Diagnosis Of Palpable Breast Masses Research Articles

The Correlation of Sonographic and Histopathologic Findings in the Diagnosis of Palpable Breast Masses in Zaria.

Presently, histology is the gold standard in definite diagnosis of breast masses. Ultrasound is a relatively cheap, non-invasive, and non-ionizing imaging modality which is widely available in most hospitals. An assessment of its accuracy in diagnosing breast masses is necessary to minimize unwarranted biopsies. This study aims to correlate the ultrasonographic and histopathologic findings in the diagnosis of patients with palpable breast masses. This was a cross-sectional hospital-based study, which involved 100 consecutive patients who presented with palpable breast masses in Zaria. This was carried out for a period of 7 months (November 2016-June 2017). They had a clinical breast examination to identify the mass, which was then imaged and biopsied via ultrasound-guided fine needle aspiration cytology. The generated data were analysed using SPSS version 23.0 (Chicago, IL, USA). There were more benign masses (63%) than malignant masses (29%). On correlating the final diagnosis of ultrasound to that of histology, it was found to have a sensitivity of 89%; specificity of 94%; positive predictive value of 89%; negative predictive value of 94%; and accuracy of 92%. This study shows that there was a correlation between ultrasound and histology findings in differentiating between benign and malignant masses. This proves that ultrasound has a significant role to play in evaluating and diagnosing clinically palpable breast masses.

FNAC OF BREAST LUMP WITH HISTOPATHOLOGICAL CORRELATION

Introduction – FNAC has become increasingly popular in diagnosis of palpable breast masses. As it is sensitive, specific, economical and safe for screening of breast lesions Aims and objectives – to determine the histopathologic correlation of FNAC of breast lumps seen in department of pathology, Govt medical college, siddipet. Methods – 2 yrs. retrospective study if breast lumps , with all patients who had FNAC, with subsequent histopathological confirmation over the period July 2018 –July 2020. A total 232 cases included in which 187 cases are subjected to excision biopsy or mastectomy Results –2 yrs. under review (2018-2020) a total of 232 FNAC of breast lump were done. 197 (84.9%) benign cases, 13(11.6%) malignant cases, 8 (3.5%) inflammatory cases were diagnosed cytologically in which 98(42.24%) cases are fibro adenoma, 27(11.6%) are malignant cases and suspicious of malignancy, 26(11.2%) of gynecomastia, 23(9.91%) of fibrocystic disease with female predominance of 8:1 ratio (206:26). Age ranging from 9 yrs. – 85 yrs. with mean age of 47yrs ± 14.2 yrs. Conclusion – we therefore concluded that FNAC is a reliable diagnostic tool of breast lump in our hospital. FNAC guides the surgeons for further plan of management.

Accuracy of clinical and ultrasound examination of palpable breast lesions in a resource-poor society

Background: Palpable breast masses are common presentations in resource-poor societies. Clinical and ultrasonographic breast examinations are commonly available means of evaluation. Objective: The objective of this study was to compare the accuracy of clinical breast examination (CBE) and ultrasonography in the diagnosis of palpable breast masses. Methodology: Consenting females presenting with palpable breast masses at the general surgical outpatient clinic were assessed clinically by the most senior surgeon, ultrasonographically by two radiologists, and the diagnosis compared with histologic examination. Results: One hundred and thirteen patients were recruited during the study period from January 2013 to April 2014. Of these, 53 patients (46.9%) had breast core biopsy, while 60 (53.1%) had open surgical biopsy. Only 67 (59.3%) patients had their histological results available. The mean age was 41.58 years (range 16–78). CBE achieved a sensitivity of 82.1%, specificity 67.9%, positive predictive value (PPV) 78%, negative predictive value 73%, overall accuracy 76.1%, false positive rate 32.1%, and false negative rate 17.9%. Breast ultrasonography had a sensitivity of 86.8%, specificity 72.4%, PPV 80.5%, negative predictive value 80.8%, overall accuracy 80.6%, false positive rate 27.6%, and false negative rate 13.2%. Conclusion: This study revealed no statistical significant difference between the accuracy of CBE and breast ultrasonography. We recommend that both should be used in the evaluation of palpable breast masses.

Correlative study of FNAC and histopathology for breast lesions

Introduction: Fine needle aspiration cytology has become increasingly popular in diagnosis of palpable breast masses as it is sensitive, specific, expedient, economical and safe for screening of breast lesions. It has high sensitivity and specificity. The aim of the study was to categorize breast lesions and correlate the fine needle aspiration cytology diagnosis with histo-pathological findings. Methods: A Two years study was carried out on female and male patients with age 10-72, who visited hospital with complaint of breast lump, pain in the breast or discharge from the nipple. Results: Tumors on right breast is higher in percentage (54%) and 66% of tumors are less than 6 cm in size. Two cases, which found to be malignant with FNAC have become benign in biopsy test. Conclusion: The current study initiated to find the effectiveness of this technique and compared with biopsy methods.

Advancements in Imaging Technology for Detection and Diagnosis of Palpable Breast Masses

Breast cancer is the most commonly diagnosed cancer among women worldwide and the most common cause of cancer death in women. The most common presentation of breast cancer is the presence of a palpable mass, whether noted by the patient during breast self-examination or noted during clinical breast examination. There are a variety of imaging modalities now available for the evaluation of a palpable abnormality. A thorough understanding of the indications, risks, and benefits can help the clinician guide the patient through an appropriate, comprehensive imaging work up.

The role of fine needle aspiration cytology and core biopsy in the diagnosis of palpable breast masses

Background:The modern approach to palpable breast masses is to get cytopathologic diagnosis before definitive surgery. We aimed to compare fine needle aspiration cytology (FNAC) with core biopsy in histopathologic diagnosis of palpable breast masses.Materials and Methods:Data were collected on 123 women who have suspicious palpable breast masses from 2007 to 2010.Results:Of the 123 patients, core biopsies were performed on 64 patients (Group 1) and FNAC on 59 patients (Group 2). Malignancy was confirmed in 25 out of 32 clinically suspicious patients in Group 1 (78.1%), and 20 out of 21 participants in Group 2 (95.2%). Among the clinically suspicious patients, 81.8% of 33 patients in Group 1, and 90.3% of 31 patients in Group 2 were identified malignancy. Sensitivity was 100% for core biopsy and 95% for FNAC. Specificity was 100% in both procedures. False negativity rate in FNAC were 5%.Conclusion:Sensitivity and specificity showed that in the case of true histopathologic classification, core biopsy is superior to FNAC. Nevertheless, FNAC's role as a fast, simple and cheap diagnosis cannot be ignored. It is an effective diagnostic tool in most patients, in comparison to the correct and specific typing of core biopsies in benign lesions which protect patients from the open biopsy.

Diagnostic value of breast ultrasound in mammography BI-RADS 0 and clinically indeterminate or suspicious of malignancy breast lesions.

Not only that ultrasound makes the difference between cystic and solid changes in breast tissue, as it was the case at the beginning of its use, but it also makes the differential diagnosis in terms of benign-malignant. The aim of this study was to assess the role of sonography in the diagnosis of palpable breast masses according to the American College of Radiology Ultrasonographic Breast Imaging Reporting and Data System (BI-RADS) and to correlate the BI-RADS 4 and BI-RADS 5 category with pathohistological findings. A retrospective study was conducted with the breast sonograms of 30 women presented with palpable breast masses found to be mammography category BI-RADS 0 and ultrasonographic BI-RADS categories 4 and 5. The sonographic categories were correlated with pathohistological findings. Surgical biopsy in 30 masses revealed: malignancy (56.7%), fibroadenoma (26.7%), fibrocystic dysplasia with/without atypia (10/6), lipoma (3.3%) and intramammary lymph node (3.3%). Correlation between BI-RADS categories and pathohistological findings was found (P < 0.05). All BI-RADS 5 masses were malignant, while in BI-RADS 4A category fibroadenomas dominated. A total of 53.8% of all benign lesions were found in women 49 years of age or younger as compared with 35.3% of all malignancies in this group (p < 0.05). Ultrasonography BI-RADS improved classification of breast masses. The ultrasound BI-RADS 4 (A, B, C) and BI-RADS 5 lesions should be worked-up with biopsy.

The role of Tru-cut needle biopsy in the diagnosis of palpable breast masses.

Background: Breast Lump Is The Second Most Common Presenting Symptom, After Breast Pain, To The Breast Clinic. Tru-Cut Needle Biopsy Provides Enough Tissue For Histopathological Diagnosis And Is Considered A Reliable Method For Establishing Preoperative Tissue Diagnosis.&#x0D; Objectives: To Compare The Results Of Fine Needle Aspiration Cytology (FNAC), Tru-Cut Needle Biopsy With Excisional Biopsy In Detecting Breast Cancer In Palpable Breast Masses.&#x0D; Results: This Study Shows That Tru-Cut Needle Biopsy Is Superior To FNAC In Confirming Breast Cancer In Palpable Breast Masses With Suspicion Of Malignancy And It Can Give Definitive Histopathological Diagnosis Of The Lesion With Low Cost And Low Complication Rate.Patients and Methods: This Is A Prospective Study Done In Baghdad Teaching Hospital Breast Clinic From January 2009 To October 2010.It Is Conducted On 120 Females Who Presented With Palpable Breast Masses. After Detailed History And Physical Examination The Patients Were Sent For Ultrasound Examination And/Or Mammography And Then Both FNAC And Tru-Cut Needle Biopsy Were Performed In An Outpatient Setting Followed By Excisional Biopsy.&#x0D; Conclusion: Tru-Cut Needle Biopsy Is Superior To Fine Needle Aspiration Cytology In The Detection Of Breast Cancer In Palpable Breast Masses With Low Cost And Low Complication Rate.

دور إبرة القطع النسيجي في تشخيص كتل الثدي المشخصة بالفحص ألسريري.

دور إبرة القطع النسيجي في تشخيص كتل الثدي المشخصة بالفحص ألسريري.

Palpable discrete breast masses in young women: Two of the components of the modified triple test may be adequate

Palpable breast masses in young women, though usually benign, are a common source of anxiety. Current practice is assessment using the modified triple test (MTT). This entails clinical breast examination (CBE), ultrasound scans and cytological examination of a fine-needle aspiration biopsy specimen (FNAC). It is unclear whether it is necessary to utilise all three components in most patients. We aimed to determine the diagnostic value of the MTT for the evaluation of palpable discrete breast masses in women under 35 years of age, and to assess the performance of its components when used individually or in combinations of two. This was a cross-sectional study carried out between August 2010 and October 2010 in the breast and general surgical outpatient clinics at Kenyatta National Hospital, Nairobi, Kenya. Fifty-eight patients presenting during the study period with palpable discrete breast masses satisfying the inclusion criteria were recruited. All patients had a CBE, ultrasound scans and FNAC. A core biopsy was performed as a reference standard. Main outcome measures. The test results of the MTT and its elements (CBE, ultrasonography and FNAC) were compared with the histological findings (the reference standard). The age range of the 58 patients was 18 - 34 years (mean 25.5 years, standard deviation 5.1 years). Forty-five patients (77.6%) had concordant MTT results (agreement in all the three components). Concordant MTTs had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 100%. Sensitivity, specificity, PPV and NPV were 100%, 92.3%, 60% and 100%, respectively, for CBE; 100%, 94.2%, 66.7% and 100%, respectively, for ultrasonography; and 100%, 98.1%, 83.3% and 100%, respectively, for FNAC. The combinations CBE plus ultrasound and CBE plus FNAC had sensitivities, specificities, PPVs and NPVs of 100%. Use of the MTT for diagnosis of palpable breast masses in young women (

How accurate is ultrasound in evaluating palpable breast masses?

Breast masses have become common in women. Such masses pose a potential threat to women especially in the era of increased cases of breast cancer worldwide. Breast carcinoma ranks first among the malignant tumors affecting females in many parts of the world with the rate of breast cancer being 1 in 8 in USA. There are currently more than 600 000 cancer deaths annually in Africa. By 2020, 70% of the 15 million new annual cancer cases will be in developing countries. Ultrasound is a relatively inexpensive and readily accessible imaging modality that can be utilized in the evaluation of clinically palpable breast masses. The purpose of this study was to find out the accuracy of ultrasound in the diagnosis of palpable breast masses. Eighty palpable breast masses were evaluated at ultrasound and information about the characteristic features of the masses was recorded. An impression about the diagnosis was made and results were correlated with histology findings. The overall sensitivity of ultrasound in detecting breast lumps was 92.5%. The sensitivity and specificity of ultrasound for detecting breast carcinoma was 57.1% and 62.8% respectively with a positive predictive value of 68.1%, a negative predictive value of 99.5%, a positive likelihood ratio of 39 and a negative likelihood ratio of 0.07. Ultrasound reliably differentiated cystic from solid breast masses. Ultrasound is significant in differentiating cystic from solid breast masses. Ultrasound is also important in detecting suspicious breast masses and should therefore be used in the evaluation of symptomatic breast masses.

Radiological evaluation of palpable breast masses during pregnancy and lactation

ObjectiveTo evaluate the role of different imaging modalities in the diagnosis of palpable breast masses during pregnancy and lactation. Materials and methodsForty eight patients with palpable breast masses during pregnancy and lactation were evaluated by Ultrasound. When Ultrasound revealed a benign lesion as cyst no further diagnostic evaluation was necessary. On the other hand, when Ultrasound demonstrated a suspicious lesion, mammography, MRI and or biopsy was performed. ResultsUltrasound showed a well defined lesion with the criteria of benignity categorized as BI-RADS 2 in 25 cases, 20 cases as BI-RADS 3, 2 cases as BI-RADS 4 and one as BI-RADS 5. One of the 2 cases classified as BI-RADS 4 was completely obscured on mammography. According to Goettinger score, MRI categorized 4 lesions in lactating patients as 1 intermediate and 3 suspicious. Tru-cut biopsy and US guided aspiration established the pathological diagnosis in 23 cases. ConclusionThe majority of pregnancy-associated breast masses are benign; still, a thorough evaluation of any lesion is required, in order to rule out malignancy. US constitutes the most appropriate radiologic method for evaluating breast disorders in women during pregnancy and lactation. US has a greater sensitivity than mammography in this issue. MRI is not recommended during pregnancy and shows limitation in the lactating period. MRI breast should be used for undetermined cases and for staging malignancy. When the imaging results are suspicious and for grading malignancy, biopsy should be performed to obtain a pathologic diagnosis.

Diagnosis of Palpable Breast Masses: Ultrasound-Guided Large Core Biopsy in a Multidisciplinary Setting

Cytologic diagnosis of palpable breast masses is an accepted method for diagnosis. However, the high nondiagnostic rate causes repeat biopsy, unnecessary delays, and increased costs. Our purpose is to evaluate the use of ultrasound (US)-guided large-core needle biopsy as part of the minimally invasive multidisciplinary diagnosis of palpable breast masses. We studied 502 consecutive patients with 510 palpable solid breast masses seen and evaluated by a multidisciplinary team. Patients had US-guided core biopsy. Clinical-imaging-pathologic correlation (CIPC) was done in all cases. Core biopsy was deemed conclusive if CIPC was congruent and was used to guide definitive management. The median age of our patients was 39 years. Median tumor size was 2.2 cm. Of these cases, 463 (91%) had a conclusive diagnosis on CIPC. Core needle findings on 47 masses were nondefinitive to guide therapy (fibroepithelial lesion, atypical ductal hyperplasia, intraductal papilloma, CIPC). Three cancers were detected in this group on excisional biopsy. In conclusion, US-guided large-core needle biopsy is a sensitive method for diagnosis of palpable breast masses. Multidisciplinary correlation of clinical findings, imaging, and pathology is essential for success. This approach improves use of operating room resources and maximizes patient participation in the decision-making process.

Management of Breast Masses Detected only by Ultrasonography

Purpose: Whether they are mammographically visible or not, breast ultrasonography is widely used for differential diagnosis of palpable breast masses. The aim of this study is to evaluate the usefulness of cytological examinations and ultrasonographical follow-ups in the management of non-palpable, mammographically non-visible breast masses incidentally detected only by ultrasonography screening. Methods: One hundred forty-six lesions of non-palpable and mammographically non-visible, but ultrasonographically detected solid masses (sonic masses) from 120 female patients were examined at the Breast Clinic, Chungbuk National University Hospital from January, 2000, to February, 2003. We performed ultrasonogram-guided percutaneous fine-needle aspiration biopsy in all sonic masses and proceeded all sonic masses by sequential ultrasonography at 3-, 6and 12-month intervals if there was no suspicion of malignancy. Results: One hundred thirty-eight lesions (94.5%) were ultrasonographically diagnosed as benign and eight lesions (5.5%) as malignant. Eight ultrasonographically malignant lesions were all proved to be benign by cytological examinations or ultrasonogram-guided needle localization biopsies and not palpable during the follow-up period. Cytological interpretations revealed 127 lesions (87.0%) as benign, 5 lesions (3.4%) as atypical epithelial cells and 14 lesions (9.6%) as nondiagnostic. Five atypical epithelial lesions were found benign through ultrasonogram-guided needle localization biopsies or core needle biopsies in the final diagnosis. The ultrasonography was used for follow-up in all lesions. There was no evidence of malignancy in any lesion during the follow-up. Conclusion: In our study, there was no evidence of malignancy in breast sonic masses during the follow-up period. Our data showed that sequential ultrasonographical follow-up is sufficient for ultrasonographically benign sonic masses. (Journal of Korean Breast Cancer Society 2004;7:43-48)

Accuracy of the “Triple Test” in the Diagnosis of Palpable Breast Masses in Saudi Females

For patients who present to clinicians with palpable breast lesions, the triple test: (physical examination, mammography and fine-needle aspiration cytology) can be employed to provide accurate diagnosis. In this study, the sensitivity, specificity and predictive values of triple test components were studied separately and in combination. During the study period (from January 1998 to December 1999), 140 patients with palpable breast masses were subjected to all components of the triple test followed by confirmatory open biopsy. Physical examination showed 82.6% sensitivity, 97.3% specificity and 86.4% positive predictive value. Mammography showed 87.5% sensitivity, 97.3% specificity and 87.5% positive predictive value and fine-needle aspiration cytology (FNAC) showed 91.7% sensitivity, 100% specificity and 100% positive predictive value in concordant cases (elements had either all malignant or all benign results). The triple test was 100% accurate in the diagnosis of palpable breast lesions when all three elements were concordant. Based on these results, we recommend elimination of the confirmatory open biopsy, which will result in reduced expenses and morbidity compared with open biopsy.

Diagnosis of Palpable Breast Masses by the Modified Triple Test Score: A prospective study

Purpose: The modified triple test (MTT; physical examination, ultrasonography, and fine-needle aspiration cytology) for palpable breast masses yielded 100% diagnostic accuracy when all 3 components were concordant (all benign or all malignant) in our previous study. However, about 30% of cases were discordant and required open or core needle biopsy. This study is designed to evaluate the modified triple test by scoring system, based on our experience, and to develop a method to further limit the need for surgical biopsy of discordant cases. Methods: The MTT was performed in 175 palpable breast masses of 166 female patients between August 1998 and June 2001 at the Outpatient Clinic, Department of Surgery, Chungbuk National University Hospital. Each component of the MTT was assigned 1, 2, or 3 points for a benign, suspicious, or malignant result, respectively, yielding a total modified triple test score (MTTS) from 3 to 9 points, and 25 cases with 3 points of MTTS were clinically followed up without histological confirmation. Results: Among 175 cases, concordant cases were 120 (68.6%); benign cases was 66 (37.7%), and malignant cases were 54 (30.8%). Cooncordant cases had 100% of diagnostic accuracy, sensitivity, and specificity. Arnong the 25 cases of benign concordant (MTTS 3 points), no case was proved to be malignant through clinical follow-up observation. Total discordant cases were 55 (31.4%); 15 casas of 4 points (8.6%), 11 cases of 5 points (6.3%), 4 cases of 6 points (2.3%), 18 cases of 7 points. (10.3%), 7 cases of 8 points (4.0%). In each discordant group, 0 cases of 4 pain. (0%), 2 cases of 5 points (18.2%), 3 cases of 6 points (75%), 15 cases of 7 points (83.8%), and 7 cases of 8 points (100%) were proved to be malignant by histotogic confirmation. Aspiration cytology has the highest specificity and positive predictive value of the 3 MTT components. Conclusion: Palpable breast masses that score 3 or 4 points by MTTS are benign and could be clinically followed up, and masses that score 8 or 9 points are malignant and should undergo defitive therapy. Confirmatory biopsy might be appIied on only 20% of the masses the reserve MMTTS of 5, 6, and 7 points.

Accuracy of fine-needle aspiration biopsy in diagnosis of palpable breast masses: Two-year results of a university-affiliated community hospital

Fifty-eight solid breast masses in 57 patients were subjected to fine-needle aspiration biopsy, and the results of cytologic analysis and histologic diagnosis were compared. The sensitivity was 79.2%, specificity, 85.3%, and accuracy, 82.8%. These results are within the range of those in the medical literature. Fine-needle aspiration biopsy is a useful adjunct in the management of palpable breast masses in the community hospital setting. Our data, however, do not support its use alone as a screening tool. Excisional biopsy or close clinical follow-up remains essential for evaluation and management of palpable breast masses.

Cytodiagnosis and other methods of biopsy in the modern management of breast cancer.

Since 1970 fine-needle aspiration cytology for breast tumours has grown in popularity and is now routinely used in the initial diagnosis of palpable breast masses in the United States and other parts of the world. Fast staining methods of the aspirate enables reporting within 10 minutes of the aspirate being performed. Training and experience is important in obtaining satisfactory smears for diagnosis, and pitfalls are false-negative and false-positive findings, which may have dire consequences for the patient if cytological diagnosis is the final arbiter. Conditions such as benign mammary dysplasia and sclerosing adenosis are the most common sources of highly cellular smears and often show marked atypia, which makes distinction from carcinoma difficult. Also, atypical papillary formations present a diagnostic problem, and biopsy is indicated to exclude a papillary carcinoma. Fine-needle aspirations very seldom cause traumatic complications, and these are usually of a minor degree. Seeding along the needle track has occurred, but in most cases with a larger-caliber (18 s.e.g.) needle. Aspiration itself has been shown to have no effect on the survival rates in breast carcinoma. Contemporary reports show that around 90% of cases of breast cancer can be detected with confidence by means of this procedure. The reduction in scar formation facilitates future evaluation of the patient as scar tissue often interferes with the interpretation of mammograms. Cost effectiveness is evident in terms of decreased use of anaesthetics and operating time and a reduction in the use of frozen section histology by about 80%.(ABSTRACT TRUNCATED AT 250 WORDS)

Fine-needle aspiration of palpable breast masses. A program for staged implementation.

Fine-needle aspiration (FNA) can provide a morphologic diagnosis of palpable breast masses in an accurate, efficient, inexpensive, and safe manner. However, how one acquires the skill to perform the FNA and interpret the resulting smears, while protecting the patient from the risk of false-positive or false-negative results, is scarcely considered. We used a three-phase program to acquire experience with FNA while providing services for 205 patients over a 16-month period. We performed FNA sequentially in vitro, in vivo, and finally in vivo for clinical use. With available literature and this graduated implementation program, physicians totally inexperienced with FNA can achieve results similar to those of medical centers having experience with thousands of patients.