Malignant Breast Lumps Research Articles

Ultrasound-Guided Core Biopsy of Breast Lesions in a Resource Limited Setting: Initial Experience of a Multidisciplinary Team

There is increasing tendency to multidisciplinary care of patients with of breast lesions. This study sought to evaluate the initial experience of the diagnostic arm of a new breast program in a resource limited setting. In 2015, we commenced the pilot phase of an IRB-approved breast care protocol. As part of the protocol's diagnostic arm, an ultrasound-guided breast core biopsy training was implemented. Eligible patients were clinically evaluated and underwent CNB using 16G needle under US guidance. The procedure was rated by the participants and histopathological results compared with surgical specimens. Eighty six participants (18.22%) with 113 palpable breast lesions completed the study. The diagnostic accuracy, sensitivity, and specificity were 94.44%, 92.86%, and 95.83% respectively. Unweighted kappa-coefficient (k) agreement between histopathology of core biopsy and surgically excised specimens, were 0.798 (95% CI of 0.69 - 0.90) and 0.801 (95% CI of 0.71-0.92) for benign and malignant breast lumps respectively. The procedure was well accepted and all the patients were willing to accept a repeat CNB and would recommend it. Despite the prevailing challenges, co-ordinated team diagnosis is feasible and may result in the modest improvement in the diagnostic accuracy of breast lesions and patient satisfaction.

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

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

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

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

The Role of Fine Needle Aspiration Cytology in Triple Assessment of Patients with Malignant Breast Lumps.

Background:Breast cancer is the leading female malignancy in the world and now the most common cancer in Nigeria. The evaluation of patients with breast cancer requires stepwise diagnostic approach to achieve a combined diagnostic information required to make an enhanced decision on how best to approach management. The aim of this study is to evaluate the role of fine needle aspiration cytology (FNAC) in the triple assessment of patients with malignant breast lumps in our center.Patients and Methods:This is a descriptive prospective study of patients with palpable breast lumps over an eighteen-month period. The patients were sequentially subjected to FNAC and open biopsy. Those whose lumps were malignant were further evaluated.Results:There were 88 (44.9%) and 108 (55.1%) biopsy confirmed breast cancers and benign lumps, respectively. From cytology reports, there were 12 (6.1%) unsatisfactory (C1), 96 (49%) benign (C2), 8 (4.1%) atypical (C3), 10 (5.1%) suspicious of malignancy and 70 (35.7%) unequivocally malignant (C5) smears. FNAC performed better than clinical examination in the validity tests for breast malignancy. The diagnostic results for breast malignancies were 97.2% (sensitivity), 98.9% (specificity), 1.4% (false positive rate []), 2.1% (false negative rate), 98.6% (positive predictive value), 97.9% (negative predictive value), and overall diagnostic accuracy of 98.2%.Conclusion:Considering the high performance of diagnostic cytology noted above, FNAC has proved itself to be useful and significantly accurate in making diagnosis of breast cancers in our center.

Augmentation of Classifier Accuracy through Implication of Feature Selection for Breast Cancer Prediction

Breast Cancer Examination and Prediction are great provocations to the researchers in the medical applications. Breast Cancer Examination distinguishes benign from malignant breast lumps, Breast Cancer Prediction has great deal in foretelling when Breast Cancer is expected to reoccur in patients that have had their cancers excised. Feature Selection is considered to be the preliminary step used in process to find best subsets of attributes. In this paper authors confer about the performance of five classifiers Sequential minimal optimization (SMO), Multilayer Perceptrons, Kstar, Decision Table and Random Forest with and without feature selection. The results manifest that after implying two feature selection techniques such as Correlation based and information based with ranker algorithm there is an augmentation in the accuracy rate of the classifier. It has been observed that after through implication feature selection techniques accuracy of the classifiers such as SMO, Multilayer Perceptrons, Kstar, Decision Trees, and Random Forest are enhanced.

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

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

The accuracy of fine needle aspiration biopsy to diagnose breast neoplasm

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

The comparison between cytological and histological grading of breast cancers in a Nigerian tertiary hospital

Background: Breast cancer is one of the most common cancers in Nigeria. The tumour grade is an important prognostic factor and is also important in treatment of patients. Fine needle aspiration cytology can be used as an initial diagnostic tool for planning definitive management. Grading of tumours on cytology further guides therapeutic decisions. The aim of this study is to compare the correlation between the cytological and histological grading of malignant breast lumps using the Robinson's cytological grading system and Nottingham histological grading system respectively. The Objectives are, to determine the age distribution of breast cancer in our environment, to grade breast cancers cytologically using the Robinson's cytological grading system and to grade breast cancers histologically using the Nottingham histological grading system. Methods: This was a one year prospective study that involved 30 patients who had malignant smears on fine needle aspiration cytology of their breast lump. These smears were graded using the Robinson's cytological grading system and compared with the Nottingham histological grading systems of same lumps obtained from either tissue biopsies or mastectomies. Results: The mean age of the study participants was 50.23±10.11 years with a range of 35-70 years. Most (56.7%) malignat smears were of cytologic grade 3. The histological grade was 2 in 16(53.3%) and 3 in 14(46.7%) of the same breast tissue samples. The grade 2 tumours had the highest concordance rate of 83.3%. The absolute concordance rate between Robinson's cytological and Nottingham histological grading system of breast cancers was 73.3%. Conclusion: The Robinson's cytological and Nottingham histological grading systems showed good correlation. Keywords: Breast Cancer, fine needle aspiration cytology, cytological grading, histological grading

Triple Diagnostic Accuracy on Early Stage Breast Cancer at Cipto Mangunkusumo Hospital and Persahabatan Hospital

Introduction. Breast cancer is the most common cancer in Indonesia with incidence rate 40.3 per 100.000 women and mortality rate 16.6 per 100.000 women. On early stage, the decision for operative procedure (i.e. mastectomy) requires intraoperative frozen section to assess malignancy; which is mostly unavailable in secondary hospitals. The triple diagnostic (TD) test consists of physical examination, breast ultrasonography and fine needle aspiration biopsy is an accurate and simple preoperative diagnostic method that may solve the problem. The study aimed to find out conformance of the triple diagnostic to histopathology findings in those with breast lump where the malignancy was suspected. Method. A study of diagnostic accuracy conducted enrolling subjects with suspected malignant breast lump managed in dr Cipto Mangunkusumo General Hospital (RSCM) and Persahabatan Hospital (RSP) in period of February 2016 to August 2017 who met the criteria: those underwent preoperative triple diagnostic, intraoperative frozen section and histopathology examination. The conformance of TD and frozen section were compared to histopathology findings. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were the focuses of the study. Results. There were 33 subjects enrolled (prevalence of 4.3%), mean age of 49.6 years ± 10.9, were above 40 years (78.8%). Tumor size of 2–5 cm found in 63.6% subjects, and the most histopathology finding was invasive carcinoma (84.8%). Frozen section showed sensitivity of 96.8%, specificity of 100%, PPV of 100%, NPV of 66.7% and accuracy of 97.0%. TD showed sensitivity of 77.4%, specificity of 100%, PPV of 100%), NPV of 22.2% and accuracy of 78.8% (p = 0.016). Conclusion. Triple diagnostic reaches up to 78% accuracy on early stage breast cancer may be used secondary hospital in Indonesia whenever frozen section is unavailable

Comparative study of fine needle aspiration cytology, trucut biopsy and final histopathological examination in breast lumps

Background: A lump in the breast results in anxiety for the patient and her family whether benign or malignant. Histological tissue diagnosis is a universally accepted means of definitive diagnosis of a breast lump. FNAC gives a rapid diagnosis and can be carried out in outpatient services with minimal trauma. Hence FNAC is gaining wide acceptance. Trucut biopsy is a safe method for a histological diagnosis, in operable breast cancer cases and a reliable technique to assess hormone receptor status. The trucut needle is a very handy instrument and it is now replacing the incision or excision biopsy. Aim: To find out the diagnostic accuracy of FNAC and trucut biopsy as compared to the final histopathological report in breast lumps. To compare diagnostic accuracy of FNAC and trucut biopsy in differentiating the benign and malignant lesions of palpable breast lumps. Methodology: This is a prospective study which included 70 patients having breast lump were subjected to FNAC and Trucut biopsy in Victoria hospital, Bangalore between October1, 2015 to September30, 2016 and were compared to final tissue diagnosis after subsequent admission and treatment. Various factors like age, size, duration, marital status, menstrual status and site were studied during statistical analysis. Results: There were 70 patients who presented with breast lump during the study period. Out of a total 70 breast lump study, final diagnosis was 36 benign breast lump and 34 malignant breast lumps. Sensitivity of FNAC and TRUCUT biopsy were 86.84% and 97.14% respectively. While TRUCUT was more accurate when compared to FNAC.

Clinical study of co-relation between positive axillary lymph node status and size of the tumor in breast malignancies

Background: Breast lump in women is a common clinical condition encountered in day-to-day surgical practice and needs thorough evaluation. This study is focused on co-relation between axillary lymph nodal status and the size of the breast tumor through clinical, radioimaging, and pathological studies. The axillary lymph node study also helps to differentiate benign from malignant breast lumps. Patients and Methods: This study was carried out in the Department of Surgery, Great Eastern Medical School (GEMS) Hospital, Ragolu, Srikakulam, Andhra Pradesh, India. A total of 45 patients were selected for the study from among admitted cases to the Department of Surgery through clinical assessment, laboratory investigations, and ultrasound findings. After confirming the diagnosis of breast malignancy by fine needle aspiration cytology and Trucut biopsy in few cases, the patient had undergone operative intervention. Later, the specimens were sent for histopathological study. Results: Breast malignancy was found more commonly among female patients of 45–64 years of age with an incidence of 66% in present studies. Lump in the breast was the common presenting feature in all patients. Ultrasound findings and Trucut biopsy have shown high sensitivity and specificity up to 97–99%. Conclusion: The present study concludes that for the tumor size <10 mm, axillary lymph node dissection may not be needed. Larger the size of the tumor, the more probability of lymph nodal metastasis.

Triple approach for diagnosing breast lesions-experience at a Tertiary Care Hospital

Background: Breast lesions are always a diagnostic challenge and range from benign to malignant. Fine-Needle Aspiration Cytology (FNAC) is done in patients with breast lesions. However, to get an accurate and diagnostic yield is difficult at times. Aims: The aim of this study is to highlight the role of triple approach in diagnosing breast lesions. Design and Setting: This is an observational prospective study carried out in the Department of Pathology at a tertiary care hospital over 2 years. Materials and Methods: One hundred and fifty cases of breast lump were studied. Clinical findings, imaging findings, and cytology along with histopathological findings were correlated. Results: Cytological findings were benign in 102 out of 107 patients, who were otherwise clinically and radiologically benign. In rest five patients, Breast Imaging Reporting and Data Systems (BIRADS) BIRADS II category was given on mammography. In four of these five patients, there was cytological atypia. Biopsy in these four patients showed features of fibroadenoma with mild cytological atypia and one patient showed infiltrating duct carcinoma. Mammography was suggestive of malignant breast lump in 43 patients. In three patients, breast lump was diagnosed as benign on cytological examination. However, histopathological examination confirmed the mammography findings of malignancy. Conclusion: FNAC is a well-established procedure for diagnosing breast lesion but has got many pitfalls. Hence for diagnosis a breast lesion, the triple approach consisting of histopathological examination in addition to mammography and FNAC, should be considered.

Comparison of Ultrasonography and Fine Needle Aspiration Cytology in the Diagnosis of Malignant Breast Lesions in a Rural Setup

Abstract Introduction: Breast cancer is the most common cancer diagnosed in women worldwide. These rising trends have emphasized the need of prompt detection, effective clinical evaluation, and exact diagnosis of the breast disease. Aim: To analyze and compare the sensitivity, specificity, and predictive values and accuracy of ultrasonography (USG) and fine needle aspiration cytology (FNAC) in diagnosing malignant breast lump. Materials and methods: A cross-sectional, prospective study was done. One hundred sixteen female patients attending surgery department with breast lump were included. After complete clinical evaluation of the lump, all patients underwent USG and FNAC examination for diagnosis of the lump, and further subjected to excisional biopsy/definitive surgery, the results of which were further compared with the histopathological results to determine the accuracy, sensitivity, specificity, and predictive values of FNAC and USG. Results: Out of 116, 61 (52.58%) benign lesions were found while the remaining 55 (47.41%) resulted to be malignant lesions on histopathological examination (HPE). Ultrasonography reported 46 true positive, 60 true negative, and 4 false negative cases with 6 inconclusive reports; whereas, FNAC reported 47 true positive, 61 true negative, and 6 false negative cases with 2 inconclusive reports. There were no false positive cases detected by USG and FNAC. Thus, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy for USG was found to be 92, 100, 100, 93.75, and 96.36% (χ2-value = 94.88, p-value = 0.0001,S) and values of 88.68, 100, 100, 91.04, and 94.73% were obtained for FNAC respectively (χ2-value = 92.04, p = 0.0001,S). Conclusion: In diagnosing malignant breast lesion, USG and FNAC are 100% specific. Although USG appears more sensitive than FNAC, the percentage of indeterminate report is higher with USG.

A clinico-pathological study of malignant breast lump in a tertiary care hospital in Kosi region of Bihar, India

Background: Breast cancer has captured attention of surgeons throughout the ages with its uncertain cause. Despite centuries of meandering and scientific enquiry, breast cancer is still one of the most dreaded human diseases. The breast is a complex structure and any unnatural change affects the body and psyche of the person. The aim of this study was to observe age distribution, clinical signs and symptoms and pathology of malignant breast lump and draw a correlation between clinical and histological diagnosis of patients presenting with breast lump.Methods: Seventy six (76) cases of diagnosed malignant breast lump out of a total of 200 cases were included in this study. These cases were selected among patients visiting outdoor clinic of department of General Surgery in Katihar Medical College, Katihar. The selected cases belonged to different etiology, age group and sex.Results: Maximum number of malignant tumours was encountered in the 5th decade of age group of patients, followed by in 4th decade. All cases studied were females except 2 cases which were male. The commonest sign and symptoms of presentation was painless lump in the breast followed by painful mass in the breast along with associated features of ulceration of the skin, retraction of nipple and nipple discharge. Histologically, malignant tumours were maximally observed as infiltrating scirrhous carcinoma, followed by medullary carcinoma &amp; papillary carcinoma.Conclusions: Breast cancer is a common cancer worldwide with varied presentation. Multimodality treatment approach is required for malignant breast lump which has shown improvement in both loco regional control and survival.

Ultrasonographic Discrimination of Benign and Malignant Breast Lumps with Histopathological Correlation

Background: A lump in the breast is a cause of great concern. High frequency high resolution ultrasonogram helps in its evaluation. With major advances in ultrasonographic technology during the past 20 years, ultrasonogram can now distinguish benign and malignant solid breast lumps. Knowledge of the specific benign and malignant ultrasonographic characteristics of breast lumps is imperative for accurate diagnosis and optimal patient management.Objective: To determine the validity of ultrasound in the assessment of palpable breast lump by detecting the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of ultrasonogram in distinguishing benign and malignant breast lumps.Materials and Methods: This cross sectional study was done in the department of Radiology and Imaging of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka in collaboration with the department of Pathology of BSMMU for histopathological correlation during July 2008 to June 2009. A total of 100 patients who were clinically suspected of having breast lump were included in this study. Data on clinical presentation, ultrasonographic findings including histopathological reports were collected and documented in structured forms. Analysis was done using SPSS 13.0 version.Results: The study was done in 100 women of 18–70 years of age with mean age 41.46 ± 11.62 years. Breast lumps were found with associated clinical presentation of pain in 26 (26%) cases, discharge in 12 (12%) cases, skin changes in 28 (28%) cases, nipple retraction in 10 (10%) cases, and palpable lymph nodes in 10 (10%) cases. On ultrasonogram, lesions were diagnosed as benign in 62% cases and malignant in 38% cases. Out of sonographically diagnosed 62 benign lesions 58 (93.5%) were also proved benign histopathologically and 4 (6.5%) as malignant. Out of 38 sonographically malignant lesions, 34 (89.5%) were also proved as malignant histopathologically and 4 (10.5%) as benign.Conclusion: Ultrasonographic findings of benign and malignant breast lumps correlated well in most of the cases with the histopathological results. Therefore, it can be concluded that ultrasonogram is a useful imaging tool to discriminate benign and malignant breast lumps and thus we can reduce unnecessary breast biopsies, patient discomfort and anxiety in addition to increase in cost of the patient.J Enam Med Col 2015; 5(3): 151-156

Ultrasound elastography improves differentiation between benign and malignant breast lumps using B-mode ultrasound and color Doppler

ObjectivesTo evaluate diagnostic yield of mammography, B-mode ultrasound (US), ultrasound elastography (UE) and color Doppler used alone or in combination for differentiating breast lesions. Patients and methodsSixty women presented by breast lump underwent mammographic examination, B-mode US, color Doppler assessment and UE. The result of histopathological examination of excisional biopsy was used as gold standard for comparison of results. ResultsMammography defined 36 patients had dense glandular breast and 24 patients had fatty parenchyma. Eleven patients had dense glandular parenchyma and 7 of those had fatty parenchyma had malignant lesions. Mean resistive index for malignant lesions was significantly higher than benign lesions. The mean strain ratio was significantly higher for malignant. Combined use of US and UE provided better diagnostic yield than US and Doppler, while combined use of US, UE and Doppler improved the diagnostic yield with high sensitivity and specificity and NPV of 95%. ROC curve analysis assured the high diagnostic yield of combination of US, UE and Doppler. ConclusionCombined use of B-mode US, UE and color Doppler achieved NPV of 95% thus allowed sparing of unnecessary invasive diagnostic procedures. UE as a sole diagnostic test has high sensitivity and specificity. Mammography could be used as screening test for its high sensitivity.

CLINICAL BREAST EXAMINATION;

Objective: To determine sensitivity and specificity of standardized clinical breast examination (CBE) for benign and malignant breast lumps. Design: A prospective validation study. Place &amp; duration of study: The study was conducted at Railway hospital, Rawalpindi from September 2008 to February 2010. Patients &amp; Methods: A total of 110 female patients presenting with breast lumps were recruited in the study. All of them underwent a standardized clinical breast examination along with complete triple assessment. The sensitivity and specificity of CBE was calculated and compared with that of triple assessment in the same patient. Likelihood ratios for individual characteristics of breast lumps were also calculated. Results: Sensitivity of a structured CBE to pick up carcinoma breast in a patient with lump breast was 100% (95% CI, 0.8-1) while specificity was 94.6% (95% CI, 0.86-0.97). The likelihood ratio for carcinoma breast was 17.8 (95% CI, 7.6 - 41.7). Conclusions: The standardized CBE can differentiate between palpable benign and malignant lumps reliably. This is especially important in benign lumps where a policy of follow up clinical examination can be utilized, particularly when the investigative facilities may not be readily available.

216. Don't touch that breast: Outcome of a review of pre-referral diagnostic evaluation of malignant breast lumps in Lagos, Nigeria

216. Don't touch that breast: Outcome of a review of pre-referral diagnostic evaluation of malignant breast lumps in Lagos, Nigeria

Immunhistochemical exepression of ER/PR in cytological and histopathological preparation of infiltrative ductal carcinoma of breast: comparation clinicopathological study

Background: Breast cancer is the leading cause of cancer death among women worldwide and in Iraq.Objectives: To evaluate the reliability of the immunocytochemical method in breast carcinoma aspirates with those obtained by immunohistochemistry of the corresponding excised breast tissue sections.Patients and methods: This is a prospective study. A total of (41) patient complain from malignant breast lump and (10) cases with benign mass (fibro adenoma) visited the Oncology Teaching Hospital in the Medical City in Baghdad during the period from the first of April 2012 to the end of December 2012. FNA sample taken for routine cytopathological and immuncytological study and the patient where followed up and immunhistological study was done for mastectomy or tissue biopsy samples.Results: The diagnostic sensitivity, specificity, PPV, and NPV of estrogen receptor ICC staining as Compared to the ER IHC were 92%,62%,50% and 95% respectively. The overall accuracy was 59.2%.The diagnostic sensitivity, specificity, PPV, and NPV of progesterone receptor ICC staining as Compared to the PR IHC were 93%, 62%, 58%, and 94% respectively. The overall accuracy was 73.2%Conclusion: There was no statistically significant correlation between ER , PR expression in both ICC and IHC

Awareness and practice of breast screening and its impact on early detection and presentation among breast cancer patients attending a clinic in Lagos, Nigeria.

Breast cancer is the most common malignancy among females in Nigeria. The concept of breast screening (BS) is that it would result in presentation at earlier stages. We evaluated the impact of BS on early detection and presentation of breast cancer and determined the aspects BS need improvement. All patients with a diagnosis of malignant breast lump attending clinics at a tertiary hospital in Nigeria were recruited into the study over a 2-year period. Self-administered questionnaires were given to patients. Data collected were demographics, knowledge about BS, practice of BS, the motivation to practice BS and the source of information on BS. Of 218 patients seen, 147 (67.4%) patients presented at the surgical outpatient clinic and 71 (32.6%) at the radiotherapy clinic, with age 48.01 ± 0.80 years. A total of 156 (71.6%) were aware of BS, while 62 (28.4%) were not aware. A logistic regression analysis showed that only the level of formal education predicted awareness of BS, P = 0.001 Nagelkerke's R2 = 0.126. Awareness of BS was mainly from electronic media 87 (55.7%). There was no significant difference in the ages of those aware and practicing BS 48.03 ± 1.05 years, and those not practicing BS 46.32 ± 1.94 years, P = 0.446. There was no significant difference in presentation for those practicing BS 7.41 ± 1.30 months, and those not practicing BS 11.38 ± 2.91 months, P = 0.175, with 64% practicing BS presenting late, while 77% not practicing BS presenting late, χ2 = 2.432, P = 0.488. A logistic regression analysis did not show any demographic or clinical parameters as predictive P = 0.225 Nagelkerke's R2 = 0.126. The high level of awareness and practice of BS was not translated into the presentation with early breast cancer.