Commentary on: Incidental Breast Cancers Identified in a One-Stop Symptomatic Breast Clinic

INTRODUCTION We determined whether it is safe to avoid mammograms in a group of symptomatic women with a non-suspicious history and clinical examination. PATIENTS AND METHODS Symptomatic women aged 35 years or over newly referred to a rapid-diagnosis breast clinic underwent mammography on arrival in the clinic. A breast radiologist reported on the mammograms. An experienced clinician who was unaware of the mammogram findings examined patients and decided whether a mammogram was indicated or not. If not, a management plan was formulated. Mammogram findings were then provided to the clinician and any change to the original management plan as a result of mammography was recorded. RESULTS In two-thirds (67%) of 218 patients, the clinician felt a mammogram was indicated. Half (46%) of these mammograms showed an abnormality; of these abnormal mammograms, 41% were breast cancer. Among the third (n = 71) of mammograms felt not to be indicated, 3 showed abnormalities of which 2 were breast cancer. One cancer was not suspected clinically or mammographically but was diagnosed on cyto/histopathological assessment. CONCLUSIONS A significant proportion of patients attending a symptomatic breast clinic have a non-suspicious history and normal clinical findings on examination. However, even in this group avoiding mammograms risks missing clinically occult breast cancers. It would appear sensible to offer mammograms to all symptomatic women over 35 years of age.

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Incidental breast lesions detected on diagnostic CT scans: A 3-year prospective study.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.27_suppl.69 ◽

2011 ◽

Vol 29 (27_suppl) ◽

pp. 69-69

Author(s):

A. R. Ismail

Keyword(s):

Breast Cancer ◽

Prospective Study ◽

Cancer Patients ◽

Ct Scans ◽

Breast Lesions ◽

Breast Cancers ◽

Breast Cancer Patients ◽

Breast Clinic ◽

Rapid Access ◽

One Stop

69 Background: With increasing usage of diagnostic cross sectional radiology tests, patients are presenting to rapid access one-stop breast clinic with incidental breast lesions. Methods: A prospective study over a 3-year period, collecting details of all patients shown to have breast abnormalities detected by computed tomography (CT) scans done for various reasons. These patients were assessed by clinical breast examination coupled with mammography, ultrasonography and tissue biopsy if indicated. Results: An increasing trend has been seen in the total number of thoracic CT scans with 1,939 scans in 2005 and 5,215 scans in 2010 (169% increase). 26 patients were included in this study with CT scans showing incidental breast lesions in the last three years. They were all women with age range of 50-92 (median 82.5) years. The clinical indications of CT scans included evaluation of the abnormal chest radiograph (8, 31%), preoperative evaluation of non-breast malignancy (3, 11%), infectious diseases (3, 11%), weight loss (7, 27%) and miscellaneous (5, 20%). These 13 breast cancer patients constitute 1.36% of 956 breast cancers diagnosed over this three-year period. 8 out of 13 breast cancer patients in this group (62%) had metastases at the time of diagnosis. Conclusions: A significant number of breast lesions incidentally found on CT scans are shown to be breast cancers (50%). These patients need rapid access to one-stop breast clinic for full evaluation. [Table: see text]

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COMPARISON OF MAMMOGRAPHY AND ULTRASOUND COMBINED VERSUS ULTRASOUND ALONE IN EARLY EVALUATION OF SYMPTOMATIC BREAST CANCERS IN PAKISTAN

Journal of Cancer & Allied Specialties ◽

10.37029/jcas.v3i4.155 ◽

2018 ◽

Vol 3 (4) ◽

Author(s):

Razia Bano ◽

Huma M Khan ◽

Ayesha Ehsan ◽

Awais Amjad Malik ◽

Shahper Aqeel ◽

...

Keyword(s):

Breast Cancer ◽

Diagnostic Accuracy ◽

Failure Rate ◽

Clinical Findings ◽

Initial Evaluation ◽

Breast Lesions ◽

Breast Cancers ◽

Breast Clinic ◽

Early Evaluation ◽

Symptomatic Breast

Purpose: The purpose of this study was to detect diagnostic accuracy of mammography and ultrasound combined versus ultrasound alone in early evaluation of symptomatic breast lesions.Materials and Methods: All new patients who presented to the breast clinic with symptomatic breast lesions, during the year 2012, were included in the study. A total of 695 patients were registered. Their clinical findings, mammogram, ultrasound and histopathology were reviewed.Results: Mammogram and ultrasound combined detected 693 (99.71%) lesions in total. Mammogram failed to detect lesions in 1.43% of patients, whereas the failure rate of ultrasound was 0.43%. The incidence of microcalcifications on mammogram was 19.13%.Conclusion: Ultrasound is a useful tool in the initial evaluation of symptomatic breasts. For places such as Pakistan where mammogram is not available at every centre, ultrasound can be used as an effective alternative for the assessment of symptomatic breast lesions.Key words: Breast cancer, mammography, ultrasound

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Sensitivity and missed cancer rate in the symptomatic breast clinic—A retrospective cohort study of 40 323 patients

The Breast Journal ◽

10.1111/tbj.14134 ◽

2020 ◽

Author(s):

Jeremy Batt ◽

Rachel Ainsworth ◽

Zenon Rayter ◽

James Nickells ◽

Alexandra Valencia

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Breast Clinic ◽

Cancer Rate ◽

Symptomatic Breast

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Duct Excision is Still Necessary to Rule out Breast Cancer in Patients Presenting with Spontaneous Bloodstained Nipple Discharge

International Journal of Breast Cancer ◽

10.4061/2011/495315 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6 ◽

Cited By ~ 12

Author(s):

R. E. Foulkes ◽

G. Heard ◽

T. Boyce ◽

R. Skyrme ◽

P. A. Holland ◽

...

Keyword(s):

Breast Cancer ◽

Malignant Disease ◽

Nonoperative Management ◽

Nipple Discharge ◽

Breast Clinic ◽

Exact Test ◽

Malignant Lesions ◽

Duct Excision ◽

Symptomatic Breast ◽

Rule Out

Introduction. Spontaneous nipple discharge is the third most common reason for presentation to a symptomatic breast clinic. Benign and malignant causes of spontaneous nipple discharge continue to be difficult to distinguish. We analyse our experience of duct excisions for spontaneous nipple discharge to try to identify features that raise suspicion of breast cancer and to identify features indicative of benign disease that would be suitable for nonoperative management.Methods. Details of one hundred and ninety-four patients who underwent duct excision for spontaneous nipple discharge between 1995 and 2005 were analysed.Results. Malignant disease was identified in 11 (5.7%) patients, 4 invasive and 7 insitu, which was 10.2% of those presenting with bloodstained discharge. All patients with malignant disease had bloodstained discharge. Discharge due to malignant disease was more likely to be bloodstained than that due to benign causes (Fisher's exact test, 2-tailedPvalue = 0.00134).Conclusion. Our findings do not support a policy of conservative management of spontaneous bloodstained nipple discharge. Cases of demonstrable spontaneous bloodstained nipple discharge should undergo duct excision to prevent malignant lesions being missed.

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Subtle signs of breast cancer as an important pitfall in mammographic interpretation. Establishing an accurate diagnosis in an equivocal case

Breast Disease ◽

10.3233/bd-201075 ◽

2021 ◽

pp. 1-6

Author(s):

Nikolaos S. Salemis ◽

Eleni Mourtzoukou ◽

Michail Angelopoulos

Keyword(s):

Breast Cancer ◽

Imaging Modality ◽

Benign Lesion ◽

Imaging Features ◽

Breast Cancers ◽

Breast Clinic ◽

Delay In Diagnosis ◽

Delay Of Treatment ◽

Equivocal Case ◽

Related Mortality

Mammogram is the standard imaging modality for the early detection of breast cancer, and it has been shown to reduce disease-related mortality by up to 30%. Mammogram, however, has its limitations. It is reported that 10–30% of breast cancers may be missed on a mammogram. Delay in the diagnosis and treatment may adversely affect the prognosis of patients with breast cancer. We present a case of multifocal invasive early breast carcinoma, which was misinterpreted twice as intramammary lymph nodes, thus resulting in a delay in diagnosis for eighteen months. The tumors were detected incidentally after the patient presented to our Breast clinic for symptoms related to a concomitant benign lesion involving the same breast. We describe the tumors’ imaging features and discuss the possible reasons that likely led to repeated misinterpretation. Awareness of possible causes for missed breast cancer is necessary to avoid delay of treatment initiation that may adversely affect prognosis.

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