THE VALUE OF MODIFIED TRIPLE ASSESSMENT IN THE DIAGNOSIS OF PALPABLE BREAST LUMPS

Breast Lumps in females are a common clinical problem which requires rapid and early evaluation with an important aim of excluding any breast malignant lesion. We have modified this approach by substituting mammogram with ultrasound for the assessment of breast lesions. Distinction of benign lesion of breast from malignant lesion is of paramount importance for patient care and proper management. An early and accurate diagnosis is important because the treatment can be initiated much earlier for the better prognosis. Nowadays Triple assessment has been used as a main diagnostic method in the evaluation of breast lesions. Therefore it is important to evaluate the validity and reliability of triple assessment in the evaluation of breast lesion.

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Role of triple assessment modalities in diagnosis of palpable breast lump

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20184059 ◽

2018 ◽

Vol 6 (10) ◽

pp. 3435

Author(s):

Ashwinkumar S. Gadhvi ◽

Udit I. Gadhvi ◽

Dhaval A. Bhimani ◽

Darshil K. Rajgor

Keyword(s):

Benign Lesion ◽

Malignant Lesion ◽

Breast Disease ◽

Breast Lump ◽

Size Number ◽

Life Saving ◽

Triple Assessment ◽

Palpable Breast ◽

Sensitivity Specificity

Background: One fourth of women suffer from breast disease in their lifetime. Carcinoma of breast is the second most common cancer in the world. Timely and accurate diagnosis of breast lump with early intervention can be life saving. There are various modalities for the diagnosis of breast lump such as USG, FNAC and Mammography, MRI etc. but none of them is perfect. There are numerous reports suggesting that if the results of clinical assessment, mammography and FNAC are all combined, the diagnostic accuracy is nearly 100%. Furthermore, these techniques also provide information about tumor size, number, extent and grade preoperatively.Methods: Study was randomized, prospective, observational and longitudinal including 100 patients, selected according to inclusion criteria.Results: The sensitivity, specificity and accuracy of triple test in present study were 98.68%, 87.5%, and 96% respectively. Out of 100, 76 patients were confirmed as having benign lesion and 24 patients having malignant lesion by histopathology examination.Conclusions: Results of triple assessment are same as the results by histopathology examination in majority of cases. It is highly accurate, can be used as a confirmatory diagnostic tool for breast lump, thus there is no need to perform diagnostic open biopsy for breast lump.

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UTILITY OF FNAC AS A FIRST LINE INVESTIGATION IN THE EVALUATION OF PALPABLE BREAST LUMPS WITH HISTOPATHOLOGICAL CORRELATION: A FIVE YEAR STUDY.

10.36106/gjra/2915610 ◽

2021 ◽

pp. 253-255

Author(s):

Manisha Khare ◽

Saraswathi J ◽

Yogita Sable ◽

Yasmeen Khatib ◽

Prajakta Gupte

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Ductal Carcinoma ◽

Benign Lesion ◽

Breast Lesions ◽

Benign Lesions ◽

Malignant Lesions ◽

Palpable Breast ◽

Breast Lumps

Introduction: Fine needle aspiration cytology (FNAC) is a simple cost-effective and rapid diagnostic modality for the evaluation of breast lumps. The aim of the present study was to correlate the cytological diagnosis with histopathological ndings and to nd out the accuracy of FNAC in the evaluation of breast lesions. FNAC is very helpful in distinguishing benign from malignant lesions and deciding the further management of the patient. Materials And Methods: The study comprised of 250 cases of FNAC of palpable breast lesions with histological correlation. All the aspirates were examined using PAP and Giemsa stains. The accuracy of FNAC was calculated by determining the sensitivity, specicity, positive predictive value, negative predictive value and accuracy. Results: Total 250 cases were studied of which there were 246 female and 4 male patients. A concordant diagnosis was made on FNAC in 134 out of 136 of benign lesions, one of two cases of suspicious for malignancy and all 112 cases of malignant lesions. Fibroadenoma(FA) (63.2%) was the commonest benign lesion observed while ductal carcinoma (42%) was the most frequent malignancy seen. In the diagnosis of breast lesions FNAC had a sensitivity of 99.12%, specicity of 98.54%, positive predictive value of 98.25%, negative predictive value of 99.26% and accuracy of 98.8%. Conclusion: FNAC is a reliable tool for diagnosis of breast lesions. It is minimally invasive and is a good alternative to biopsy in the diagnosis of benign lesions. However for the cases which fall into “suspicious for malignancy” category biopsy is advisable.

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Sonoelastography in the diagnosis of breast mass: an extended armamentarium

International Surgery Journal ◽

10.18203/2349-2902.isj20180344 ◽

2018 ◽

Vol 5 (2) ◽

pp. 523

Author(s):

K. Manickkam Kannappan ◽

Bhawna Dev ◽

Ramya Ramakrishnan

Keyword(s):

Sensitivity And Specificity ◽

Benign Lesion ◽

Percutaneous Biopsy ◽

Strain Ratio ◽

Breast Lesions ◽

Strain Elastography ◽

Non Invasive ◽

Triple Assessment ◽

Breast Lumps ◽

Negative Biopsies

Background: To presenting with breast lumps are very common in surgical practice and the routine use of ultrasound in the diagnosis is well validated. But there are gray zones in equivocal cases which increase the number of negative biopsies. To increase the sensitivity and specificity of ultrasound by adding another non-invasive modality, namely strain elastography, can reduce this rate. To evaluate the sensitivity and specificity of strain elastography in the diagnosis of breast masses.Methods: As part of the triple assessment patients presenting with breast lumps underwent ultrasonography and strain elastography, where strain ratios were calculated. Based on which they either underwent percutaneous biopsy or surgical excision. A total of 30 patients with breast lesions underwent sonomammogram in which the breast lesions were both graded with BIRADS and also the elastography and strain ratio was calculated.Results: Strain ratio has higher sensitivity and specificity which makes it a valid diagnostic tool in the evaluation of breast masses.Conclusions: It can also help in reducing the number of benign lesion biopsies and also reduce the number of negative biopsies. Being a non-invasive modality, it is much more patient compatible and economically cheaper when compared with MRI and modalities.

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Non-Palpable Breast Lesions

Acta Radiologica ◽

10.1177/028418518802900305 ◽

1988 ◽

Vol 29 (3) ◽

pp. 285-288

Author(s):

P. Hallgrimsson ◽

R. Kåresen ◽

K. Årtun ◽

A. Skjennald

Keyword(s):

Malignant Lesion ◽

Breast Lesions ◽

Routine Procedure ◽

Localization Method ◽

Palpable Breast

Marking of non-palpable breast lesions for biopsy has become a routine procedure in patients in whom mammography has suggested malignancy. Between October 1981 and December 1985 a localization method was used in 123 patients. In 35 per cent of the biopsies a malignant lesion was disclosed. In patients with a mass only, malignancy was found in 37 per cent of the biopsies. If microcalcifications alone were the main reason for the biopsy, malignancy was disclosed in 25 per cent. If both a mass and microcalcifications were present, 52 per cent of the biopsies disclosed a malignant lesion.

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99mTc sestamibi scintimammography

Nuklearmedizin ◽

10.1055/s-0038-1623909 ◽

2004 ◽

Vol 43 (01) ◽

pp. 16-20

Author(s):

E. Derebek ◽

P. Balcı ◽

M. A. Koçdor ◽

B. Değgirmenci ◽

T. Canda ◽

...

Keyword(s):

False Negative ◽

Malignant Lesion ◽

Excisional Biopsy ◽

Breast Lesions ◽

Benign Lesions ◽

Complementary Method ◽

Diagnostic Role ◽

Malignant Lesions ◽

Palpable Breast ◽

99Mtc Sestamibi

Summary Aim: Investigation of the diagnostic role of technetium-99m methoxyisobutylisonitrile (99mTc sestamibi) scintimammography in non-palpable, suspicious breast lesions described as microcalcification, mass and increased density using mammography. Patients, method: 35 women with non-palpable breast lesions were enrolled in the study. Anterior, left and right lateral, ipsilateral posterior oblique images were obtained 15 min after the injection of 740 MBq of 99mTc sestamibi. All scintigraphic images were evaluated visually and focal increased 99mTc sestamibi uptake was accepted as malignant lesion. Breast lesions were classified as microcalcification (13 women), mammographic mass (16 women) and increased density (6 women). Excisional biopsy was performed in all of them irrespective of the scintigraphic results. Results: The focally increased 99mTc sestamibi uptake was seen in 11 breast lesions with malignant lesions and in 4 breast lesions with benign lesions. The diffuse uptake of 99mTc sestamibi was seen in 18 breast lesions with benign lesions and 2 breast lesions with malignant lesions. There was no false positive result of 99mTc sestamibi in microcalcification group and there was no false negative result of the mammographic mass and increased density groups. Conclusion: Scintimammography might be a complementary method in decision making for the non-palpable, suspicious breast lesions that were evaluated as microcalcification, mass and increased density mammograpically.

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Mammographic evaluation of palpable breast masses with pathological correlation: a tertiary care centre study in Nepal

Journal of Institute of Medicine ◽

10.3126/jiom.v32i2.4940 ◽

1970 ◽

Vol 32 (2) ◽

pp. 21-25 ◽

Cited By ~ 1

Author(s):

G Gurung ◽

RK Ghimire ◽

B Lohani

Keyword(s):

Breast Cancer ◽

Benign Lesion ◽

Tertiary Care ◽

False Negative ◽

Malignant Lesion ◽

Institute Of Medicine ◽

Breast Lump ◽

Major Health Problem ◽

Malignant Lesions ◽

Palpable Breast

Introduction: Breast cancer is one of the major health problem for all countries. . In Nepal , breast cancer is the second most common cancer in female. Early detecting tools like mammography can able to detect location , size, morphology, and nature of breast lesions that can help to reduced mortality and morbidity from breast cancer significantly. Methods: This prospective study was carried out at the department of Radiology, Surgery and Pathology for a period of one year. A total of 100 patients with clinically palpable breast lump were subjected to mammography and subsequently to FNA or biopsy. The mammograms were reviewed by two senior consultant radiologists and pathology by a senior pathologist. Results: Out of 100 patients, 65% had mammographic features of benign lesion and 35% had features of malignancy. Pathology revealed 64% of lesion to be benign and 36% of lesion to be malignant. There were four false negative (6.2%) and three false positive (8.6%) cases. The sensitivity and specificity of mammography were 88.9% and 95.53% respectively. The mean age of patient with malignant lesion was 46.3 years (SD=11.5) and 34.7 years (SD=10.6) for benign lesions. Among malignant lesion 37.1% had lobulated, 14.3% had oval, 31.4% round and 17.1% had irregular shape with spiculated margin in 60% and indistinct margins in 34.3%. Among benign 7.7% showed lobulated shape, 41.5% oval and 50.8% round shape. Circumscribed margin was found in 93.9% of benign and 5.7% of malignant lesions. Punctuate and polymorphic calcification was found in malignant lesions (25.7% and 5.7%). Secondary changes were found in only in the malignant cases. Halo sign was found only in benign cases and most common in fibroadenoma (38.4%). Conclusions: Mammography is an effective diagnostic tool for benign and malignant characteristic of palpable breast mass. Keywords: Breast lump; mammography; micro calcification DOI: http://dx.doi.org/10.3126/joim.v32i2.4940 Journal of Institute of Medicine, August, 2010; 32: 21-25

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RETROSPECTIVE ANALYSIS OF MAMMOGRAM, SONOMAMMOGRAM AND ITS HISTOPATHOLOGICAL CORRELATION AS AN AID FOR DIAGNOSIS OF BREAST LESIONS

10.36106/ijsr/2803236 ◽

2021 ◽

pp. 1-4

Author(s):

Sathish babu ◽

Arifkhan Sainudeen ◽

Abdul Eksana

Keyword(s):

Breast Cancer ◽

Breast Imaging ◽

Ductal Carcinoma ◽

Histopathological Examination ◽

Benign Lesion ◽

Malignant Lesion ◽

Breast Lesions ◽

Care Hospital ◽

Malignant Breast ◽

Malignant Lesions

INTRODUCTION: Breast cancer is the most common cancer impacting 2.1 million women each year and also relates to the most cancer related deaths in women. In 2018, it was estimated that 627,000 women died from breast cancer which approximates to 15 % of all cancer related deaths among women [1]. The triple test– clinical examination, mammography and core biopsy helps in differentiating benign and malignant lesions. Histopathological examination is considered being the gold standard test for confirming malignant lesions and forms the basis of management. AIM: To assess sensitivity of mammogram with ultrasonography in diagnosing various breast lesions and to correlate the categorized breast lesions (BI-RADS) with histopathology reports and thereby obtain specificity and NPV of evaluation using Mammogram and ultrasonography. STUDY DESIGN: Retrospective analytical study. Study Period: July 2018 – July 2019. METHODS: The results of ultrasonography and mammography of 72 cases diagnosed clinically with breast lesions over the period of one year in tertiary health care hospital were compared with histopathology reports. RESULTS: The mean age of the patients was 45.65 ± 3.19. Our results showed that in histopathology reports in 20 patients (27.78%) were malignant, 51 cases (70.83%) had benign disease and 1 case 1.39% was borderline malignant. Fibroadenoma was the commonest benign lesion whereas infiltrating ductal carcinoma was the most common malignant lesion. Breast Imaging – Reporting and Data System (BIRADS) by mammogram revealed category II in 54.1%, III in 20.8%, IV in 16.6% and V in 8.3%. The specificity of mammography alone in diagnosing malignant breast lesions was 90.1%. When combined (ultrasound and mammogram), the specificity in diagnosing malignant breast lesion was 98.5% CONCLUSION: Mammography and sono-mammogram plays an important role in the diagnostic and surgical management of breast lesions with correlative histopathology evaluation. The diagnostic accuracy shows significant improvement when mammogram was combined with ultrasound correlation and thereby improving sensitivity and specificity of diagnosing malignant breast lesions.

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Histomorphological spectrum of breast diseases

Journal of Nepal Medical Association ◽

10.31729/jnma.775 ◽

1970 ◽

Vol 39 (136) ◽

pp. 338-341

Author(s):

Usha Rani Singh ◽

A N Thakur ◽

S P Shah ◽

A Mishra

Keyword(s):

Benign Lesion ◽

Malignant Lesion ◽

Breast Disease ◽

Breast Diseases ◽

Fibrocystic Disease ◽

Duct Carcinoma ◽

Malignant Lesions ◽

Breast Lumps ◽

Medical University ◽

Breast Tissues

All breast lumps are considered to be carcinomas until proved otherwise and are acause of concern both for the patient and surgeon. The study was undertaken to knowthe histological spectrum of breast disease at B. P. Koirala Institute of Health Sciences(BPKIHS). BPKIHS is a recently started Medical University in the easternregion of Nepal. No data regarding breast diseases in this region is available as yet.152 breast tissues sent for histopathology from Jan. 96 - Dec. 98 were studied. Peakincidence of benign lesion was in 21 to 30 years and malignant lesions in 31 to 50years. No breast lesions were seen in the first decade of life. Cancer was seen in18.42% of cases. Fibroadenoma & Fibrocystic disease were the commonest benign &infiltrating duct carcinoma the commonest malignant lesion. Specimens from 10 malebreasts were received. Gynaecomastia was the commonest lesion in the males. Infiltratingduct carcinoma was seen in a 70 years male. Some uncommon breast lesionslike Syringocystadenoma & cysticercosis were also seen. In 3.28% of cases no lesionswere seen.Key Words: Breast, Fibroadenoma, Fibrocystic disease,carcinoma, Gynaecomastia.

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Cytomorphological Patterns of Palpable Breast Lesions Diagnosed in Selected Teaching and Referral Hospitals in Kenya: A Prospective Study

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqz118.012 ◽

2019 ◽

Vol 152 (Supplement_1) ◽

pp. S97-S97 ◽

Cited By ~ 1

Author(s):

Josephine Rioki ◽

Emily Rogena

Keyword(s):

Fine Needle Aspiration ◽

Ductal Carcinoma ◽

Needle Aspiration ◽

Anaplastic Carcinoma ◽

Breast Lesions ◽

Age Group ◽

Fine Needle ◽

Referral Hospitals ◽

Palpable Breast ◽

Breast Lumps

Abstract Objective To study the patterns of breast lesions among women with palpable breast lumps presenting to fine-needle aspiration clinics. Methods This study involved 768 women aged 16 to 97 years who presented with palpable breast lumps to fine-needle aspiration clinics (FNACs) at Kenyatta National and Nakuru Teaching and referral hospitals from September 2016 to December 2018. The study was approved by Kenyatta National Hospital–University of Nairobi Ethical Review Committee (KNH-UoN ERC); P 334/16. A structured questionnaire was used to obtain qualitative data. Fine-needle aspiration was performed after obtaining informed consent and smears were stained with both H&E and Papanicolaou stains. Results Lesions were categorized as fibroadenoma, 287 (44.1%); ductal carcinoma, 59 (9.1%); breast abscess, 39 (6%); benign cysts, 33 (5.1%); galactocele, 32 (4.9%); fibrocystic changes of the breast, 29 (4.5%); suspicious of malignancy, 27 (4.1%); duct ectasia and inflammatory breast lesions, 24 each (3.7%); atypia, 12 (1.8%); invasive ductal carcinoma, metastatic carcinoma, and lipoma, 4 each (0.6%); anaplastic carcinoma and malignant phylloides, 1 (0.2%); and others. Out of 768 smears evaluated, 117 (15.2%) smears were nondiagnostic. The age group most affected was 20 to 34 years (47.2%) followed by 35 to 49 years (26.2%). Women between 24 and 30 years had the following frequencies: anaplastic cancer (100%), invasive ductal and metastatic cancer (50%), and suspicious of malignancy (56%). Conclusion Fibroadenoma was the most frequent lesion followed by ductal carcinoma, breast abscess, benign cysts, and galactocele, respectively. Generally, benign lesions formed the bulk of all lesions diagnosed in the two referral facilities. From this study, it is evident that the young age group (reproductive age) is the one most affected with ductal carcinoma, anaplastic carcinoma, and invasive carcinoma. The number of nondiagnostic category was quite high and this warrants proper training and competence evaluation for the clinicians/health care workers who participate in performing fine-needle aspirate procedures.

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Cytological Study of Palpable Breast Lumps with their Histological Correlation

International Journal of Medical and Dental Sciences ◽

10.19056/ijmdsjssmes/2013/v2i2/86767 ◽

2013 ◽

Vol 2 (2) ◽

pp. 128

Author(s):

R. Bhagat ◽

M. S. Bal ◽

V. K. Bodal ◽

A. K. Suri ◽

K. Jindal

Keyword(s):

Diagnostic Accuracy ◽

Ductal Carcinoma ◽

Histopathological Examination ◽

Low Cost ◽

Benign Lesion ◽

Malignant Lesion ◽

High Sensitivity ◽

Breast Lesions ◽

Breast Cancers ◽

Sensitivity Specificity

Background:FNAC is an inexpensive and highly accurate means of diagnosing both benign and malignant breast lesions. The procedure provides a rapid and non-morbid diagnosis before the operation which enables the patient and the surgeon to discuss and plan therapeutic alternatives in a rational atmosphere.Objectives: To evaluate role of fine needle aspiration cytology in the diagnosis of breast lesions and to compare the cytological findings with the histopathology wherever possible. In addition the sensitivity, specificity and accuracy of FNAC in breast lesions are carried out.Material and Methods: The present study was carried out on 200 patients who presented with palpable lump in the breast in the Department of Pathology, Government Medical College, Patiala over a period of 2 years. Cytological Diagnosis was correlated with histological findings wherever possible.Results: Cytologically, the lesions were categorized into 4 major categories, benign 143 (71.5%), malignant 37 (18.5%), suspicious or atypical 10 (5%) and unsatisfactory 10 (5%). Out of these 200 cases, 85 cases (42.5%) were available for histopathological examination. The most common benign lesion in this study was fibroadenoma 23/52 (44.2%) and the most common malignant lesion was infiltrating ductal carcinoma (28/33) Diagnostic accuracy of FNAC for benign lesion was 94.2% while for malignant lesion, it was 96.7%. The sensitivity, specificity and overall diagnostic accuracy of FNAC came out to be 93.7%, 98.1% and 96.4% respectively.Conclusion: FNAC is a simple and reliable method for diagnosis of both benign and malignant lesions quite accurately thus reducing unnecessary surgeries. The present study proved that the procedure has high sensitivity, specificity and diagnostic accuracy. Though it cannot categorize the lesion in some cases but it can rule out malignancy in most of the cases. Considering its low cost and quick results, it can be a potential tool for screening of breast cancers.

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