Management Of Benign Breast Disease Research Articles

Prevalence, Impact, and Diagnostic Challenges of Benign Breast Disease: A Narrative Review.

Benign breast diseases, which are commonly seen in clinical practice, have various clinical presentations and implications, as well as management strategies. This article describes common benign breast lesions, presentations of these lesions, and typical radiographic and histologic findings. Also included in this review are the most recent data and guideline-based recommendations for the management of benign breast diseases at diagnosis, including surgical referral, medical management, and ongoing surveillance.

Management of breast complaints and high-risk lesions

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

Benign breast pathology in general practice

Many thousands of patients present each year to general practice with breast symptoms. Patients are often concerned that their symptoms might indicate cancer; however, the majority represent benign breast disease. On average, a full-time GP will diagnose one or two cases of breast cancer a year. It can be difficult to distinguish between potentially malignant and benign conditions in the GP setting, as well as manage patient anxiety and expectations. This article aims to cover pathology, diagnosis and management of benign breast disease and improve confidence in managing patients diagnosed with benign disease. The article will not cover the topics of breast cancer or breast pathology in pregnancy and male patients.

Benign Breast Disease.

Benign breast disease presents commonly in routine gynecologic care. Presenting symptoms such as breast mass, nipple discharge, or breast pain may raise concern for malignancy. Once breast cancer is ruled out, gynecologists must identify and appropriately treat benign breast disease. While most benign lesions can be managed conservatively, high-risk breast lesions can increase the future risk of breast cancer and may require additional screening imaging and surgical excision. Pharmacologic therapy may also have a role in certain conditions. Gynecologists should be proficient in the identification and management of benign breast disease.

Clinical profile and management of benign breast disease

Background: Benign breast diseases are group of non cancerous condition which includes a variety of disease. The pt. commonly present with lump. Pain and nipple discharge.Material and method: It was prospective observational study. Carried out at opd of general surgery department at hallet hospital GSVM medical college Kanpur from October 2017 to November 2019. A total of 200 pt were studied and all pt underwent detailed history recording and clinical examination. Subsequently based on assessment they underwent USG or mammography of breast. After that they underwent FNAC or excisional biopsy with HPE. Result: Out of 200 pt most common presentation was breast lump (82.5%) followed by breast pain (15%) and nipple discharge (7.5%). The most common age of presentation was 21-30 years with Right side of breast more commonly involved than left side. The most common clinical diagnosis was fibroadenoma (45%) followed by fibroadenosis (31%) mastalgia (15%) all lipoma (2.5%). Conclusion: Benign breast disease present mainly is 21-30 year of age group and fibroadenoma is commonest of them all. It can be diagnosed clinically and confirmed by FNAC is more than 90% of cases excision is main stay of treatment.

Management of benign breast diseases at a tertiary care hospital

Fibroadenoma is the most common lesion of the breast; it occurs in 25% of asymptomatic women. They are benign, spherical, well-demarcated tumors of varying size. They arise from the epithelium and stroma of the terminal duct-lobular unit. It is usually a disease of early reproductive life; the peak incidence is between the ages of 15 and 35 years. About 50 cases of benign breast diseases were selected, only inpatient cases are considered for the study. Outpatient cases, males, malignant cases and cases which were operated early were excluded from the study. Majority of our cases were managed surgically (90%). Only 5 out of 50 i.e. 10% cases were managed conservatively. All the 5 cases which were managed conservatively are Fibroadenosis. Conservative line of management included.

Pathologic discordance to clinical management decisions suggests overtreatment in pediatric benign breast disease.

Breast masses in pediatric patients are often managed similarly to adult breast masses despite significant differences in pathology and natural history. Emerging evidence suggests that clinical observation is safe. The purpose of this study was to quantify the clinical appropriateness of the management of benign breast disease in pediatric patients. A multi-institutional retrospective cohort study was completed between 1995 and 2017. Patients were included if they had benign breast disease and were 19years old or younger. A timeline of all interventions (ultrasound, biopsy, or excision) was generated to quantify the number of patients who were observed for at least 90days, deemed appropriate care. To quantify inappropriate care, the number of interventions performed within 90days, and the pathologic concordance to clinical decisions was determined by reviewing the radiology reports of all ultrasounds and pathology reports of all biopsies and excisions. A total of 1,909 patients were analyzed. Mean age was 16.4years old (± 2.1). The majority of masses were fibroadenomas (60.4%). Only half of patients (54.3%) were observed for 90 or more days. 81.1% of interventions were unnecessary, with pathology revealing masses that would be safe to observe. The positive predictive value (PPV) of clinical decisions made based on suspicious ultrasound findings was 16.2%, not different than a PPV of 21.9% (p < 0.25) for decisions made on clinical suspicion alone. Despite literature supporting an observation period for pediatric breast masses, half of patients had an intervention within threemonths with one out of ten patients undergoing an invasive procedure within this time frame. Furthermore, 81.1% of invasive interventions were unnecessary based on final pathologic findings. A formal consensus clinical guideline for the management of pediatric benign breast disease including a standardized clinical observation period is needed to decrease unnecessary procedures in pediatric patients with breast masses.

Select Choices in Benign Breast Disease: An Initiative of the American Society of Breast Surgeons for the American Board of Internal Medicine Choosing Wisely® Campaign.

Up to 50% of all women encounter benign breast problems. In contrast to breast cancer, high-level evidence is not available to guide treatment. Management is therefore largely based on individual physician experience/training. The American board of internal medicine (ABIM) initiated its Choosing Wisely® campaign to promote conversations between patients and physicians about challenging the use of tests or procedures which may not be necessary. The American society of breast surgeons (ASBrS) Patient safety and quality committee (PSQC) chose to participate in this campaign in regard to the management of benign breast disease. The PSQC solicited initial candidate measures. PSQC surgeons represent a wide variety of practices. The resulting measures were ranked by modified Delphi appropriateness methodology in two rounds. The final list was approved by ASBrS and endorsed by the ABIM. The final five measures are as follows. (1) Don't routinely excise areas of pseuodoangiomatous stromal hyperplasia (PASH) of the breast in patients who are not having symptoms from it. (2) Don't routinely surgically excise biopsy-proven fibroadenomas that are < 2cm. (3) Don't routinely operate for a breast abscess without an initial attempt to percutaneously aspirate. (4) Don't perform screening mammography in asymptomatic patients with normal exams who have less than a 5-years life expectancy. (5) Don't routinely drain nonpainful, fluid-filled cysts. The ASBrS Choosing Wisely® measures that address benign breast disease management are easily accessible to patients via the internet. Consensus was reached by PSQC regarding these recommendations. These measures provide guidance for shared decision-making.

Role of Imaging in Benign Breast Disease

Department of General Surgery, VIMSAR, Burla, Odisha, India Email: dharbind_chiku@yahoo.co.in, Contact number 8763090706, 9437025626 ABSTRACT Non invasive techniques of imaging in benign breast disease are proving to be an important tool in the diagnosis and management of Benign breast disease. Mammography and Ultrasonography are two important non-invasive techniques which can substantially prove to be an important diagnostic tool in the management of benign breast disease. Some benign breast disease like fibroadenomas and phylloids tumors have to be evaluated for any component of malignancy unless otherwise proved. Even if a clinical finding are benign, an imaging technique gives reassurance to the patient and reduces psychological worry. Benign breast disease are on the rise and are a common cause of psychological distress in women, especially of younger age group.

Clinicopathological pattern of benign breast diseases among female patients at a tertiary health institution in Tanzania

Background: Benign breast diseases are a neglected entity in developing countries despite the fact that they constitute the majority of breast complaints. There is a paucity of published information regarding benign breast diseases in Tanzania. This study describes our experience in the management of benign breast diseases outlining the clinicopathological pattern and treatment modalities of these diseases in our local setting.Methods: This prospective descriptive study was conducted between November 2009 and March 2013 at Bugando Medical Centre in Tanzania on female patients aged 10 years and above presenting with benign breast diseases.Results: A total of 346 female patients with benign breast diseases were studied. The majority of patients, 255 (73.7%) were younger than 30 years. Breast lump was the most frequent presentation in 67.6% of patients. Fibroadenoma 95 (60.0%) was the most frequently diagnosed benign breast disease followed by fibrocystic changes (19.0%). Out of 295 patients who had histopathological examination, 64 (21.7%) had proliferative lesions. Of these, 18 (28.1%) had proliferative lesions with atypia while 46(71.9%) had proliferative lesions without atypia. Eight (2.6%) patients were HIV positive with the median CD 4+ count of 258 cells/μl. The majority of patients, 295(85.2%) underwent surgical treatment of which lumpectomy was the most common procedure performed. Conclusion: Benign breast diseases are more common than malignancies in our environment and occur mainly in young women less than 30 years of age and were mostly fibroadenoma and fibrocystic change. Though premalignant lesions of proliferative lesions with atypia were less common in this study, it is advisable that all cases of breast lesions should be carefully evaluated to exclude possibility of breast cancer.

Diagnosis and Management of Benign Breast Disease

Diagnosis and Management of Benign Breast Disease

Impact of fine-needle aspiration cytology, ultrasonography and mammography on open biopsy rate in patients with benign breast disease.

The management of breast disease has been influenced by breast imaging and fine-needle aspiration cytology (FNAC) for preoperative diagnosis. To investigate the impact of introducing an in-clinic FNAC service on patient management, the pathology records of patients presenting before and after introduction of the service were studied. Four management changes emerged. The number of patients investigated by histology and/or cytology increased (from 266 to 503), as did specimen numbers (392 to 728). The use of pathological services changed, with more cytology specimens (39 to 554), fewer needle-core biopsies (62 to three) and fewer excision biopsies (245 to 118). The number of patients admitted for surgery fell, especially those with a benign histological diagnosis (174 to 49). These figures demonstrate a change in the management of benign breast disease, from surgery with histopathological diagnosis to cytological diagnosis with surgery only if indicated clinically or from imaging.

Management of benign disease of the breast

The management of benign breast disease provides the majority of the workload for a specialist breast surgeon in the outpatient setting. Ninety percent of referrals to the symptomatic breast clinic will be for the assessment of the signs and symptoms of benign breast conditions. It is essential not to underestimate the impact of these signs and symptoms and to rapidly make the correct diagnosis and reassure the exclusion of an underlying breast cancer. Nipple discharge may account for 8% of referrals and is perceived by the public to be closely associated with breast cancer. Often a well taken clinical history will direct one to the appropriate diagnosis before examination or breast imaging. The common causes of discharge (physiological, duct ectasia, periductal mastitis, epithelial hyperplasia, intraductal papilloma) often have characteristic features. However, the clinician must maintain an index of suspicion to prevent an underlying breast carcinoma (associated with 10% of cases of nipple discharge) from being overlooked. The incidence of acute infections of the breast has declined in the UK due to improved personnel hygiene. The early prescription of appropriate antimicrobial agents has also reduced the presentation of established breast abscesses. Traditionally, breast infection is classified as lactational and non-lactational, the latter being closely associated with cigarette smoking. The aggressive inflammatory breast cancer may present with a clinical picture identical to a florid infection; suspicion being raised when there is no response to appropriate treatment. Mastalgia is a common and sometimes debilitating problem that affects many women. It is vital to establish whether the pain is cyclical or non-cyclical or located in the chest wall. There are many preparations available for the management of mastalgia, although little decisive evidence for efficacy. An underlying carcinoma is a very rare cause for pain and exclusion of this fear may result in acceptance of symptoms in the majority of cases.

Office management of benign breast disease.

University of Massachusetts Medical School, Worcester, Massachusetts Correspondence: Samuel Zylstra, MD, MPH, Women's Pavilion, Milford Whitinsville Regional Hospital, 14 Prospect Street, Milford, MA 01757.

Progesterone receptor induction by danazol in cultured cancer cells and the rat uterus

We have previously reported that clinical trials relating to the use of danazol in the management of benign breast disease show a positive correlation between favourable clinical response and an induction of progesterone receptors in the affected tissue which is maintained for a period of at least 6 months subsequent to the cessation of treatment. Further studies designed at elucidating more clearly the actions of danazol at the cellular and molecular levels have confirmed that progesterone receptors are down-regulated by short-term progestin action at the level of the mRNA transcript, but that danazol is subsequently able to produce an enhanced cellular response, inducing progesterone receptors in the presence of oestrogenic agents. Uteri from danazol-treated rats showed a doubling of progesterone receptor concentrations compared with the control uteri. In the mammary cancer cell line T-47D, cells treated with danazol had increased progesterone receptor concentrations of 558.4±32.0 compared with 152.6±7.0 fmol/mg protein in the control cells. In both cases, these inductions were observed following a period of progesterone receptor suppression. Short-term molecular studies on T-47D cells indicated that progesterone and danazol initially inhibit mRNA transcription, but that 24 h after treatment an induction is observed. This is especially marked in the danazol-treated cells.

Cole's precancerous hyperplasia of the breast

Due to his recognition as the discoverer of the first test for visualization of the gallbladder, his profile research on dissemination of cancer and his stimulation and interest in stress and immunity, one of Warren Cole's most significant reports has not been accorded due recognition. In 1944, Cole presented data at the Southern Surgical Association Meeting which clearly identified the premalignant histologic change in the breast. In the published report, Cole and Rossiter [Ann Surg 119:573-590, 1944] presented a classification of benign breast histology: 1) adenofibrosis, 2) parenchymatous hyperplasia, 3) precancerous hyperplasia, and 4) cystic disease. Following the work of Warren in 1940 [Surg Gynecol Obstet 71:257-273], who stated that the chronic cystic mastitis had an incidence of breast cancer over 3 times the expected rate, this report of Cole and Rossiter focused on the worrisome lesion atypical epithelial hyperplasia. Since then, Haagensen ["Diseases of the Breast," Philadelphia: Saunders] has stressed that gross cystic disease is the lesion most associated with increased risk of cancer. In an attempt to resolve these seeming contraindications, we reviewed the charts of patients referred to a private breast clinic. With the advent of mammography, sonography, and thermography, the incidence and management of benign breast diseases has changed over the years. This study focuses on the current management of breast masses and reinforces the significance of Cole's classification.

Specificity of ultrasonography in the diagnosis of benign breast masses.

Ultrasound has become increasingly important in the management of benign breast disease. The main reasons are its ability to distinguish between cystic and solid lesions, its special advantages in examining the dense breast, and the absence of potential radiation hazard. This paper evaluates the specificity of automated ultrasound in the diagnosis of benign lesions. The usefulness of the signs established for the diagnosis of benign masses is analyzed. Atypical lesions are discussed and the role of ultrasonography in the differential diagnosis of benign lesions is reviewed.

Mammography in the diagnosis of breast carcinoma: an evaluation of direct referral facilities for family practitioners.

An enquiry has been made into the value of direct referral facilities for mammography by family practitioners. This study showed that provided that the limitations of mammography are appreciated, such a system is useful as a contribution to the management of benign breast disease and in the doubtful cases unlikely to have a carcinoma. The number of very early carcinomas discovered has been disappointing and the main use of this type of service has been in reinforcing clinical opinion.