Efficacy and Safety of Vacuum-Assisted Excision for Benign Breast Mass Lesion: A Meta-Analysis

Background and Objective: Breast mass lesions are common; however, determining the malignant potential of the lesion can be ambiguous. Recently, to evaluate breast mass lesions, vacuum-assisted excision (VAE) biopsy has been widely used for both diagnostic and therapeutic purposes. This study aimed to investigate the therapeutic role of VAE. Materials and Methods: Relevant articles were obtained by searching PubMed and EMBASE on September 3, 2021. Meta-analyses were performed using odds ratios and proportions. To assess heterogeneity, we conducted a subgroup analysis and meta-regression tests. Results: Finally, 26 studies comprising 18,170 patients were included. All of these were observational studies. The meta-analysis showed that the complete resection rate of VAE was 0.930. In the meta-regression test, there was no significant difference. The meta-analysis showed a recurrence rate of 0.039 in the VAE group. The meta-regression test showed no statistical significance. Postoperative hematoma, pain, and ecchymosis after VAE were 0.092, 0.082, and 0.075, respectively. Conclusion: VAE for benign breast lesions showed favorable outcomes with respect to complete resection and complications. This meta-analysis suggested that VAE for low-risk benign breast lesions is a reasonable option for both diagnostic and therapeutic purposes.

Histopathological study of benign breast lesions

Benign breast lesions are common in young females and are painless. Fibroadenoma is the commonest lesion among all the breast lesions and occurs in any age.1:To study the age and sex wise distribution of benign breast lesions; 2: To study the clinicopathological changes of benign breast diseases; 3: To study different types of benign breast lesions; 4. To study the histomorphological changes of benign breast lesions with clinical correlation.A prospective study of two years was done to evaluate the different types, patterns of benign breast lesions in females in relation to age, clinical and radiological features.A total of 140 benign breast diseases were studied. Fibroadenoma (76; 54.2%) was the most common lesion noted in younger females (18-24yrs) followed by fibrocystic disease (25; 17.8%) & benign phyllodes (14; 10%).FNAC followed by histopathological examination were the diagnostic criteria used for confirmation of the lesions.Benign breast lesions were common in young females, presented with painless, mobile breast lumps. Mastalgia and nipple discharge were other symptoms.

Vacuum-Assisted Excision, Scarless Solution for Fibroadenoma Breast—A Single-Center Experience

Background Fibroadenoma is one of the most common benign breast lesions that is frequently surgically excised in breast practice. Aim The aim of this study was to determine the efficacy and safety of ultrasound-guided (USG) vacuum-assisted excision biopsy (VAEB) of fibroadenoma. Settings and Design A retrospective observational study. Methods and Materials A total of 113 patients with 163 fibroadenomas who underwent USG-guided VAEB under local anesthesia with 7G and 10G probes using an Encor Enspire equipment were included in the study. The patients were followed up after 1, 6, and 12 months. The fibroadenomas up to 4 cm were excised as per the U.S. Food and Drug Administration-approved guidelines of the American Society of Surgeons for percutaneous removal of benign breast lesions. Results The percentage of complete excision rate was 98.8% and the most frequent complication encountered was hematoma including immediate and delayed accounting for 3.06%. There were no recurrent lesions in our study. Conclusion USG-guided VAEB of benign breast lumps can be a safe and effective alternative to surgical excision and had better patient satisfaction in terms of efficacy and cosmesis.

PROPORTIONS OF VARIOUS BENIGN BREAST LESIONS AMONG WOMEN PRESENTING AT TERTIARY CARE INSTITUTE OF INDIA: A CROSS-SECTIONAL STUDY

Background and Aim: Benign Breast Diseases (BBDs) is a group of non-cancerous breast diseases. A triple assessment which is done by a clinical examination, imaging like ultrasonography (USG) or mammography and a pathological examination – FNAC or core needle biopsy, during the initial consultation, allows clinicians to give immediate reassurance to most of the patients. The aim of the study was to find out the proportions of various benign breast lesions among women aged 18 years and above. Material and Methods: A prospective study was conducted in the Department of Surgery, Tertiary care institute of India for a period of 20 Months. Based on the pilot study sample size derived was found to be 102. A performa was filled with patient particulars, history and clinical findings in female patient attending department of surgery OPD with breast related symptoms. Patients will be followed up with histopathological, cytological and radiological studies in indicated cases. The patients will be followed up for 1 year. Most common benign breast related symptoms and condition among the study group and probable risk factors for the same will be analyzed. Results:The commonest case among the study population was fibroadenoma 37 (36.27%). The next common was acute breast abscess, followed by fibrocystic disease (9). Lump alone detected either by patient herself or by the clinician was the most common presenting complaint in around 40 patients, followed by lump with pain in around 37, followed by either pain, nipple discharge. Fibroadenoma could be diagnosed clinically with an accuracy of about 89%. Abscess breast, phyllodes tumor and galactocele and few cases of granulomatous mastitis was also able to be diagnosed clinically. Conclusion: Fibrocystic disease is commonest amongst proliferative breast lesions followed by Sclerosing adenosis. Breast abscess is the commonest lesion amongst inflammatory breast lesions. Breast self-examination and health education to females is very important in cases of benign proliferative lesions. Key Words: Benign Breast Diseases, Fibroadenoma, Phyllodes tumor, Ultrasonography

MRI-Based Machine Learning in Differentiation Between Benign and Malignant Breast Lesions

BackgroundDifferential diagnosis between benign and malignant breast lesions is of crucial importance relating to follow-up treatment. Recent development in texture analysis and machine learning may lead to a new solution to this problem.MethodThis current study enrolled a total number of 265 patients (benign breast lesions:malignant breast lesions = 71:194) diagnosed in our hospital and received magnetic resonance imaging between January 2014 and August 2017. Patients were randomly divided into the training group and validation group (4:1), and two radiologists extracted their texture features from the contrast-enhanced T1-weighted images. We performed five different feature selection methods including Distance correlation, Gradient Boosting Decision Tree (GBDT), least absolute shrinkage and selection operator (LASSO), random forest (RF), eXtreme gradient boosting (Xgboost) and five independent classification models were built based on Linear discriminant analysis (LDA) algorithm.ResultsAll five models showed promising results to discriminate malignant breast lesions from benign breast lesions, and the areas under the curve (AUCs) of receiver operating characteristic (ROC) were all above 0.830 in both training and validation groups. The model with a better discriminating ability was the combination of LDA + gradient boosting decision tree (GBDT). The sensitivity, specificity, AUC, and accuracy in the training group were 0.814, 0.883, 0.922, and 0.868, respectively; LDA + random forest (RF) also suggests promising results with the AUC of 0.906 in the training group.ConclusionThe evidence of this study, while preliminary, suggested that a combination of MRI texture analysis and LDA algorithm could discriminate benign breast lesions from malignant breast lesions. Further multicenter researches in this field would be of great help in the validation of the result.

Is Elevated Choline on Magnetic Resonance Spectroscopy a Reliable Marker of Breast Lesion Malignancy?

BackgroundContemporary magnetic resonance imaging (MRI) of the breast represents a powerful diagnostic modality for cancer detection, with excellent sensitivity and high specificity. Magnetic resonance spectroscopy (MRS) is being explored as an additional tool for improving specificity in breast cancer detection, using multiparametric MRI. The aim of this study was to examine the possibility of 1H-MRS to discriminate malignant from benign breast lesions, using elevated choline (Cho) peak as an imaging biomarker.MethodsA total of 60 patients were included in this prospective study: 30 with malignant (average age, 55.2 years; average lesion size, 35 mm) and 30 with benign breast lesions (average age, 44.8 years; average lesion size, 20 mm), who underwent multiparametric MRI with multivoxel 3D 1H-MRS on a 1.5-T scanner in a 3-year period. Three patients with benign breast lesions were excluded from the study. All lesions were histologically verified. Peaks identified on 1H-MRS were lipid (0.9, 2.3, 2.8, and 5.2 ppm), choline (3.2 ppm), and water peaks (4.7 ppm). Sensitivity and specificity, as well as positive and negative predictive values, were defined using ROC curves. Cohen’s Kappa test of inter-test reliability was performed [testing the agreement between 1H-MRS and histologic finding, and 1H-MRS and MR mammography (MRM)].ResultsCholine peak was elevated in 24/30 malignant lesions and in 20/27 benign breast lesions. The sensitivity of 1H-MRS was 0.8, specificity was 0.741, positive predictive value was 0.774, and negative predictive value was 0.769. Area under ROC was 0.77 (CI 0.640–0.871). Inter-test reliability between 1H-MRS and histologic finding was 0.543 (moderate agreement) and that between 1H-MRS and MRM was 0.573 (moderate agreement). False-negative findings were most frequently observed in invasive lobular cancers, while false-positive findings were most frequently observed in adenoid fibroadenomas.ConclusionAlthough elevation of the choline peak has a good sensitivity and specificity in breast cancer detection, both are significantly lower than those of multiparametric MRM. Inclusion of spectra located on tumor margins as well as analysis of lipid peaks could aid both sensitivity and specificity. An important ratio of false-positive and false-negative findings in specific types of breast lesions (lobular cancer and adenoid fibroadenoma) suggests interpreting these lesions with a caveat.

Efficacy of FNAC in Diagnosis of Breast Lumps - A Retrospective Study

Background: FNAC is an established and highly accurate method for diagnosis of breast lesions. Its further advantage is to give rapid diagnosis, cost-effectiveness, excellent patient acceptance and minimal or no morbidity. The study aimed to diagnose various breast masses before operation by FNAC and to compare the result of FNAC with histopathological study to assess the efficacy of FNAC. Materials and Methods: The study entitled “Efficacy of FNAC in diagnosis of Breast Lumps” is a retrospective study conducted in department of surgery with collaboration of pathology department at Nalanda Medical College and Hospital, Patna during the period of July 2017 to December 2019. During this period, 150 FNAC cases were selected for study. Results: Fibroadenoma was the most commonly diagnosed entity in benign breast lesions, followed by fibrocystic disease. Among malignant lesions, infiltrating ductal carcinoma was the most common. The overall diagnostic accuracy of FNAC in benign breast lesions was 94.59%. The fibroadenomas were correctly diagnosed in 92.96% cases. There were 5.41% false negative results in our series. There was no false positive result giving specificity of 100%. Conclusion: FNAC is an inexpensive, simple, safe and readily acceptable procedure to the patient and plays main role to provide rapid and accurate diagnosis of breast lumps. FNAC enables us to differentiate benign from malignant lesions with high sensitivity, specificity and diagnostic accuracy. Keywords: Breast Lump, FNAC, HPE: Histopathological Examination.

Impact of circulating miRNA-373 on breast cancer diagnosis through targeting VEGF and cyclin D1 genes

Background Breast cancer (BC) is the common primary tumor among females. Hence, there is an urgent need to improve the early prediction and diagnosis of BC. For that reason, the object of the current study is to analyze the expression levels of miRNA-373 and its target genes including vascular endothelial growth factor (VEGF) and cyclin D1 in women with BC. Results Upregulation of miRNA-373 and its target genes was observed in BC patients followed by patients with benign breast lesions compared to downregulation in controls. There was a significant association between the expression level of miRNA-373 and all clinical features. The same associations were observed between its target genes and all clinico-pathological features except hormonal status. The correlation between miRNA-373 and both genes was significant. Conclusions Our results prove that miRNA-373, as an oncomir, would be a vital biomarker for BC diagnosis and prognosis by targeting both VEGF and cyclin D1.