type (68.3%) while malignant neoplasm accounted for 30.2% and invasive ductal carcinoma (89.1%) was most prevalent. Moreso, the majority were in grade 2; 152 (76.8%) using the Nottigham grading system. However, the commonest benign neoplasm was fibroadenoma (53.7%) followed by fibrocystic change (20.1%).&#x0D; Conclusion: Breast lesions are common in this environment. Benign breast neoplasms are more commoner than malignant diseases. One in three of every sub-Saharan woman diagnosed with malignant breast lesion may not survive five years post-diagnosis. The prognosis of breast malignancies in sub-Saharan is poor due to late Presentation, ignorance, and poverty.

Implementation of Non-Invasive Quantitative Ultrasound in Clinical Cancer Imaging.

Quantitative ultrasound (QUS) is a non-invasive novel technique that allows treatment response monitoring. Studies have shown that QUS backscatter variables strongly correlate with changes observed microscopically. Increases in cell death result in significant alterations in ultrasound backscatter parameters. In particular, the parameters related to scatterer size and scatterer concentration tend to increase in relation to cell death. The use of QUS in monitoring tumor response has been discussed in several preclinical and clinical studies. Most of the preclinical studies have utilized QUS for evaluating cell death response by differentiating between viable cells and dead cells. In addition, clinical studies have incorporated QUS mostly for tissue characterization, including classifying benign versus malignant breast lesions, as well as responder versus non-responder patients. In this review, we highlight some of the important findings of previous preclinical and clinical studies and expand the applicability and therapeutic benefits of QUS in clinical settings. We summarized some recent clinical research advances in ultrasound-based radiomics analysis for monitoring and predicting treatment response and characterizing benign and malignant breast lesions. We also discuss current challenges, limitations, and future prospects of QUS-radiomics.

Differentiation of benign and malignant breast lesions using diffusion-weighted imaging with a fractional-order calculus model

PurposeTo assess the feasibility of using three diffusion parameters (D, β, and μ) derived from fractional-order calculus (FROC) diffusion model for improving the differentiation between benign and malignant breast lesions. MethodIn this prospective study, 103 patients with breast lesions were enrolled. All subjects underwent diffusion-weighted imaging (DWI) with 12b values. Inter-observer agreement with respect to quantification of parameters by two radiologists was assessed using intraclass coefficient. Conventional apparent diffusion coefficient (ADC) and three FROC model parameters D, β, and μ were compared between the benign lesion and malignant lesion groups using the Mann-Whitney U test. Then, a comprehensive prediction model was created by using binary logistic regression. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of the parameters using histopathological diagnosis as the reference standard. ResultsThe FROC parameters and ADC all exhibited significant differences between benign lesions and malignant lesions (P＜0.001). Among the individual parameters, the sensitivity of μ was higher than ADC (95.92% for μ vs 91.84% for ADC), and the specificity of β was higher than ADC (72.22% for β vs 70.37% for ADC). The combination of ADC and FROC parameters (D and β) generated the largest area under the ROC curve (0.841) when compared with individual parameters, indicating an improved performance for differentiating benign lesions from malignant lesions. ConclusionsThis study demonstrated the feasibility of using the FROC diffusion model to improve the accuracy of identifying malignant breast lesions.

Сlinical patterns of a malignant phyllodes tumor: a case report

Phyllodes (phylloides) tumors of the breast are uncommon neoplasms accounting for not more than 1 % of all breast tumors. The disease occurs in women of any age, more often at 40–50 years. At early stage, the disease has no specific clinical symptoms or diagnostic signs. In particular, according to Wang Sh. (2017), the clinical diagnosis can be made in some cases only based on the histological examination of the excised material. We present our case report of a malignant phyllodes tumor.A 50-year-old patient had been diagnosed with fibrocystic breast disease (FBD) in 2014. The patient was followed up for a long time, during which the disease was stable. A scheduled examination revealed an irregular lesion in the right breast consistent with fibroadenoma based on cytology findings. The mass had enlarged 4 times over 2 years of follow-up. The biopsy results showed a phyllodes tumor without signs of malignant growth.Conclusion. Women presenting with a breast mass lesion require a multidisciplinary approach for treatment decision. Core needle biopsy with histological and immunohistochemical analyses is the method of choice for the morphological diagnosis of large, rapidly growing tumors. A proper diagnostic tool enables early diagnosis.

Estrogen-DNA Adducts and Breast Cancer Risk in Premenopausal Asian Women.

This study provides evidence that endogenous estrogen-induced genotoxicity may contribute to the carcinogenesis of breast cancer in premenopausal Asian women. This work could have important preventive implication for the emerging disease in East Asia.

Tubular Adenomas of the Breast Are Cytologically Distinct from Fibroadenomas

Introduction: Increasing molecular evidence indicates that tubular adenoma of the breast is distinct from fibroepithelial lesions, leading to its reclassification as an epithelial tumor in the 5th World Health Organization classification of tumors of the breast. However, tubular adenoma remains poorly characterized on fine-needle aspiration cytology (FNAC) and often not distinguished from fibroadenomas. In this study, the largest cohort, to date, of histologically confirmed aspirates of tubular adenomas were reviewed and compared with aspirates of fibroadenomas. Findings from this study further define the cytological features of tubular adenoma and allow differentiation from fibroadenoma. Methodology: Aspirates of histologically confirmed tubular adenomas were reviewed for features of the background, myoepithelial, epithelial, and stromal components and then compared to a cohort of aspirates of fibroadenomas. Results: Totally, 43 (tubular adenoma) and 94 (fibroadenoma) aspirates were included. Tubular adenomas displayed moderate epithelial cellularity with high cohesiveness, with stromal fragments containing epithelium. Tubules are more common in tubular adenomas (p = 0.009) and “tubular fragments” (tissue fragments containing multiple tubular structures with/without stroma) is a pathognomonic feature of tubular adenoma (p < 0.001). Calcification and fibrocystic changes were variably seen (4.65–13.5%) but without difference to fibroadenomas (p > 0.05). Cytomorphologically malignant features and mitoses were absent in all aspirates of tubular adenoma. Presence of tubules and stromal fragments were independent factors associated with tubular adenomas, whereas a predominance of large epithelial fragments and naked stromal fragments were associated with fibroadenomas. Conclusion: Tubular adenomas are not only histologically and molecularly separate from fibroepithelial lesions but also a distinct entity on FNAC.